What's at Stake
The issue of appropriate and adequate compensation of HHAs directly relates to the availability of necessary workers and quality of care delivered to people receiving home health care services. There is a critical and growing need for home health aides and a current and even greater projected shortage of these workers in the near future. Wages and benefits obviously play a vital role in the ability to recruit and retain conscientious workers to provide quality care.
Direct care workers, including home health aides, are the paraprofessionals who provide the bulk of paid long-term care. They work in diverse settings, including private homes, adult day centers, assisted living residences and nursing homes. The more than a million direct care workers in the United States provide services that may include assisting with personal care, providing oversight for people with cognitive or mental impairments, observing and reporting changes in a client's condition, administering medications and monitoring vital signs, preparing meals and housekeeping, as well as providing comfort and companionship.
Most home health aides are women supporting children, who perform difficult work for low pay. Many handle high caseloads, are provided with minimal training and have few opportunities for advancement. It is not surprising, then, that turnover among personal and home care aides is extremely high — averaging between 40 and 50 percent on an annual basis. High turnover and workforce instability affects clients directly in the quality of care they receive and in outright disruptions of service delivery.
The aging of the U.S. population as well as federal and state interest in providing alternatives to institutionalization means that the need for direct care workers is expected to increase markedly in the coming years. In 2000, 13 million Americans received some form of long term care, the bulk of which was provided by direct care workers. This number is expected to skyrocket. The New York State Department of Labor estimates that in the New York area alone an increase of nearly 33 percent of direct care workers will be needed by 2012. Almost every state in the country has already reported a critical shortage of direct care workers, resulting in a "care gap" that leaves many older and disabled people with inadequate or no source of care.
Quality and affordable home care is an important issue for older people and people with disabilities because most choose to receive home services as an alternative to institutionalization. Should agencies not have to pay overtime or comply with state minimum wage standards, it will result in fewer workers available to provide these needed services, increased turnover and poorer quality services. The Pennsylvania Supreme Court's ruling is an important marker as states engage in this debate.
What's at Stake