Caregivers Do Double Duty to Make Ends Meet

In the next decade, home-care work is expected to add more jobs than any other occupation, with an additional 1.2 million needed by 2026, according to the Bureau of Labor Statistics. Yet even with high demand and tight supply, wages remain stubbornly low.

By Clare Ansberry | Oct 27, 2018 | This article originally appeared in The Wall Street Journal

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Caregivers Do Double Duty to Make Ends Meet

Cincinnati

After working more than three decades as a home-health aide, Youlanda Allen brings home $32,500 a year including overtime, which is why she also cleans houses on weekends.

“I need my hustle jobs on the side,” says Ms. Allen, 51 years old, who began her career while in high school and continued while raising two children. She’s cared for hundreds of people, some with dementia and broken hips, others with heart disease. Most have been older, although she once cared for a 19-year-old man with AIDS. She helps them get out of bed, dressed, bathed and fed. She combs their hair and changes their sheets. Over the years, grateful families have sent her letters.

“Thank you again for all the loving care you provided for Donna these last few months,” one husband wrote. “Please continue to do the same for others in what is a very difficult job.”

Ms. Allen, who works for Village Home Health and Hospice in Cincinnati, loves her job and the people she cares for. But she doesn’t want her 21-year-old daughter to do the same work. “She’s not going to make a lot of money doing this,” Ms. Allen says. “You always want better for your kids.”

Demand for these workers, who provide the majority of hands-on non-medical care to older adults, is strong now and for the foreseeable future because of the aging baby-boom generation, longer life expectancies and growing rates of chronic conditions. In the next decade, home-care work is expected to add more jobs than any other occupation, with an additional 1.2 million needed by 2026, according to the Bureau of Labor Statistics.

Home-health-care agencies can’t find enough workers. “We are competing withMcDonald’s and Wendy’s and retail stores,” says Valerie Landell, CEO of Village Home Health and Hospice, which is a subsidiary of Maple Knoll Communities and has 78 employees, including Ms. Allen. None of six job candidates showed up for interviews one recent day, Ms. Landell says.

Yet even with high demand and tight supply, wages remain stubbornly low. Between 2007 and 2017, inflation-adjusted median hourly wages for direct-care workers—including home-health aides, personal-care aides and nursing assistants—fell 2% to $11.83 from $12.08, according to PHI, an organization that works with the direct-care industry. A 40-hour work week at that rate yields an annual income of around $24,600.

Sue Pratt, who owned a home-care agency before starting the non-profit Care Collaborative to support direct-care workers, six months ago opened a thrift shop in her hometown of Deerfield, Mass., to raise funds to help these workers pay for training at a community college. Proceeds also go to help make small loans to those who don’t qualify for bank loans, but need to replace bald tires, she says. “Our culture does not embrace these workers,” she says.

Direct-care wages are determined largely by reimbursements to agencies. Most reimbursements come from Medicaid, the nation’s largest funder of long-term support services to people with low incomes and limited assets, and to a lesser degree, Medicare, which pays for acute short-term care. Nineteen percent of long-term support services is paid out-of-pocket and 8% from private insurance, but large reimbursers generally set wage scales.

Medicaid reimbursement rates have stayed flat or decreased in many states. In Ohio, where Ms. Allen works, the reimbursement rate for home-health services has fallen 1.7% since 2010, while costs have risen at least 10%, Ms. Landell says. The reimbursement rate is $23.57 for the first hour of a visit. The actual cost, including wages, benefits, mileage reimbursement, a stipend for cellphones and software to document visits, is about $28, Ms. Landell says.

Workers at her agency are paid $16.25 a visit, which must be at least 45 minutes but can last up to two hours, depending on the client. Many agencies pay by the hour instead. In each visit, certain tasks must be completed and recorded.

In fiscal year 2018, 15 states put in place wage increases for Medicaid-reimbursed direct-care workers to address shortages and turnover caused in part by low pay, according to a report from the Kaiser Family Foundation.

Perception also plays a role in keeping wages low. “We see a lot of outdated assumptions about what caregiving represents,” says Robert Espinoza, vice president of policy at PHI. Many people don’t understand the skills needed to deal with people with dementia, who may be combative, or the physical demands of lifting people from beds to wheelchairs. Aides generally get 75 hours of training and pass a test to be certified.

Shae Moore, a 29-year-old single mother in Erie, Pa., works seven days a week for two home-care agencies. “I don’t have as much time as I should with my son,” says Ms. Moore, who relies on extended after-school programs and relatives to take care of her 9-year-old, Ty’Varus, until she gets home.

Caregiving comes naturally to her, she says. “Overall, if you love helping people, it’s a great career.” Her take-home pay from Excel Home Care for 42 hours is just under $400 a week. Every two weeks she takes home an additional $100 for 12 hours of part-time care work for another agency.

Paul Randolph, intake supervisor at Excel Home Care, says average pay for the company’s 3,000 personal-care assistants is $10 to $13 an hour. “We’re limited in what we pay because of reimbursements,” says Mr. Randolph.

At Village Home Health, Ms. Landell says her workers take home an average $400 a week, but can make more working overtime. “I couldn’t live on that,” she says.

Not everyone can handle the work. Ms. Allen, the home-health aide, says she has heard many workers over her 35-year career say, “They don’t pay me enough to do this.” She trains new aides and can tell who won’t last by the way they interact with clients.

Ms. Allen typically starts her work day at 7 a.m., seeing eight-to-10 people a day. She spends most mornings at assisted- and skilled-nursing facilities and in the afternoons drives to people’s homes, some an hour away. She volunteers for overtime and holiday shifts and takes home about $650 a week.

She’s quick at changing sheets and emptying trash, but is patient with her clients. “I take the time to get to know them,” she says. When one woman, a pianist, seems blue, she takes her down to a community room to play the piano. People stop and applaud. “She is doing something positive, entertaining and contributing to her community,” Ms. Allen says.

One of her regular clients is Margaret Jenkinson, a 95-year-old who has cardiovascular disease and can’t walk on her own. Her late husband used to live at the same facility, and Ms. Allen remembers the two of them having lunch together.

She sees Mrs. Jenkinson five days a week, helping get her out of bed and showered. She cuts her nails when needed and curls her hair. She knows Mrs. Jenkinson loves seeing the children who attend a Montessori school on the grounds and wheels her down to watch them.

Ms. Allen stops in to visit Helen Corn, 89, an artist who is now nearly blind. Mrs. Corn has trouble breathing and is largely confined to a wheelchair. Her feet are bandaged due to an infection. Ms. Allen puts on gloves, removes the bandages, and gently applies a protective cream, all the while engaging Mrs. Corn in conversation. She helps Mrs. Corn pick out an outfit, handing her shirts to examine with her good eye, and returning the unchosen ones, folded, to the drawer.

“Anyone I take care of I think of as family. It could be my mother or grandmother. I want someone to take good care of me,” she says.

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