A Decent Living for Home Caregivers—And Their Clients

A Decent Living for Home Caregivers—And Their Clients

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At-home caregivers are among the least protected and most undervalued workers in the U.S. Low federal reimbursement rates lay at the heart of the problem. 

By Heather Rogers

This article appears in the Summer 2015 issue of The American Prospect magazine. Subscribe here.

Laddie Read, a 69-year-old with cerebral palsy, can’t get up without help. When he awoke one morning last April expecting to find his home-care aide and instead saw a complete stranger at the foot of his bed, Read was terrified. “I had no idea who was there,” he recalls. “If you were bedridden and somebody just walked into your house,” he says, “how would you feel?”

Read requires help to move from room to room, get into his wheelchair, use the bathroom, dress, and bathe. He can’t cook, shop, or clean the house. To assist with all these tasks, the Portland, Oregon, resident relies on home-care aides seven days a week. It turned out that the stranger was a replacement. His usual aide couldn’t come in—but no one bothered to tell Read. While abruptly losing caregivers isn’t uncommon in Read’s decades of using the service, it was no less upsetting. The new aide couldn’t understand what Read was saying—his caregivers must be trained to understand his severely impaired speech—and had no clear idea of how to perform the job. “It felt like hell,” Read said, speaking through an interpreter. “When this happens, my whole world stops.”

Thousands of people dependent on home-care workers face similar disruptions every day. Turnover in the industry is extreme. In 2014, the median rate topped 60 percent, as documented in an industry study—that’s six out of ten caregivers leaving the job every year. It’s not surprising that so many workers flee the profession, which has intense physical and emotional demands—and poverty wages. The median earnings are less than $21,000 a year. That’s well below the annual median across all occupations, which is almost $35,000, and just above the federal poverty line for a family of three. Earnings are so low that about half of all at-home caregivers are on some form of means-tested public assistance, including Medicaid and food stamps, according to the Paraprofessional Healthcare Institute, a research organization.Why is pay so bad for these workers? One explanation is that home-care aides comprise several traditionally marginalized groups. About 90 percent of home-care workers are women; almost half are of color. And since the job doesn’t require a high school diploma, most have low education levels.America’s chronic devaluing of care work, be it for children, the ill, disabled, or aging, reinforces a vicious cycle of low status and low pay.So entrenched is the discriminatory view of caregiving that the country’s most important labor law deliberately shuts these workers out. When the Fair Labor Standards Act (FLSA) was passed in 1938, it transformed the lives of American workers by setting the eight-hour day and establishing other basic protections, including extra pay for overtime. However, the law excluded domestic caregivers. Astonishingly, it still does. As a result, home-care aides do not even have the right to receive minimum wage and overtime pay.

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