Majority of States Lacked Caregiver Hazard Pay, Sick Leave During Pandemic

More than half of U.S. states did not support direct care workers with hazard pay or paid sick leave policies during the first 18 months of the COVID-19 pandemic, a new study from the New York-based direct care worker advocacy organization PHI revealed.

Home-based care workers were among those overlooked when it came to policy changes.

According to the study, 26 states did not address hazard pay or paid sick leave, while the other 24 states and the District of Columbia did.

“It was surprising and disappointing that so few states implemented hazard pay for home care workers, given their critically important role in the pandemic response,” Kezia Scales, senior director of policy research at PHI, told Home Health Care News in an email.

Scales – one of the co-authors of the study – and her colleagues came away with several lessons from the study, including the need to sustain short-term wage increases in the industry by permanently raising the wage floor.

Researchers with PHI also advocated for the need to develop a national compensation strategy for direct care workers that creates a “livable, competitive wage” for this workforce.

For home care workers, Michigan was a bright spot in a sea of underwhelming policy changes, Scales said.

According to the report, Michigan’s hazard pay policy stabilized caregivers’ economic situation and found that it increased home care workers’ hourly wages and weekly earnings by $2.43 and nearly $90, respectively.

Scales and her colleagues deemed Michigan to have the most generous and sustained example across all states.

“Michigan implemented a wage increase for these workers early in the pandemic that was eventually made permanent through the state budget, which is a great example of translating a crisis response into a longer-term solution,” Scales said.

Other states like Arkansas, Massachusetts and Rhode Island implemented policies that applied to a broad range of occupational groups.. Those included home health aides as well as licensed nurses, therapists and personal care aides.

Creating policies and updating the ones on the books for home-based care workers is just one way to keep them in the field, Scales said. Updating hazard pay policies can go a long way in retaining staff in an industry that desperately needs it.

“Home care workers faced significant risks delivering care during COVID-19, while also experiencing enhanced economic pressures due to lost wages and, in many cases, decreased family incomes and more,” she said. “Hazard pay helps these workers maintain financial stability during such a crisis, while also signaling to them that their contribution is seen and valued – which makes them more likely to stay in the field.”

Colorado, Massachusetts and Virginia enacted policies that addressed paid sick leave for home-based care workers, according to the report.

However, Scales said while the industry could learn from Virginia’s Paid Sick Leave for Home Health Workers — which became effective on July 1, 2021 — what is really needed is paid sick leave coverage for the full workforce.

“Maryland offers a good alternative example,” Scales said. “As well as having a paid sick leave policy in place for all workers, the state passed the Essential Workers’ Protection Act in 2021, which is designed to provide enhanced coverage for essential workers – like home care workers – during a public emergency.”

Virginia’s legislation mandates paid sick leave for home care workers, defined as those who provide personal care, respite, or companion services to individuals receiving consumer-directed services under Virginia’s Medicaid state plan. Scales would rather see states pass sweeping changes that cover all health care workers.

Stakeholders and lawmakers should act now, Scales argued, in order to correct some of the issues that are ongoing and on the horizon.

“We must make every effort to document and learn from what happened during COVID-19, and how the home health sector responded, so that we can make improvements now and be better prepared for the future,” she said.

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