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At nearly 88,000 strong, direct-care workers comprise Wisconsin’s largest workforce — yet many earn wages low enough to qualify for public benefit programs, according to a fact sheet released by PHI this month.

The median hourly wage for home health aides, for example, is just $10.35, while personal care aides earn $9.62 an hour. Both wage levels are lower than 200% of the federal poverty level ($10.42).

Due to those low wages — as well as the fact that many direct-care workers can only find part-time employment — more than 40 percent of Wisconsin’s direct-care workers qualify for state and federal assistance programs, such as food stamps or Medicaid.

The estimated cost of these public benefits is more than $180 million — the equivalent of a $1 to $2 public subsidy for every hour worked by a Wisconsin direct-care worker, the PHI fact sheet reports.

Other Findings

Wisconsin’s direct-care workforce is its single largest occupational grouping, at 87,797. (Retail salespersons are next, at 76,180.)

Included within those 87,797 direct-care workers are:

• 37,630 nursing aides, orderlies, and attendants;
• 22,080 home health aides;
• 19,630 agency-employed personal care aides; and
• 8,457 independent providers in public programs.

According to the fact sheet, direct-care workers comprise nearly one-third (32 percent) of Wisconsin’s overall health care workforce.

PHI’s analysis also shows that direct-care workers’ wages are declining. In 2000, for example, personal care aides earned an inflation-adjusted median wage of $10.69 an hour — more than a full dollar higher than in 2010.

Fact Sheets Support Advocacy Efforts

The Wisconsin fact sheet is one in an ongoing series of PHI fact sheets providing overviews of the direct-care workforce in select states.

It was funded by a Health Care Workforce Development Grant from the state of Wisconsin.

Stakeholders in Wisconsin say that the fact sheet will be used to educate state legislators about Wisconsin’s direct-care workforce.

For information on direct-care workers in each of the 50 states, visit the PHI State Data Center.

– by Matthew Ozga

Three brief stories on direct care:

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CMS Proposes Guidelines for State Balancing Incentive Payments Program

The Centers for Medicare & Medicaid Services issued a “State Medicaid Directors Letter” (pdf) on September 12 to provide guidance for establishing the State Balancing Incentive Payments Program, a provision of the Affordable Care Act.

The new program, created to serve more people in home- and community-based settings, will assist states in “transforming their long-term care systems” by:

• improving systems performance and efficiency;
• creating tools to facilitate person-centered assessment and care-planning; and
• enhancing quality measurement and oversight.

The Balancing Incentive Program offers a targeted increase in the Federal Medical Assistance Percentages (FMAP) for non-institutional long-term services and supports (LTSS) to states that undertake structural reforms to increase access to home- and community-based LTSS.

On October 7, the Friday Morning Collaborative, a coalition of national aging and disability organizations, is hosting a webinar on the Balancing Incentive Payments Program. Registration is free, but space for the webinar is limited.

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State Direct-Care Worker Associations to Hold Annual Meetings

The Arizona Direct Care Worker Association (ADCWA) is holding its 4th Annual Conference and Celebration in Tucson on October 5 to honor and educate certified nursing assistants, home care workers, and professional caregivers in the state. To learn more about the event and register, visit the ADCWA website.

The Florida Professional Association of Care Givers is sponsoring its 16th Annual Caregivers Convention entitled, “Building a Quality Direct Care Workforce for Tomorrow’s Demands!” The all-day educational meeting will take place in Altamonte Springs on October 20. A registration form and more information is available at the association’s website.

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Des Moines Register Editorializes on Better Rewards for Caregivers

The Des Moines Register published an editorial in late August arguing that to ensure an adequate supply of direct-care workers to care for aging Iowans, those workers must have better wages, health coverage, education and training, and be valued in the medical field for the critical work they perform.

The editorial also explains that worker turnover is costly to employers, Medicaid, and consumers.

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PHI Newsletter Survey

If you have not done so already, please take a moment to give us your feedback on the PHI Quality Care, Quality Jobs newsletter by completing this anonymous survey. Thank you to all of the subscribers who already responded.

Senator Tom Harkin (D-IA), the chair of the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP), and Senator Robert Casey, Jr., a fellow HELP Committee member, are calling for an end to the “companionship exemption,” which excludes home care workers from federal wage and overtime protections that most workers enjoy.

In a September 12 letter (pdf) to Department of Labor (DOL) Secretary Hilda Solis and Office of Management and Budget (OMB) Director Jacob Lew, the senators write that the DOL’s broad interpretation of the companionship exemption in the Fair Labor Standards Act (FLSA) is a “longstanding injustice that must be corrected.”

Harkin and Casey explain that when Congress expanded FLSA in 1974 to include most domestic workers, it included a “narrow exemption” for companionship services “to address concerns that the FLSA would be extended to teenagers, neighbors, and friends who provided occasional or informal services, such as babysitters.”

“A professional caretaker is not the type of informal and casual relationship that Congress sought to exempt,” the letter states.

Low Pay and Inadequate Benefits

The senators write that millions of home care workers “provide physically and emotionally demanding and often life-sustaining care.” Despite performing a “critical job,” these workers “receive low pay [and] minimal to low benefits.”

Noting that “a shortage of qualified home care workers and high turnover endanger our ability to meet our nation’s long-term needs,” the senators advise that “one way to ensure that we meet these challenges is to provide home care workers the critical protections under FLSA.”

The senators urge Solis and Lew to “complete the notice of proposed rulemaking on companionship services regulations,” adding that they “hope that the ensuing comment period and final regulation will be completed within a reasonable time period.”

