To say that home health aides’ work is demanding is an understatement. They help elderly and disabled individuals get out of bed, bathe, dress, use the bathroom, eat their meals, and take their medications. They act on behalf of family members who don’t have the time or resources to take their loved ones to the grocery store or a doctor’s appointment. Home health aides serve as the first line of defense by recognizing symptoms and behavioral changes and taking action to prevent costly and potentially dangerous hospitalizations. They make it possible for 14 million Americans to stay in their homes and out of expensive and impersonal institutional settings like hospitals and nursing homes. Along the way they often become trusted members of the family.
Performing this necessary and in-demand work takes a physical and emotional toll, yet these individuals do it with compassion day in and day out.
So why do we treat home health aides as low-wage, low-value workers?
Among the 2 million home health aides working on the U.S. today — most of them women and people of color — the average hourly wage is under $12 per hour. Nearly one-quarter of home health aides live below the federal poverty line.
Wages for home health aides are largely determined by the rate that Medicaid pays for their services, which is set by each state. Medicaid is the largest payer for home health aide services, and for good reason: keeping people at home is a popular option — 90 percent of individuals say they would rather age in place —and it makes the most fiscal sense for states to keep their aging and disabled populations out of cost-heavy, potentially infectious institutional environments.
One source of the wage problem lies in the maintenance and funding of state Medicaid programs. Some states, like Florida, haven’t increased their reimbursement rates for aide services in decades. Other states, like Ohio, tend to raise rates slightly every few years, but not enough to keep up with the cost of providing services. In both scenarios, wages have fallen well below the cost of living at a time when wages in other industries have steadily risen. Failing to adequately support home health aides is something of a paradox since they help Medicaid keeps costs down by keeping people out of nursing homes and other long-term care facilities.
To complicate the matter, as states across the country have proposed mandatory minimum wage increases, state governors and legislators have by and large not recognized the need to raise in tandem the abysmal reimbursement rates for home health aides in state-funded Medicaid programs.
Companies that provide Medicaid-based home health aide services, like the one I work for, are already trying to get by on razor-thin margins while competing for quality workers, and the minimum wage trend is putting such companies under extreme financial strain. As states continue to offer providers of these services limited rates but increase the pressure by mandating higher wages without a proportionate increase to Medicaid funding, providers are starting to question whether they can continue to keep offering such services and remain sustainable.
Competition for workers is another looming issue. With the graying of the U.S. population, the demand for home health aides is increasing. As one of the country’s fastest growing occupations — it’s the third most in-demand job sector — the U.S. is projected to face a shortage of nearly 450,000 home health aides by 2024. This occupation is projected to be. But home health aide companies can’t compete with Amazon, Walmart, and other industries that can offer workers higher wages, generally less-strenuous work environments, and more consistent work schedules.
Home health aides are not low-value workers. They provide essential services to millions of Americans who need help living at home. It is a workforce we need to stop neglecting. It’s time we recognize their value and treat them like the essential health care professionals they are.
As state legislatures and the federal government continue to ponder the fate of health care in our nation, they mustn’t overlook the value and necessity of home health aides.
Low government funding, increased pressure through wage mandates, an aging generation, and greater competition for workers are creating an emergent care gap: There simply aren’t enough home health workers to provide these needed services. What can be done to close this worrisome gap?
To make this care a priority and ensure that seniors and individuals with disabilities aren’t forced into high-cost facilities, it’s essential that home health aides are attracted to the industry not just by their sheer compassion for the work but through their ability to earn a fair living wage. Given that approximately three-quarters of home and community-based services are government-funded, state and federal governments must begin to regularly review Medicaid rates and ensure that wages for home health aides can stay in step with other occupations.
These workers deserve much more than a living wage — but we can at least start with that.
David Totaro is the chief government affairs officer at BAYADA, a home health care agency based in New Jersey with services in 23 states and five countries.