Politics & Government

NC home-care workers for older people underpaid, advocates say

Christine Boone (right) of Nurse Care NC carefully watches as Susan uses her walker at her Chapel Hill home Friday. Health care workers like Boone are paid just above minimum wage and have huge responsibilities in their work. Medicaid reimbursements are low and it makes a living wage difficult for these workers who care for the infirmed and elderly.
Christine Boone (right) of Nurse Care NC carefully watches as Susan uses her walker at her Chapel Hill home Friday. Health care workers like Boone are paid just above minimum wage and have huge responsibilities in their work. Medicaid reimbursements are low and it makes a living wage difficult for these workers who care for the infirmed and elderly. cliddy@newsobserver.com

Poor working conditions and low pay for home care workers earned mentions from President Barack Obama and industry experts at this month’s White House Conference on Aging. On Monday, the conversation moved to North Carolina.

A state representative, a lawyer with the N.C. Justice Center, a representative from the Alliance for Retired Americans and a home care worker discussed poor working conditions in the profession at a N.C. Association of Educators panel Monday afternoon.

Niki Cannady, a home care worker in Raleigh and Durham, began her career 20 years ago, when a friend’s grandmother fell ill. She took a class, earned her certification and cared for the woman until she died.

Even now, Cannady never knows what to expect from a day at work. Clients have called the police on her and yelled at her in confusion. She stays despite the difficulties and low wages not only because she enjoys the people but also because she feels her clients deserve to age in place, not in residential care.

“At the end of the day, it’s not in vain,” she said.

Nearly 90 percent of people 65 and older prefer to stay in their homes for as long as possible, according to the AARP. The Bureau of Labor Statistics estimates the country will need one million new home care workers by 2022, when the occupation is expected to have grown by 49 percent, more than four times the average rate for all professions.

Hourly wages for home care workers in North Carolina hover around $9, said panel member Allan Freyer, director of the Workers’ Rights Project of the N.C. Justice Center.

Kimberly Thomas, a Triangle home care worker, attended both the White House conference and Monday’s panel organized by the Justice Center. Despite working between 90 and 120 hours every week, Thomas said, she still struggles to make ends meet.

“I love my work, but that’s not enough,” Thomas said. “No one cares for the caregiver.”

Thomas joined Fight for $15, the organization founded in 2012 that originally advocated for higher wages and the right for fast food workers to unionize. The movement has recently spread to other professions, including home care work, one of the lowest paid professions in the country. Nearly 50 percent of home care workers live in households that receive public assistance of some kind, according to the National Employment Law Project. About 20 percent use food stamps.

Medicaid rates govern wages

Ari Medoff, CEO and owner of Nurse Care of North Carolina, the only employer at Monday’s discussion, said he would love to pay his home care workers more. But with a reimbursement rate for personal care services of $13.88 per hour, that isn’t possible at the moment. “It’s not easy to be a better employer in this space,” he said.

Medicaid is the primary funding source for long-term services for people with disabilities and seniors, Freyer said. North Carolina has the seventh lowest Medicaid reimbursement rate for caregiving in the country, Freyer pointed out, and the rate has only declined in recent years. Five years ago, the rate was $15.52 per hour.

Medicaid reimbursement rates are set by the state General Assembly. After overhead costs, too little of the $13.88 hourly reimbursement is left over to pay home care workers, and the legislature should increase the rate, said Tracy Colvard, a lobbyist for the Association for Home & Hospice Care of North Carolina. “That would help tremendously,” Colvard said.

Care is challenged

Medoff said he wants to work with his caregivers to improve their jobs. Recently, Nurse Care of North Carolina began promising minimum hours to some of its employees, and Medoff hopes to expand those promises to more of his workers.

Medoff thinks career development programs are severely lacking, too. Home care workers receive minimal raises over the course of their employment, he said, and more should be done to help the aides advance their careers.

Bill Dworkin, interim president of the N.C. Alliance for Retired Americans, noted that a home-health aide may be the only person a client sees all week.

“Home health care workers should receive decent pay, decent health care benefits so that they in turn can give quality care to the most vulnerable in our society,” Dworkin said.

After 20 years in the profession, Cannady still makes $10 per hour. The week she worked 120 hours caring for a pediatric client, she looked forward to overtime pay. But her paycheck reflected only baseline pay — no overtime.

Cannady works for two agencies to make ends meet. Living on less has forced her to give up life’s comforts, like a smart phone, good car insurance and regular haircuts. “I sacrifice a lot,” she said.

Fight for $15

In the last year, both Thomas and Cannady joined the Fight for $15 movement, whose members attended the Conference on Aging to question panelists about work they said was underpaid and undervalued.

Home care workers struggle to find enough hours to piece together a full-time job. Colvard said an aide would be lucky to work 30 to 32 hours per week for a single agency. When a patient dies or moves to a more intensive form of care, the home care worker is often out of work.

Sporadic hours and poor pay drive many workers from the profession. Nearly 62 percent of home care workers left their jobs in the last year, according to a Home Care Pulse survey. High turnover rates disrupt the care patients receive, Freyer said. “Seniors are not able to get the same kind of consistent care,” he said.

Wildeman: 919-829-4845

Twitter: @mkwildeman

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