Wage Mandates for Home Care Workers Gain Steam Behind Societal Support, Advocacy

Home-based care workers are generally underpaid. That’s something almost everyone in the industry can agree on.

Getting them more money, however, is another issue. Regardless, the labor situation is worsening.

A survey published by the John A. Hartford Foundation Wednesday found that Americans strongly support raised wages for direct care workers.


Specifically, 73% of survey respondents believed that direct care workers were underpaid after they were given wage details. Americans also aren’t aware of how much direct care workers are paid – 72% of Americans overestimated how much direct care workers made in the first place.

There were other key findings from the survey as well, including:

– 60% of Americans believing direct care workers would benefit from more training, with nine days being the current, national average


– 94% believing that government oversight was important to help direct care workers in nursing homes and home care agencies protect older adults

– Nearly half of respondents not believing they would need direct care support as they aged, although 66% will in reality.

Policymakers and home care worker advocates are banking on this societal support to push legislation forward in states like New York that would help raise wages.

For instance, the Fair Pay for Home Care Act in New York has gained considerable steam and bipartisan support. The legislation, which advocates are hoping to implement by Jan. 1 of 2023 to address the state’s workforce shortage, would ensure home care workers are paid at least 150% of the minimum wage.

While providers are worried based on past experiences that wage hike mandates could put them in a crunch without corresponding reimbursement increases, an amended version of the Fair Pay for Home Care Act also ensures Medicaid increases for providers if and when the wage hikes are realized.

“We’re facing an incredibly challenging workforce shortage that has been building for at least a decade, but that has been exacerbated significantly by the pandemic,” Laura J. Ehrich, the VP for public policy at the New York State Association of Health Care Providers (HCP), told Home Health Care News. “In part because wages are so incredibly low and in part because Medicaid reimbursement rates do not keep up with the actual cost of putting home care workers in homes. And also, in part, because it’s frankly a low-esteem job.”

Advocates such as Ehrich don’t see the legislation as anything less than vital.

Without it, they believe that the workforce shortage in New York could reach catastrophic levels and to a point where many seniors are not able to receive care in the comfort of their own homes.

“The amended version of the bill contains language – that we helped to write – that includes those adequate reimbursement rates to employers,” Ehrich said. “So as the bill is currently written, there is language that protects employers by making sure that the reimbursement rates are inextricably linked to home care wages.”

And though it would only raise home care workers’ wages, Ehrich and HCP President Kathy Febraio believe that it would force providers across the continuum to consider raising their wages as well. A competitive labor market, after all, is better for the workers and would guarantee they are being paid closer to what would be considered a fair wage.

“I think anytime something this profound is proposed, it makes people nervous,” Febraio said. “That’s not our intent, to take people from other parts of the health care spectrum. That doesn’t help the overall long-term care infrastructure, but it is likely that there will be ripple effect into other sectors and we hope that it means that their wages can be addressed over time.”

Plus, the labor battle for home care providers right now is more against retailers and fast food businesses than it is against each other, Bryan O’Malley – the executive director of the Consumer Directed Personal Assistance Association of New York State – told HHCN.

“Over half of [providers] have indicated that their workers left because of low wages, and that number actually doesn’t count the workers who didn’t provide reasons, so it’s presumably higher,” O’Malley said. “If you raise the wage, … it is very likely that they will come do the work because the work is much more fulfilling than working at a fast food restaurant, at Target, or at an Amazon warehouse.”

An offsetting, cost-saving measure also comes into play with the legislation, O’Malley said. Many home care workers, ironically enough, rely on Medicaid while they care for Medicaid beneficiaries. Rising them out of poverty with higher wages would change that.

“If you raise the wage and make it a meaningful one that’s not poverty level, folks don’t have to rely on Medicaid or SNAP in order to survive,” he said.

The debate taking place in New York is the one grabbing the most attention right now, but it is far from an anomaly. States across the country are grappling with workforce shortages and are running out of time to come up with innovative ways to raise wages without leaving providers behind.

As for the Fair Pay for Home Care Act, the next step will take place in March, when the New York Assembly and Senate begin to release more information on their budgets. After that, negotiation will begin between the political parties.

Though the legislation is not yet included in the budget for 2023, that hasn’t concerned advocates, and they are bullish on getting it through so wages are raised by this time next year.

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