Caregiver Registries, Wage Hikes Pose Persistent Problems for At-Home Care Providers

With the caregiver turnover rate at an all-time high of 82%, workers remain the hottest commodity in home-based care. Providers worry labor issues — such as the rising minimum wage and the growing popularity of caregiver registries — could compound the problem even more in the years to come.

While labor issues are taking center stage nationwide, Connecticut and Minnesota are currently at the forefront.

In Connecticut, legislators are considering a bill that would require home care agencies to submit all employee contact information to the state, which would then be made public.


Opponents say the bill would hurt more than 35,000 employees in Connecticut’s home care industry, increasing unions’ access to caregivers and their valuable data.

Specifically, the Connecticut bill would make an employee’s name, identification number, agency and training history publicly available. Gender, home mailing address, telephone number and email address can also be made available upon request.

“Under the bill, if a homemaker-companion agency or employee organization requests reported information, [the Department of Consumer Protection] must provide it, including contact information,” according to the Connecticut Office of Legislative Research.


In a publicly submitted testimony, Regina McNamara — owner and president of Plainville-based Always There Home Care — wrote, “this bill benefits no one but unions.”

“Our caregivers provide amazing care and support,” McNamara wrote, according to the Yankee Institute for Public Policy. “They deserve not to have their privacy destroyed, their lives disrupted simply because unions (which they neither want nor understand) need to fill their coffers.”

Providers in California — where labor unions will have access caregivers’ information from the state registry starting July 1 — have voiced similar concerns about forthcoming legislation in their state.

“It doesn’t appear to us to be fair to caregivers,” Dean Chalios, president of the California Association for Health Services at Home (CAHSAH), previously told Home Health Care News. “These folks are hardworking people. We don’t think they should have to have their lives interrupted by a union that’s trying to organize them.”

Relative reimbursement

Meanwhile, in Minnesota, home health care providers say a mandatory pay raise for Medicaid caregivers could put agencies out of business.

The problem is reimbursements, which aren’t rising in proportion to pay increases.

The minimum wage for Medicaid caregivers in Minnesota is set to soon increase from $12 to $13.25 per hour. The $1.25 per hour raise is the result of an agreement between Service Employees International Union — the union representing caregivers — and the Minnesota Department of Human Services.

Meanwhile, reimbursement is currently only set to increase by only 41 cents, from $17.40 to $17.81. If that doesn’t change, the ramifications will be detrimental, providers worry.

“The consequence is that smaller agencies will not be able to absorb the losses and some may close,” Andre Best, CEO of Best Home Care, told HHCN. “If a number of agencies close — leaving clients and caregivers looking for a new home — that will be bad because some will not be able to find a home and some people are going to go without care.”

North Saint Paul, Minnesota-based Best Home Care employs about 600 caregivers.

“For a company like mine, this change would amount to several hundred thousand dollars in losses,” Best also told the Minnesota Star Tribune. “Should the underfunded contract move forward, agencies will be forced to close. Even the future of agencies with lean and efficient operations is uncertain.”

His concerns echo those of other industry experts facing the same problem in other states, such as Arizona and Illinois. One such executive is Darby Anderson, chief development officer at Addus HomeCare Corporation (Nasdaq: ADUS).

“Providers may say, ‘I’m just not going to do Medicaid anymore because the rates aren’t sustainable,’” Anderson previously told HHCN. “‘I’ll provide private pay or work more primarily in other sources of funding and not work in Medicaid,’ which is going to leave a gap in the provider pool.”

Best says the legislature must move to increase reimbursement funding proportionally — or wage increases must be delayed until that can happen.

“[Personal-care attendants] (PCAs) should receive higher wages, but the PCA reimbursement rate must be increased proportionally to keep PCA agencies financially viable so they can continue providing recipients and caregivers with quality services and support,” Best said.

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