Drawing Attention to Low Pay, Fragile Existence of Home Health Workers

Their role is essential and growing as the nation’s elderly population increases, and many older persons seek to stay in their homes. But with pay and benefits only a rung above fast food workers, home health aides are a little seen and often unheard part of the managed care continuum. That changed one September morning in Ohio, when a rally brought their plight literally into the sunshine.

Holly Dawson told her story to a reporter for National Public Radio (NPR). She shared how she still visits a former client who had to switch to a different provider funded by his veterans’ benefits, after taking a fall while she was off-duty. Dawson made $13 an hour working for him, less than half the $37 he paid her agency. But that wage was good compared to the national average, which is $9.50 an hour.

Dawson has no health insurance, and hasn’t had it for years. That’s typical in her industry, an irony that doesn’t sit well with many policymakers, who ask how wise it is to let these vital caregivers see their own health needs go unmet when the most vulnerable are utterly dependent on them.

The Affordable Care Act (ACA) includes financial carrots to encourage hospitals and doctors to keep patients healthy. Under these provisions, some experts believe home healthcare workers should be compensated as vital front-line personnel with a critical role in achieving these new goals. According to the NPR report, the US Department of Labor found more than 1 million will be needed over the next decade.

Paying these workers more, and ensuring they have their own healthcare, is not just a matter of simply fairness, although that’s important. How smart is it to perpetuate a system that lets healthcare workers live in poverty and encourages them to show up with colds or fevers, because missing a day’s work means missing a day’s pay?

Low wages also encourage high turnover, which is bad for both agencies and clients, as a report in New Jersey revealed. A report in The Record of Hackensack this week said there are more than 9000 unfilled home health aide positions, according to research provided to Bergen Community College by Economic Modeling Specialists International. The gap is expected only to grow along with the elderly population, with many aides ready to retire.

Women account for most of these workers, and experts told The Record that due to low wages, there simply won't be enough younger aides to replace those who are leaving the industry due to age.

Unless a solution is found, it will be hard to achieve the goals outlined in a recent report by the Institute of Medicine, Dying in America, which called on Medicare to redirect more resources toward patient-centered and family-centered end-of-life solutions, including those that allow patients to remain at home instead of in the hospital.

In October, the Obama Administration announced initiatives to improve nursing home and home healthcare through quality measures, including more disclosure for consumers. But it remains to be seen if these steps will improve compensation for workers.

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