DOL hosted two listening sessions on the companionship exemption earlier this summer and is expected to issue revised regulations this fall.

For more information on the companionship exemption and how to contact Secretary Solis, visit the PHI Campaign for Fair Pay.

In a letter (pdf) to President Obama, PHI President Steven Dawson explains why investment in quality direct-care jobs presents a strong opportunity to put thousands of people back to work.

The already-great demand for eldercare/disability services and will only grow as the Baby Boomer generation advances to retirement age. Because of that surging demand, “direct-care jobs are uniquely positioned to help repair and stabilize our faltering economy,” Dawson writes.

The September 8 letter coincided with the unveiling of the Obama administration’s jobs plan during a joint session of Congress.

In the PHI letter, Dawson tells Obama that direct-care jobs must pay family-sustaining wages and provide adequate health benefits.

“We urge you to invest in improving the quality of these jobs by requiring a wage floor for positions created by the investment and by offering health insurance coverage” through Medicaid, Dawson writes.

Investment in quality direct-care jobs has huge positive implications beyond the workers themselves. A strong direct-care workforce supports working family caregivers throughout the country.

When family caregivers know their loved ones are safe and secure under the skillful care of well-trained direct care workers, they can focus on producing maximum value for their employers — and, thus, the nation’s economy.

“In short,” Dawson writes, “the caregiving infrastructure created by the direct-care workforce is as essential to a well-functioning economy — and as worthy of investment — as roads and bridges.”

More information on the eldercare/disability service industry’s untapped potential for job creation can be found in PHI FACTS 2 (pdf).

– by Matthew Ozga

Iowa’s direct-care workforce is among the lowest-paid employment groups in the state, according to a survey published by the Iowa CareGivers Association.

The average direct-care worker in Iowa makes just $11.50 an hour, according to the 1,276 survey respondents, a group that included certified nursing assistants, home health aides, and personal care assistants.

By contrast, Iowa’s median hourly wage for all workers is $14.40.

Nearly half (49.9 percent) of Iowa’s direct-care workers live in households earning under 200 percent of the federal poverty level.

Iowa’s direct-care workers also struggle to obtain health insurance, the survey found: nearly one-forth (23 percent) of respondents said they were not insured. Overall, 12.4 percent of Iowa’s adults lack health coverage.

Additionally, only 43 percent of direct-care workers in Iowa are offered paid sick leave.

Low Pay Discouraging to Workers

According to the survey, this lack of adequate wages and benefits is driving many Iowans away from direct care. More than 20 percent of direct-care workers surveyed said that they are actively seeking to leave the field entirely in order to find better-paying jobs.

“Workers are leaving direct care at exactly the wrong time,” said John Hale, a public policy consultant for the Iowa CareGivers Association. He notes that, of the ten jobs expected to be most in demand over the next decade, three are in the field of direct care.

“We cannot meet the future demand for workers who will enter and stay in the profession unless we make these jobs better by improving their pay and benefits,” Hale continued.

Recommendations for Future

The report offers several ways that Iowa can address the issue of low pay and benefits for direct-care workers.

For example, the report says that Iowa could insure more workers by expanding Medicaid eligibility to 133 percent of the federal poverty level. The Affordable Care Act will require all states to do that beginning in 2014, but states have the option of expanding Medicaid eligibility (pdf) at any point before then.

The report further recommends that Iowa expand eligibility levels for its subsidized child care program, as well as increase the size of its Earned Income Tax Credits.

– by Matthew Ozga

Iowa’s direct-care workers still lack adequate wages and benefits, according to an Iowa CareGivers Association survey that is set to be released in the coming days.

The survey, conducted by the Child & Family Policy Center, is the third — and so far, most comprehensive — overview of Iowa’s direct-care workforce published over the past decade. The last survey was released in 2004.

Like the rest of the country, Iowa is facing a shortage of direct-care workers just when the demand for their services is peaking. The aging of the baby-boomer generation will create a need for an additional 10,000 new direct-care workers in Iowa alone over the next 10 years.

In that context, the need for high-quality direct-care jobs is more urgent than ever.

“The needs of persons with disabilities and aging Iowans will go unmet if we continue to ignore and undervalue this incredibly important workforce,” said Di Findley, the executive director of the Iowa CareGivers Association.

“We can no longer, as a society, get by thinking that we can compensate people poorly simply because they are nice, caring people,” she continued.

Specific Survey Findings

Among the findings in the 2010 Iowa survey:

• Iowa’s direct-care workers are among the lowest-paid in the state, earning an average of $11.50 an hour, compared with the median hourly wage of $14.40 for all Iowa workers.
• A majority of direct-care workers in Iowa work full-time hours — but nearly half (49.9%) report household incomes that fall below 200% of the federal poverty level. Nearly one out of five direct-care workers in Iowa (18.2%) are below the federal poverty line entirely. Many rely on public benefit programs such as food stamps and child care assistance to make ends meet.
• Across the board, direct-care workers are less likely to be covered by health insurance than non-elderly workers throughout Iowa.
• More than one-fifth of all direct-care workers in Iowa say they are actively trying to leave the field, mostly due to low pay and poor benefits.

The survey suggests that some of the financial difficulties faced by Iowa’s hard-working direct-care workers could be offset by expanding public services, such as Medicaid eligibility and earned income tax credits, to more Iowans.

It also recommends that the Iowa government use its position of as a primary purchaser of direct-care services (under Medicaid) to raise wages and provide more benefits.

– by Matthew Ozga