New Research Sounds Urgent Alarm to Overhaul Home Care Industry & End Abusive Work Conditions

Survey of workers in fastest-growing U.S. industry details clear solutions to fill critical shortage of home care workers.

NATIONWIDE— As Senate Republicans consider the Graham-Cassidy bill, which would eliminate health care coverage for millions, a new report by the National Employment Law Project (NELP) provides an in-depth look at the systematic causes for home care worker shortages nationwide—including wage theft, independent contractor misclassification, low pay and lack of basic benefits. With proposed Medicaid cuts in the Graham-Cassidy bill threatening to devastate an already underfunded and undervalued workforce, the report points to union representation as the most effective way to support the more than two million home care workers nationwide and improve health outcomes.

Due to the rapidly aging population in the United States, home care is the most in-demand profession in the country, expected to grow by 26 percent by 2024. But the industry annual turnover rate is around 60 percent due to low pay and lack of basic benefits, creating a critical shortage of home care workers. To assess the factors that contribute to these growing vacancies, NELP surveyed thousands of workers across the country, comparing the experience of union and non-union workers.

“Seniors and people with disabilities desperately need in-home care, yet, because of high worker turnover, many are inappropriately forced into nursing homes or family members are forced to cut back or leave the workforce to provide care,” said Caitlin Connolly, home care campaign coordinator at NELP and the co-author of the report. “Caregivers who love this work are fleeing the workforce due to unsustainably low pay and lack of basic benefits—the very issues raised in our report. Strengthening union rights and worker protections would go a long way toward improving long-term services and supports in this country; cutting Medicaid will not.”

The report, which surveyed roughly 3,000 workers across 47 states and the District of Columbia, found that allowing home care workers to form unions for a voice on the job had a positive impact for both workers and consumers, including improving training opportunities, lowering turnover, and raising pay. Findings include:

  • Union workers were paid around $2 per hour more than non-union workers.
  • Sixty-one percent of union workers had health insurance, versus 28 percent of non-union workers.
  • Union respondents were substantially more likely to be able to take a sick day, with 55 percent of workers receiving paid time off, compared to 28 percent of non-union respondents.

“Before there was a union here, I was getting paid $3.90 an hour,” said Lynda Harper, an Illinois home care worker. “We fought for fair pay, but even still, I was getting ripped off. My last client of the day was an elderly lady who was only allotted 4 hours of care. That was not nearly enough, and I frequently drove 38 miles in the middle of the night to help her, unpaid. I was all she had, but I shouldn’t be forced to choose between letting a patient suffer and working for no money.”

The report revealed clear solutions to overhaul the home care industry across the country, including:

  • Increased Wages: Although home care revenues have grown, wages in the workforce have declined since 2004. The survey found that roughly one-third of workers earn less than $10 an hour, and 75 percent of workers putting in 40 or more hours a week said they worry about paying the bills.
  • Full-Time Schedules: With 61 percent reported working part-time, 81 percent of respondents wanted to work more hours. Almost one-third of workers held at least two jobs, and 53 percent of respondents are currently seeking additional employment to make ends meet.
  • Improved Wage Theft Enforcement: Employers may restrict home care workers’ hours to keep labor costs low, but the majority of workers reported working “off the clock,” many because they were concerned for the health of the consumers they supported.
  • Full Benefits: Sixty percent of workers reported not receiving employer-provided health insurance. Of the 112 workers surveyed aged 65 or older, 79.5 percent did not have employer-provided retirement benefits, a sad irony in a profession dedicated to caring for seniors.
  • Sick Days: Only 19 percent of surveyed workers reported receiving paid sick days. Of respondents who were injured on the job, 57 percent lacked employer-provided health insurance, and 78 percent indicated they had no sick days.
  • Correct Worker Classification: Home care agencies frequently mislabel their employees “independent contractors” to deny them basic workplace protections and benefits. Answers to survey questions about tax documents indicate that 23 percent of respondents may be misclassified as independent contractors.

“The survey results support what we knew—that this is hard, undervalued work,” said co-author Anastasia Christman, a senior policy analyst with NELP. “Not coincidentally, this important but poorly compensated work is disproportionately done by women of color, many of whom have years of experience but still have to supplement their home care work with other jobs to make ends meet.”

The union gains workers have made are threatened by the renewed efforts to cut Medicaid in Congress. Like most long-term care services, home care is predominantly funded through Medicaid, and cutbacks could result in significant job loss for paid caregivers. By pushing healthcare costs to states via block grants, the new bill would likely result in deep cuts, loss of coverage for people with pre-existing conditions, and elimination of tax credits that help working families access and afford healthcare.


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