We Need More Home Care Workers. But First We Have to Pay Them Enough.

Loretta Copeland, an 81-year-old who lives in Harlem, uses a wheelchair and depends on an aide to help her with daily tasks like cooking and bathing. But New York’s home care labor shortage, currently the worst in the nation, has made it hard for her to get help. While she understands why people won’t work for such low wages, she is afraid she will end up in a nursing home.

“I worked all my life and now I can’t even get help. That bothers me,” Ms. Copeland said in a recent interview. “I want to be able to enjoy what time I have left.”

By 2040, the population of American adults aged 65 and older will nearly double, and that of adults aged 85 and older is expected to quadruple over the same period. As our aging population grows, the need for home care is increasing. Yet in New York, as in much of the rest of the country, there are too few workers.

The idea of moving into a long-term-care home is accompanied by dread for many older adults. Indeed, research shows that a majority of Ms. Copeland’s peers want to age at home. In the past few years, the coronavirus pandemic’s devastating toll on nursing homes, assisted-living facilities and group homes further highlighted the need for more long-term-care options. Yet right as home care workers are needed more than ever, these workers are fleeing the profession.

If President Biden’s Build Back Better plan clears Congress, it would set aside $150 billion to expand access to home care through the Medicaid program that supports in-home health care, helping to reduce a backlog of people waiting to receive subsidized home care and improve wages for providers. In New York, aging adults and disabled people are among those rallying for better pay.

A 2019 report found that about a quarter of all home care patients in New York reported they were unable to find workers, and nearly 20 percent ofhome care positions went unfilled because of staff shortages. Between 2021 and 2040, the state is projected to have nearly a million home care job openings, and the rest of the country is not far behind. But despite a surplus of unfilled jobs, many are finding that they simply can’t afford to do this type of work.

Home care workers in the state earn $13.20 an hour in most counties — less than fast-food workers.A report by the Consumer Directed Personal Assistance Association of New York State found thatlow pay and lack of basic benefits were driving home care workers in the state away from the profession. Of those who remain in the work force, a majority rely on public assistance.

Staffing shortages have long plagued the home care industry. But stagnant wages combined with an aging boomer population and the strain of the pandemic are pushing the industry to the brink. To end the home care crisis and keep aging adults on wait lists for in-home care out of nursing homes, home care workers must be paid a livable wage.

A 2021 report by the City University of New York found that higher wages would reduce turnover and attract new workers, while generating new jobs and revenue for the state. In New York, where a majority of home care workers are female and people of color, higher wages also offer an opportunity to invest in two historically underpaid work forces.

Raising wages would save New York State over $1 billion a year by increasing tax revenue and moving home care workers off government assistance. Additionally, studies suggest that aging adults who receive home care often reduce their inpatient hospital costs — saving states Medicaid dollars by keeping aging adults healthier and out of hospitals.

New York state sets the pay rate for the vast majority of home care workers. Fair Pay for Home Care, a bipartisan spending proposal that would include salary increases for home care workers in the state’s budget, is currently under consideration. In the coming weeks, Gov. Kathy Hochul will decide whether it ends up in the final state budget.

Investments in Medicaid home- and community-based services were also the focus of last week’s Senate Aging Committee hearing titled, “An Economy That Cares.” Home care workers, and the people and families who depend on them, told senators why raising wages for home care workers should be a priority for both state and federal legislators.

As states across the country grapple with rising health care costs and aging populations, New York’s proposal for higher home care wages could offer a model for how we can care for aging adults while making wise investments that will channel funding into the local economy.

Whether we are growing older, recovering from surgery or living with a disability and need help with things like making meals, transportation to and from appointments and running errands, most Americans will need home care at some point. Let’s make sure when the time comes, the work force is ready.

Ai-jen Poo is the director of the National Domestic Workers Alliance. Ilana Berger is a co-executive director of the New York Caring Majority and the New York director of Hand-in-Hand: The Domestic Employers Network.

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