The Plight Of The Home Health Worker

When we place our children in daycare we expect the facility or home to be approved by a governing board, the state or other industry requirements. After all, we’re placing our most precious gifts in the care of someone we don’t know.

And yet, when it comes to home health care for our parents, grandparents or other elderly family member we are at the mercy of a caregiver who may not even be able to read. Most agencies screen and train their employees but some don’t. The vast majority of home health aides don’t receive health benefits or retirement, must pay for their own gas, and when they don’t visit their clients they aren’t paid. Nearly half of all home care workers live at or below the poverty level and many receive benefits such as food stamps or utility assistance. Median pay was $9.70 hourly, less than most fast food workers, maids or short-order cooks.

With Medicaid and Medicare failing to increase reimbursement rates and with ever-looming cuts home health services are feeling the pain. They’re not protected by federal law and so make easy targets. But what this really means is that the quality and availability of home health aides will continue to decrease. The turnover rate among home health aides is estimated to be anywhere from 30 percent to 50 percent, sometimes higher.

The Fair Labor Standards Act was amended in 1974 to exempt home health aids from minimum wage and overtime requirements because they were seen simply as companions. That’s changed drastically as more and more home health aides have to become dieticians, cooks, nurses and administer medication. President Obama has introduced plans to modify the exemption to extend minimum wage and overtime benefits to home health workers but optimism is low that these changes will be made.

The National Health Statistics Report from the Centers for Disease Control and Prevention estimates that employment of home health aides will rise by 50% between 2008 and 2018 from 921,000 to 1,382,000. This is an alarming prediction, especially coupled with the predicted rise in Alzheimer’s and dementia rates which means care will go beyond simple meal preparation and hygiene. Elderly home care patientsm, especially those with Alzheimer's or dementia, will be vulnerable to health care aides, many of whom are randomly recruited and poorly trained with little or no background investigation or drug testing.

This is not to say that all home health care workers are bad. On the contrary, many of them choose to care for the elderly, and they provide attention and even love for their clients. They could make more with a paper route than home health but continue day after day to offer their services to people who need it and may even be the only personal contact their clients have all day. Patients develop strong bonds with their caregivers and it can be confusing and heartbreaking when their aides are forced to find other work because they can’t support their families.

It’s critical that a compromise be reached that would allow the elderly to remain in their homes and be cared for by qualified and compassionate health care workers who make a living wage.  We owe it to our parents and our grandparents as well as the people we trust to care for them. Plans should be made now before critical levels of caregivers are needed but are nowhere to be found.