When our loved ones age and begin to need help with what health care providers call “activities of daily living,” we want that assistance to be available and provided by caring individuals. Most people receive that assistance from family members or friends through what is known as informal caregiving. These family caregivers allow millions of elders to continue living in their communities for as long as possible, avoiding the nursing home placements that none of us want for ourselves or for those whom we love.
But family caregivers are not always available to provide all — or sometimes even any — of the needed care. Some frail elders needing assistance may not have a living or healthy enough spouse to provide care; their children — if they have any — may live out of state or be employed full time outside the home and not available to meet their parents’ needs. When family caregivers are not available to provide all the necessary assistance, paid home care aides fill the gap.
Personal care aides or personal support specialists, as they are called in Maine, make up the fastest growing occupation in the country. The Bureau of Labor Statistics projects that between 2010 and 2020 the demand for personal care aides will increase 71 percent and will produce more than 600,000 new jobs nationally (ranking fourth on the list of occupations projected to add the most new jobs to the economy during that period of time).
In Maine, the overall job growth between 2008 and 2018 is projected to be 2 percent, yet for personal care aides, that projected growth is 26 percent. With the aging of our population nationally and in the state, and with the decreased availability of family caregivers, as more women work outside the home, it is not surprising that we have this growing demand for paid caregivers. So who are these people with whom we entrust our loved ones? And are there enough of them to meet the growing demand?
Currently in Maine, there are an estimated 5,760 personal care aides working through home care agencies and an additional 2,100 independent providers employed through Alpha One. Not included in these numbers are those workers who are employed privately by families, a number that is hard to estimate. Annual turnover rates ranging between 25 and 50 percent are typical among workers for home care agencies. This is lower than the turnover rates reported by nursing homes for their direct care staff (which can reach 100 percent), but still high enough to cause concern and cost to agencies and affect care for consumers.
I have recently completed overseeing a study on the job experiences of home care workers in Maine. This study followed a group of 261 personal support specialists for 18 months who were working for agencies serving all 16 counties of the state. More than a third of these workers — 90 study participants — terminated their jobs during this time. Many reasons were reported for why they left their employment, but the most pervasive was the inability to support themselves and their families given the low wages (with an average wage of $9 per hour) and the instability and part-time nature of the hours.
Related compensation issues included lack of mileage reimbursement, paid sick time and paid vacations. Sadly, despite working in a health profession, more than a quarter of the study participants (28 percent) lacked health insurance; many of these workers would have been covered by the expanded MaineCare legislation that Gov. Paul LePage recently vetoed.
What we also learned in our study was that these workers left the work despite loving it. They enjoyed working with elders, believed — like most of us do — that it was important to help people remain in their homes for as long as possible, had high levels of job satisfaction, and generally would have chosen to continue in the field if the compensation had been better.
A large portion of home care is paid through government programs such as Medicaid. A recent report published by Demos, “Underwriting Bad Jobs: How Tax Dollars are Funding Low-Wage Work and Fueling Inequality,” points out that millions of U.S. workers employed through government contracts, loans and health care spending are paid wages too low to support their families, ultimately resulting in a weaker economy and hindering economic growth. Home care aides are among these workers, which also include “workers sewing military uniforms, hospital aides funded by Medicare, security guards with contracts to protect public buildings, and food cart vendors at the National Zoo.”
The report suggests that President Barack Obama has the authority to raise these wages paid by tax dollars through an executive order. Executive orders have been used successfully in the past to address social problems such as employment discrimination and could be used in this instance to require public contractors, subsidized businesses and companies receiving public benefits to pay living wages and offer employee benefits.
Offering home care aides livable wages and health insurance would not only allow many caring workers to continue to do the job they love but would also demonstrate our respect for the work they do and the elders they care for. This would bring us closer to our shared vision of helping our aging family members, neighbors and friends to remain at home and in their communities for as long as possible.
Sandy Butler is a professor at the School of Social Work at the University of Maine. She is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.