It used to be that the things you could count on in life were birth, death and taxes. To that list, most of us can add relying upon others in our later years. While we all would like to see ourselves staying as healthy as possible and aging gracefully, even actively, in truth, 70 percent of those who reach the age of 65 (and eight Americans hit that milestone per minute) will need some form of care or support services.
That care wouldn't happen without home care workers. Nearly two million home care workers help seniors and people with disabilities live independently in their homes and communities. These caregivers often work long hours, doing difficult work without overtime pay. High levels of burnout and turnover are common. Current laws exempt these individuals from the definition of a worker; rather they are classified as "companions." Yet that category falls far, far short of the work they do every day.
Who are these home care workers that so many Americans depend upon to care for their families at such vulnerable times? They are women like Thelma, a home aid worker from Los Angeles, who describes her work as "life-sustaining." Thelma says that, along with assisting clients to the bathroom, ensuring that they follow doctors' instructions, and cleaning soiled clothing, she does the "invisible work" of inspiring her clients when they are depressed, helping to improve their quality of life. Workers like Thelma ensure the dignity of the aging and people with disabilities--something every American hopes their family members can count on. But Thelma does this work for only $35 a day, as she is excluded from the federal law that guarantees most other workers the right to earn a minimum wage and receive time-and-a-half pay for overtime.
The demands of America's rapidly aging population have transformed the industry, requiring higher levels of professionalism and service than ever before. Home care is a rapidly growing sector, with total revenue estimated to be more than $84 billion in 2009, up from roughly $40 billion in 2001.
Yet, while more than half of such workers are paid at least the minimum wage, many do not receive time-and-a-half when they work more than 40 hours a week. With annual wages averaging below 200 percent of the federal poverty level, more than 40 percent of home care workers must rely on public benefits such as food stamps and Medicaid.
Home care work is also high-risk work. In 2010, one-third of injured home care workers missed a month or more of work (and wages) because of the severity of their injuries. The low wages and high injury risk associated with home care work contribute to substantial turnover in the field--between 44 and 65 percent each year, according to some estimates. This turnover has a negative effect on older Americans and people with disabilities, who find it difficult to cope with a revolving door of unfamiliar faces entering their homes, not to mention the significant costs for the home care agencies that have to recruit new workers. Studies have shown a correlation between high workforce instability and low quality of care.
National survey data suggests that considerable capacity exists to create more balanced workloads for home care workers, which would limit increases in overtime costs for home care companies and minimize the cost of recruiting and hiring new workers. According to Labor Secretary Hilda Solis, Medicare and Medicaid, which cover about 75 percent of home care costs, would likely pay an additional $31.1 to $169.5 million each year toward home care workers, roughly less than 0.06% to 0.29% percent of federal and state outlays for home care. It's a modest increase to ensure that two million working professionals are provided with fair wages and protections, and secure quality services for aging adults and people with disabilities.
By 2050, 27 million Americans are expected to need long-term home care. If the workers we all depend on for these services are not fairly compensated or protected, we can't expect quality care for the long-term. If growing old with dignity is a priority, we must ensure the dignity of home care workers.
The question isn't if our nation can afford to pay fair wages to home care workers, but how we can afford not to.
Ai-jen Poo is the co-director of Caring Across Generations, a national coalition of 200 advocacy organizations working together for quality care and support and a dignified quality of life for all Americans. More information at www.caringacrossgenerations.org. She is also director of the National Domestic Workers Alliance, a national alliance of domestic workers in 19 cities and 11 states, working to gain respect, recognition and protections for America's 2.5 million domestic workers. More information at www.domesticworkers.org.