Blog Miscellaneous

Home-Based Care Sector Needs Innovation and Policy Supports To Raise Job Quality For Working Women

a woman in yellow cardigan preparing a food while an elderly man sitting on the side
by Dr.Elizabeth Nisbet and Dr. Jennifer Craft Morgan:

In New York State, many women, often people of color and immigrants, work as personal care or home health aides to care for persons with chronic illness, disability or dementia who need assistance with daily living tasks. Over 300,000 of these women hold a job largely financed with public funds and in some cases, as direct government employees.

The majority of home-based care services in the U.S. is funded by public sources including Medicaid and Medicare. These jobs are usually low wage, high demand with poor working conditions and few opportunities for advancement. They also exemplify two trends in the workforce that help explain the situation of many low-income working women today: occupational segregation, or the overrepresentation of certain groups of workers in certain jobs, and growth of low-wage work in the service sector. According to PHI, nearly 90% of home care aides are women; well over half are women of color and aged 45 or above. Bureau of Labor Statistics data indicate their median pay in 2016 was $10.60 per hour, while the occupation is projected to grow 40% by 2026. However, public policy is changing aide pay in some places. For example, home health aides working for larger New York City-based agencies must earn $13 an hour plus benefits (as of December, 2017). Recent national legislation (2016) also afforded many aides nationwide first-time rights to overtime pay, rights that New York aides have enjoyed under a more limited law already.

Our recent study in the Journal of Applied Gerontology examines the experiences of these aides highlighting the difficulty getting enough work hours or maintaining a stable schedule. This problem has been well-documented for restaurant and retail workers, but it looks different for care aides, whose schedules depend on the needs of low resource clients, Medicaid or Medicare policy changes, and on decisions made by employing agencies.

Our interviews with 30 people in 17 agencies who hire aides and assign schedules focused on how labor and health care policy affect employer practices. Interview participants believed Medicaid policy change had, at least in the short term, shortened visits to patients and reduced the number of patients, which made it harder to create good schedules. They reported that aides wanted more hours. They were cutting back on overtime and reorganizing schedules to respond to regulations about overtime and pay for time traveling to homes, because they said the current structure of health care funding did not cover those costs (since then, the state provided some funds to Medicaid plans that are intended to address this). There were also changes to the way round-the-clock care was authorized so that people stayed 24 hours in a home and were paid 13, instead of working one of two 12-hour shifts.

Some innovative employers were adopting new ways to improve job satisfaction and provide steady work, such as hiring an aide to work in the office who could go out on short-notice visits, hiring mentors to help new hires, and finding new ways schedulers and aides could work together. Some aides working for more than one unionized agency may also pool hours to gain enough time to receive health care benefits.

In the restaurant and retail sectors, some workers desiring better schedules are benefiting from state laws related to scheduling notification or call-in or send-home practices. Policies like this could be helpful to care workers too, but care work presents different challenges: income can be dramatically affected by a patient’s death, change in health, or sudden admission to the hospital, and total work hours are limited by what public programs will authorize. As this occupation grows, continued attention to how policy and employer innovations can serve care aides, their patients, and their employers is needed.

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About the author:

Dr. Elizabeth Nisbet is an Assistant Professor of Public Management at John Jay College of Criminal Justice, City University of New York. Her research focuses on public and private sector responsibilities for public services and labor markets, and on how labor, health, and immigration policies affect both public services and low-wage work.

About the author:

Dr. Jennifer Craft Morgan is an Assistant Professor in the Gerontology Institute at Georgia State University in downtown Atlanta. Her primary research interest is in workforce studies within health care organizations. She has led six major funded projects evaluating the impact of career ladder, continuing education and financial incentive workforce development programs on health care worker outcomes, quality of care outcomes and perceived return on investment for health care organizations and educational partners. She has published and presented widely in both scholarly and practice-based outlets. Her work seeks to tie research, education and service together by focusing on the translation of lessons learned. This translation of research into lessons and tools serves to help stakeholders, such as employers, program implementers, and workers, to build evidence- based solutions to pressing problems.