Kimberly Weems has been a home care worker in Atlanta for over 14 years. She first got interested in the field after caring for a blind uncle. “It’s my passion,” she said. “This is just something I’ve always wanted to do, to keep people’s loved ones in their homes.”
But her passion doesn’t always pay the bills. She’s currently making $8.50 an hour and doesn’t get any extra pay for overtime hours or for the time she spends traveling between clients. It’s a challenge to live on that while caring for her five-year-old granddaughter with special needs. Her granddaughter currently uses a walker, but doctors want her to use canes to improve her balance. “But being that they’re so expensive. Right now it’s just impossible,” Weems said.
Her experience is widespread in the home care industry. The country’s nearly 2 million aides make an average wage of $9.61 an hour, according to a new report from the Paraprofessional Healthcare Institute (PHI) shared exclusively with ThinkProgress. That comes to $1,652.92 a month for a full-time worker before taxes, often not enough to cover basic expenses.
While average wages are on paper above the federal floor of $7.25 an hour, “there are all sorts of reasons why in practice it actually falls below minimum wage,” Abby Marquand, PHI’s director of policy research, said. Like Weems, many are not paid for overtime or travel time. “You’re paid barely above minimum wage just for the hours you’re actually there with a client.” Unpredictable and part-time hours reduce average pay even more, so that median annual earnings for a home health aide are just $13,000 a year.
Wages have also been declining rather than increasing. Weems left her current agency for a better job a few years ago, but after her client passed away she had to return. In the intervening time, however, the agency’s pay went from $10 an hour to her current wage of $8.50. Adjusted for inflation, home care aides’ wages have declined 5 percent over the last decade.
That leaves many of them living in poverty. A quarter of home care workers and their families live below the federal poverty line, or $24,250 a year for a family of four. More than half earn below 200 percent of the poverty line. Home care workers’ wages aren’t enough to support a family of two in most states.
Patricia Evans, who has worked as a home care aide in Chicago for three years, knows how uneven hours can make the work’s low pay even more difficult. “One of the main problems with being a home care aid is not being able to get enough hours,” she said. Right now she works 27 hours a week, but they’ve been as low as 10 or 12 weekly and as high as 44. That means that while she makes $10.35 an hour, a good deal above her state’s $8.25 an hour minimum wage, it’s still hard for her to get by. “The main thing that takes a hit would be my food budget,” she said. “My mom helps me out with that and there are a couple of food banks I go to every month.”
And it’s not the kind of work that’s easy to supplement. “It’s kind of hard to have another job with this if you’re going to have set hours,” she noted.
While neither Evans or Weems qualify for public benefits, many home care aides do given that they make poverty wages. Nearly three out of five live in a household that receives one or more benefits like food stamps, Medicaid, and heating assistance.
“There’s an injustice in paying these workers poverty-level wages,” PHI’s Marquand said. “They’re living in poverty and expected to provide some of the most essential services.”
The work required is often physically taxing: the rate of on-the-job injuries for home health aides in 2010 that resulted in missed work was about twice that of the overall labor force. Weems has a client with vertigo who needs help going to the bathroom, getting dressed, and being bathed. That’s on top of what Weems calls light duties: cleaning the house, doing the dishes, making the bed, and doing laundry. And harder work doesn’t come with more pay. She tries to avoid the most physically taxing clients, but noted, “Even if it is a strenuous case, the pay still doesn’t change.”
“To do this job, you have to be a special type of person,” she said.
Evans is another one of those special people. One client with dementia needed help bathing, dressing, and eating. Another who was developmentally disabled wasn’t able to keep his apartment clean and well maintained. “I know that if I hadn’t come in there and really done some drastic work, he probably would have lost that apartment,” she said.
The people doing this work are also an especially vulnerable group. Nearly 90 percent are women and more than half are people of color, while one in four is an immigrant. The issue of low pay is “a civil rights issue, this is an economic justice issue,” Marquand said.
Some of the country’s most deep-seated issues serve to suppress pay. The workforce has been excluded from basic labor rights in the Fair Labor Standards Act, which requires minimum wage and overtime, due to a loophole called the “companionship exemption” that regards this work as more akin to the company of a babysitter. This exclusion “is definitely rooted in our history of racism and sexism,” Marquand pointed out. On top of that, “we have this long history of ageism and most of us don’t want to face our own mortality.” Most people don’t think about the need for this work or the workforce itself until they’re forced to. “It ends up trickling down to how we overlook these workers and these jobs. We’re not really dealing with this system at large,” she said.
Last year, the Department of Labor (DOL) proposed getting rid of the companionship exemption and requiring this workforce to be paid minimum wage and overtime just like all other workers. But a federal judge issued a ruling vacating the rule change in January. While the DOL is likely to appeal the decision, Marquand noted, “The continuation of this exemption makes it a lot harder to advocate for improving the quality of these jobs, because it basically says these aren’t really workers, this isn’t real work.”
The low pay doesn’t just impact home care aides themselves. It can hurt their clients too. The PHI report notes that half of the workforce turns over every year. “To put it simply,” it states, “workers leave because they can’t afford to stay.” Evans knows workers who simply couldn’t afford to keep doing the work. “They had to leave clients they dearly cherish so they can make a livable wage in another career,” she said. “That’s sad, because this work isn’t considered technical, but really it is because it requires a great deal of people skills, and not everybody is gifted with those skills.” Constant turnover leaves families scrambling to find new aides for their loved ones and training them all over again. On top of that, high turnover is costing the long-term care industry around $6 billion a year.
At the same time, demand is only going to increase. The elder population is expected to more than double by 2050. It’s projected that the country will need a million new home care aides between 2012 and 2022. But it’s hard to recruit talented workers to a job that pays so little. “If paying these workers a little bit more so they can climb out of poverty is what breaks the system, we have a problem,” Marquand said.
In the meantime, Weems and Evans continue to do the work. “I keep moving, keeping moving on and hoping that something’s going to come my way,” Weems said.