The surprising link between home care for the elderly, pulling people out of poverty

Sandy Butler, University of Maine

Originally published in the Bangor Daily News on June 9, 2015.

In May, I attended two hearings before the Legislature’s Health and Human Services Committee to testify on two seemingly unrelated bills: LD 1350, Resolve to Increase the Reimbursement for Direct-care Workers Serving Adults with Long-term Care Needs, and LD 1268, An Act to Reform Welfare by Establishing Bridges to Sustainable Employment.

The two bills, however, are closely linked by the phenomenon of low wages that characterize women-dominated fields: service-industry jobs, including those related to caring for our children and elderly. These low wages mean many employed women — especially those raising children on their own — remain poor despite working. A recent analysis by the Institute for Women’s Policy Research found that the poverty rate for working women would be cut in half (from 8.1 percent to 3.9 percent) if women were paid the same as men working comparable jobs.

LD 1350 is about raising wages for home care workers, 90 percent of whom are female. The work they do is generally considered “women’s work,” and, like other caring professions, it’s undervalued in the U.S., something aptly pointed out by Leo Delicata, public policy advocate for Legal Services for the Elderly, in his testimony at the May 6 public hearing.

We need these workers badly, and that need is only increasing. But despite growing demand, wages have remained flat, even decreasing 5 percent in value over the last decade. With one in four home care workers living in households below the federal poverty line and over half living in households at 200 percent of the poverty line or below, it is not surprising that these workers often need to supplement their income with public assistance such as Medicaid, food stamps, or housing and heating assistance. Nationally, three of five home care workers receive benefits from at least one of these programs.

In my own research on turnover among home care workers in Maine, compensation was central to workers’ decisions about whether to terminate their employment. Turnover is a big problem in this field, ranging from 44-65 percent annually, costing employers and compromising client care. Participants in my 18-month study — one-third of whom left their jobs during that time — mentioned wages and lack of health insurance, mileage reimbursement, paid sick days and holidays as contributing to their decisions to leave, despite truly loving their work.

Luckily, testimony on May 6 was fully supportive of LD 1350, which requires the Department of Health and Human Services to increase reimbursement to direct-care service providers to $25 per hour, 85 percent of which must be used for wages and employee benefits. Some employers at the hearing asked that the 85 percent figure be lowered given rising administrative costs. The bill remains with the committee at the moment; ultimately, it will need to be considered by the Legislature’s Appropriations Committee because of its price tag.

The second hearing I attended, on May 12, concerned a number of bills related to Maine’s Temporary Assistance for Needy Families (TANF) program — a significantly more contentious topic. Several bills proposed a punitive approach through restrictions and sanctions generally based on anecdotes about how parents use their benefits. In general, such bills focus attention and state money on monitoring systems — some of which may be illegal — to control recipients’ use of funds and on hiring new state employees to root out fraud, something that has turned out to be quite minimal despite the common belief that it is rampant.

This ill-directed attention and money could be better spent on helping low-income, often low-skill parents — most often single mothers — obtain and sustain employment with livable wages. This is the idea behind LD 1268, sponsored by Rep. Drew Gattine, D-Westbrook, which tries to ease the “welfare cliff.” It’s a welcomed contrast from many of the other bills, which do little to help families escape poverty. The bill has been tabled, and there is a request for it to be carried over to next year’s legislative session.

If the Legislature passes LD 1350 and raises home care workers’ wages, this could be a field that interests some parents receiving TANF. Given livable wages, helping parents on TANF who are suited to caregiving work become certified as home care aides could help both our long-term care system and families working toward economic self-sufficiency. But with the profession’s current low wages, lack of benefits and part-time hours, home care work would still fall short of pulling such families out of poverty.

Sandy Butler is professor of social work and graduate program coordinator in 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.

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