The COVID-19 pandemic has made many Americans rethink how we care for our loved ones as they age or live with a disability. As the pandemic devastated nursing homes and other in-patient care settings, many began wondering, is this our best option?

For millions of Americans who live with a disability or need extra help, the answer has long been “no.” Decades of advocacy have helped to keep people in the community and out of institutional care settings. This shift is improving care and reducing costs for consumers.

The home care workforce has made these gains possible. Home care workers help older adults and people living with disabilities to remain in their homes and in their communities. This is difficult, skilled labor involving intimate support from birth through end of life care.

Yet, home care workers suffer some of the greatest job instability, driven by low wages, a lack of benefits, and fluctuating work hours that make pay unpredictable. These hardships fall disproportionately on women, people of color, and immigrants who comprise the vast majority of the home care workforce. From an equity perspective, it is imperative that these workers get the compensation they deserve.

Demand for home care is high and growing: the Bureau of Labor Statistics estimates that home care will have the highest number of openings in the next decade. The United States is projected to have over 80 million people aged 65 and older by 2040, and an estimated 70 percent of people who reach age 65 will need long-term care. However, need is already outpacing available services: today, over 600,000 people are waitlisted for home care because states don’t have enough in their budgets to meet demand.

The American Rescue Plan Act (ARPA) of 2021 signaled a commitment to make a meaningful investment in home care. This report provides a state-by-state analysis of how much ARPA funding went to each state and how states are using this funding. We also provide excerpts from qualitative interviews with home care workers, a client, and a state administrator. These interviews illustrate how federal funding impacts home care workers and underscore the urgent need for additional investments.

Based on the early experiences across states, we recommend the following policy design changes to help investments reach workers faster and address consumer needs: States should consider (1) adopting higher base wages rather than passing funding to home care agencies through higher reimbursement rates; (2) Making wage increases permanent; and (3) adopting family care programs to ensure family caregivers (who care for people in their own household) are eligible for home care wages.

“[Home care] is the gold standard for America. Where the level of love is higher, people live longer.” — Joan Steede, home care worker, Phoenix, Arizona

Home care workers provide more than just care; they help families and clients everyday.

Joan Steede, a home care worker in Arizona, explained, “It's a combination of health care, housework, cleaning, [and] walking a dog.” Joan supports people at all stages of life: “Probably in a week I go to three different homes, four hours, 12 hours, eight, it varies. I [meet] three, four different families and I may never see them again or the following week, I'll see them again. So I'm a floater. I do whatever they send me to.”

Joan recently helped to provide end of life care for a retired attorney suffering from dementia. The home care Joan provided was “invaluable,” according to the client’s son, Robert Shipman. “For his type of condition. It was the best option.”

“Being able to find somebody like Joan to help enabled him to stay home, which I thought was really important.” Robert said that his father’s condition made more clinical environments difficult. When his father went into the hospital followed by an assisted care rehab facility, it took a toll. “In a setting where he knew nobody, he seemed kind of scared by it a little bit.” As someone with dementia, being back home in a familiar environment enhanced his quality of life. In addition, Joan kept his father engaged. “She interact[ed] with him quite a bit. I think that helped quite a bit.”

Getting care at home also honored his father’s preferences. “Psychologically, he seemed more comfortable with it. He wanted to do it that way and Joan was able to enable that.”

Home care workers also provide greater independence and autonomy to individuals living with disabilities. According to José Hernandez, who shared his experience of living as a C5 quanriplegic during the pandemic in a recent interview hosted by the American Association of People with Disabilities, “If our workers were paid better, we would have a bigger pool and you can hold your aides to a higher standard.” Research proves his point: In California, an increase in wages led to a large decrease in turnover, an increase in hours worked, and an increase in the overall number of workers.

LISTEN to Audio Story: José and Gabrielle. “In this conversation, José Hernandez and Gabrielle Broder, both of whom are classified as C5 quadriplegic, talk about their experiences living with a disability during the pandemic.” An audio story produced by Alexa Burke; Illustration by Micah Bazant.

Denzel Norwich is a 75-year-old grandfather in West Virginia, who became a home care worker after retiring when he heard from a friend that a quadriplegic neighbor needed help. As he observed, people need home care at all life stages: “that can start at the age of zero, clear going to the age of 110. There's all types of [home] health care needed.”

“All of us might need to have someone take care of us someday.” — Kate Jones,¹ home care worker, Parkersburg, West Virginia

The demand for home care will only grow as America ages and lives longer. Most people need home care at some point in their lives and 77 percent of people age 50 and older say they want to age in place. The COVID-19 pandemic also showed how institutional care settings can be dangerous and isolating, as well as more expensive than home care, underscoring the need for alternatives.

Yet, for people experiencing many of life’s biggest transitions, “you're on your own. And I'm seeing a growing older America,” said Joan Steede, a home care worker in Arizona.

With over three decades in home care, Steede would know. She became a home care worker as a single mom while studying to become a paralegal in 1990. She initially worked with the American Cancer Society to provide hospice care and has worked in the field on and off for 35 years since. Now, her two adult children are also caregivers. “Thirty years ago, my clients were in their 70s. Yesterday, I cared for a lady, 97 [years old], who is not going anywhere. We haven't figured out how to provide care for the older adults.”

The undersupply of home care workers, and insufficient health care coverage of home care services prevent many patients from getting the help they need. “I could probably work 54 to 60 hours a week right now. That's how bad the need is, but I can’t do it,” said Joan Steede. Across the country, shortages of workers are impacting how much care is able to be offered. In some communities, half of all providers say they can’t find enough . In addition, inability to pay is another barrier. For “the majority of Americans, their health care covers a couple of hours a day,” according to Steede.

