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Watch Part 2
The U.S. needs more home care workers. Is this the solution?
With about 10,000 baby boomers retiring every single day, home care is one of the fastest growing, most needed occupations in America. But there's a problem: The current median pay is just $10.49 per hour. Economics correspondent Paul Solman reports on why these vital workers get paid so little.
Many of us will want to stay at home as we grow into old age. But as the baby boom generation matures, the country is facing a shortage of home care workers to make that possible.
Our economics correspondent, Paul Solman, has the first of two reports on this issue. It's part of our series Making Sense, which airs Thursdays on the "NewsHour."
Monica Poremba works 75 to 95 hours a week as a home care worker, and that's not even counting commuting time.
It's not very often that I get a client right in town where I live. So, there is a lot of driving involved.
Unpaid driving time she spends getting to her clients in rural areas outside summer vacation hot spot Traverse City, Michigan.
I'm going to make it some real breakfast, OK?
Poremba never knows what she will find when she arrives to care for Tom, who has advanced dementia, and needs her care desperately.
One day, a couple of weeks ago, he wanted me to come out to the garage to look at something. And he had taken brick red spray paint to the wheel of his leisure van, thinking it was a cleaner of some sort. So, now he has one wheel of his leisure van that is painted brick red, when he really meant to just clean it.
Your pills are right here. Don't forget to take those.
After six to eight hours here with Tom, Poremba will head to another client.
Everybody is always calling you. Can you pick up this shift, that shift? It's hard to have a life when you work that many hours.
Every year, there is just an increased demand for our services.
Amy Northway is Poremba's Boss at Monarch Home Health Services.
I literally get calls daily for clients that we have to turn away because we just cannot staff them.
Michigan, like the rest of the country, is facing a critical shortage of home care workers to assist older adults and people with disabilities who live at home with daily tasks like eating, cleaning, bathing.
Gerontologist Clare Luz.
In Michigan alone, we're going to need 32,000 more direct care workers by 2020.
With about 10,000 baby boomers retiring every single day, home care is one of the fastest growing occupations in America. With some 50 percent more workers needed by 2026, these are among the most-needed jobs of the future. Problem is, in the present, the median pay is just $10.49 an hour.
People like myself make between $8 and $11 an hour. I think $11.50 is the high range.
Last year, single mother Bea Kurek supplemented her home care income with nursing home work.
Can you say how much you made in the last year, let's say?
I would have made somewhere around 19.
But, I mean, I…
Yes. I was really proud of myself for making that much.
For making it to $19,000.
So, if you just do home care in a year, how much can you make?
I am not quite sure. I haven't ever been brave enough to try that.
Kurek and her daughter, Evelyn (ph), rely on help from family and public health coverage.
She's got Michigan Child and I have got Medicaid. If I didn't have the government medical, I really — I would be in a bad spot, especially because I have migraines and I have epilepsy. And I would lose my medication. And my medication costs $2,200 a month.
Kurek recently quit the nursing home. Now she will have to manage with home care as her sole income.
But you really can't make ends meet without family help doing that, right?
No, I can't, which is why I might also have to pick up a night job as waitress.
A quarter of home care workers live in households below the poverty line. And more than half rely on some form of public assistance.
Why the low pay? Luz ticked off the usual explanations.
We are an ageist society. We don't place a lot of value on older adults or the people that take care of them. It's invisible. And it's historically women's work.
And, as we know, a lot of women's work has never been compensated financially. It's done in the home. It's not paid.
And even when it is paid, this job is often disrespected.
I have had clients call, "My girls are not here yet," meaning the home health aide or the personal care aide isn't there yet.
Alyssa Lawrence has been in home care for 10 years.
My clients have called and said, "Hey, my cleaning lady isn't here yet." It's not just a cleaning lady. You know, you have somebody in their home that relies on somebody for showering, bathing and toileting, and their family members won't even go in and do it.
But in Traverse City, even the maids make more than the home care workers. We passed a sign outside a hotel hiring housekeepers at $15 an hour. No surprise it's so hard for Amy Northway to find workers.
A lot of our employees or potential employees take those housekeeping positions because they sometimes pay $25 an hour, and there's absolutely no way I can compete with that.
For instance, McDonald's, they're hiring $11 an hour. The employee can stay there for eight hours or whatever her scheduled shift is, and be done, whereas, in home health care, we're asking this caregiver to show up at one client's, work for a specified amount of time, get in her car, drive across town. That's gas. That's wear and tear on her car.
It's time that she's maybe not getting reimbursed for. And that makes it very difficult for us.
So, why don't you pay them more?
I can't. I wouldn't have a business if I paid them more than that.
But with growing demand, not enough workers, basic economics says wages simply have to go up. The catch, home care is dominated by one payer. Yes, some is paid for privately through long-term care insurance or personal savings.
But 70 percent is paid for by the government. Medicare only pays for short-term home care. So, Medicaid is the primary long-term home care payer, channeled through local area agencies on aging.
Our area agency clients reimburse us right around $17.50 an hour.
Seventeen-fifty, so roughly…
There's very little margin, yes, in those clients. And our private pay clients, of course, do pay more for that, but they really do kind of offset our other clients who aren't able to afford to pay that.
With government doing the bulk of the paying, it effectively dictates how much employers can pay their home care workers.
What's the point at which, if you were paying caregivers that much, you would go out of business?
Fifteen or 16 dollars an hour.
You would go out of business, you would go bankrupt?
If I did that continually, yes.
Northway's tax, insurance and office expenses don't leave much wiggle room. Despite the low pay, however, Bea Kurek says home care is her passion.
It's a relationship. You have to take care of these people, get to know them. They're part of your family, they're part of your heart.
But she plans to return to college, so she can get a higher-paying job, hopefully as a nurse.
I don't really have a choice at this point. If I want to be able to make enough money to support my child, I'm going to have to.
But as more and more of us grow older and want to stay in our homes, Clare Luz warns, we're going to have to find a way to retain home care workers.
It's the direct care work force that's in the house day in, day out, doing the kinds of tasks that we all need to do in order to stay at home.
This is going to impact every single person. The aging of the population, the critical shortage of elder care workers is going to affect every one of us.
So, what can be done? We will explore possible answers in part two of our look at the simmering home care crisis.
For the "PBS NewsHour," this is economics correspondent Paul Solman, reporting from Michigan.
Watch the Full Episode
Paul Solman has been a business, economics and occasional art correspondent for the PBS NewsHour since 1985.
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