It’s shortly after 10 o’clock on a recent Monday night and home care worker Erica Payne is starting her job for the evening in Pittsburgh’s South Hills. She’s just arrived at the home of her client, a 60-year-old woman who uses a wheelchair. Payne is one of several home care workers who help her with daily activities.
Payne is part of a workforce that’s gotten renewed attention in recent weeks, because of a proposal by President Joe Biden to invest an additional $400 billion in federal funds to create jobs and raise wages for the nation’s home care workers. Such workers provide essential care for many seniors and people with disabilities, but often earn low wages in return.
Because of an accident many years ago, Payne’s client uses a wheelchair to get around and has limited use of her arms. Tonight, Payne is here to help get her ready for bed — she helps her brush her teeth, checks medications, picks out her clothes for tomorrow, empties her catheter, helps her get undressed, combs her hair, and uses a lifting device to move her from her wheelchair into the bed. This is the daily work of home care — assisting with the tasks that many people don’t think about but that are critical to an individual’s independence and dignity.
Critical Work, Low Wages
Payne is a home care worker four nights a week caring for her client, but she also works as a ride-share and food delivery driver. If she wants to take a day off from her home care job, it’s unpaid.
Home care workers earn around $13 or $14 dollars an hour on average, according to federal statistics. That’s less than $30,000 a year.
It’s part of why the White House has said the country’s caregiving system is in a crisis and deserves such an enormous investment.
“In addition to caring for children, families feel the financial burden of caring for aging relatives and family members with disabilities, and there is a financial strain for people with disabilities living independently to ensure that they are getting care in their homes,” administration officials wrote in the plan’s outline on the White House website. “At the same time, hundreds of thousands of people who need better care are unable to access it, even though they qualify under Medicaid. In fact, it can take years for these individuals to get the services they badly need. Aging relatives and people with disabilities deserve better. They deserve high-quality services and support that meet their unique needs and personal choices.”
The industry's low pay is often driven by low government reimbursement rates for services through Medicaid, a program funded by the federal government and the states that covers many health costs for low-income and disabled individuals. The low reimbursements and low wages combine to create a host of problems, like high turnover for workers and waiting lists for people who need services.
Payne supports the president’s plan and believes it will benefit both clients and caregivers.
“They have to have a livable wage,” she said. “They have to have some type of insurance and paid days off like it's a real profession because it is. They have to have training, they have to know what they're doing, not just to feel confident, but to be competent at their job.”
The Biden plan has not yet become a bill in either the House or Senate. But the proposal has the support of many Democrats, including Pennsylvania’s U.S. Sen. Bob Casey, who touted the plan on a call last month with reporters.
“Families across our Commonwealth and across our country need a lot of help,” he said, speaking on the May call alongside Payne. “They need help as well with services and supports to care for older Pennsylvanians. They need help caring for their children. And, of course, they need help caring for those loved ones who have a disability.”
But Democrats' slim majorities in Congress make the fate of Biden’s infrastructure plan uncertain. An infrastructure plan proposed by GOP senators last month would leave out home care and Pennsylvania’s Republican U.S. Senator, Pat Toomey, has said an infrastructure plan should be limited to the more traditional definition — things like roads and bridges.
But others argue workers like Payne are infrastructure.
Karen Jacobsen runs the Emmaus Community of Pittsburgh, which provides services to people with intellectual disabilities. She has been a longtime advocate for investments in the caregiving workforce. She also hopes the current political debate helps change how people think about caregiving.
“How do we shift a culture’s thinking?” she asked. “We have to start valuing the most vulnerable and we have to value the people who care for them.”