“I love my job. Because I love helping people. I always have. I’ve always been a servant of people. My heart is there. I love taking care of people.” — Gloria Alborzian-Hugh, home care worker, Buckeye, Arizona

Today, choosing to become a home care worker typically means earning low wages with unpredictable hours and no benefits. These impacts fall disproportionately on women and people of color, who make up the vast majority of the home care workforce. State median wages for home care workers range from $9.05 to $16.66 per hour, with a national median of $13.02 (and a yearly median income of less than 30,000 a year). This is significantly less than the national median wage, and few of these workers receive benefits. Many home care workers have wages so low that they are entitled to public benefits, with one-in-six home care workers living in poverty.

Those interviewed explained their choice to work in home care as a calling rather than a smart economic choice. “You get up and you go out, and you know that no matter what happens, you're going to make somebody's life better today is what you're gonna do, no matter what it is,” explained Norwich, a home care worker, Kenova, West Virginia. However, the work is difficult and emotionally taxing. Norwich continued, “But then there are nights I'd come home, and I just say, you know, thank you. Thank you to my supreme power. I survived this day, I didn't think I would survive, you know? I don't know why it just seemed like I always get the … people who are having trouble.”

“Right now, my agency pays me between $15 and $20 an hour and I was making almost $13 [an hour] 30 years ago. That's how far behind the industry is,” said Joan Steede of Phoeniz, Arizona, about the flatline wage growth for home care in West Virginia.

Each home care worker described their passion for helping people as why they became workers and why they choose to stay. “It's not easy. I do what I do because I love what I do. I love to make my clients happy. It is something that I love. I have a passion for it,” said Jacinth Finch, a 62-year-old Certified Nursing Assistant in Miami, Florida, who works 86 hours per week for clients assigned by five different home care agencies. “At some point in my life. I'm going to need care. And because of that, I try to give the best care that I can give, because that is the care I want to have. And when I'm looking after these people I don't see them. I see me lying in that bed, and somebody else taking care of me.”

“We just need a lot more people coming into the field, but unless the wages improve and we get some benefits, it’s not going to draw anybody in.” — Kate Jones, home care worker, Parkersburg, West Virginia

Universally, workers described low wages and the lack of benefits as a hurdle to entry and retention. In fact, the low wages paid to home care workers are increasingly an outlier among service jobs.

“Not enough people are becoming home care workers and there's a reason,” explained Joan Steede from Arizona. “If I'm on my way to make [a low wage] in a very highly charged emotional situation. Is going to be hard. A girl told me she started [at] $20 bucks at Starbucks. So she leaves health care,” she said. “Why does someone who serves you Starbucks make more than the woman who cares for your husband?”

Low compensation is also a barrier to retention. “What saddens me right now is the fact that I drove up the Wendy's and they've got a sign up [that says they] pay $15 starting off, and I'm not even making $15,” said Gloria Alborzian-Hugh, a home care worker in Buckeye, Arizona.

Jacinth Finch, a home care worker in Miami, Florida, has seen the same trend. “Target is paying $20 an hour. Even Burger King. All the restaurants now are paying a lot more than what a lot of us get in health care. And they don't have to lose their sleep at night. They go home to their family at night.”

Low wages for home care workers have created a crisis akin to the “Titanic,” said Steede. “In 20 years, you will need me, but I'll be 85 and I won't be available for you. So ask yourself who is going to care for you in 20, 40, 60 years?”

In recognition of these challenges, Congress has increased funding for home care programs. The Families First Coronavirus Response Act in March of 2020, as well as the Coronavirus Aid, Relief, and Economic Security (CARES) Act in 2021 provided additional dollars that states could use for the HCBS program. Some states used federal CARES Act resources to increase wages for home care workers, at least temporarily.

In early 2021, Congress passed the American Rescue Plan Act (ARPA), providing a 10-percentage point FMAP increase, worth an estimated $12 billion, for HCBS programs. States can use this increased federal funding to “enhance, expand, or strengthen” HCBS programs. States could choose to expand eligibility, offer broader eligibility, make long term investment in HCBS infrastructure, strengthen the direct service workforce, or address the social determinants of health. States were required to submit detailed proposals to the Centers for Medicare and Medicaid Services (CMS) and for approval before they can access ARPA funds. While some states have been approved, many are still moving through the approval process. States must spend this funding by 2024.

The American Rescue Plan’s investments in home care are beginning to show results. Forty-six states and DC are using ARPA dollars to improve home care worker compensation through wage passthroughs, hazard pay, bonuses, temporary and permanent increases, training, and benefits. Thirty-four states are making special payments such as bonuses; 18 states are providing temporary wage increases; 12 states are making wage increases permanent; and five states are increasing benefits (see table 1). Though some data in the table is “unspecified,” as it was not mentioned in the state plans, this provides an overview of how and when the money was distributed.

The most common way that states are increasing home care worker compensation using ARPA funding is through special payments, such as a one-time spot bonus. For example, Iowa provided a one-time $2,500 bonus per employee. Louisiana increased pay by $100 per month per worker. Three states provided transportation benefits and one provided childcare benefits.

In addition, 11 states are using ARPA funds to increase home care worker wages permanently. For example, Illinois increased the Direct Service Professional rate by $1.50 per hour. Colorado now guarantees a home care wage of $15 per hour. These could be administered in a variety of ways, whether through a wage passthrough, as North Carolina is hoping to do (use a certain percentage of the increased funds must be spent directly on wages) or, as mentioned above in Illinois and Colorado, by specifying a new wage that workers are guaranteed.

Other states are using a combination of incentives. For example, Nevada provided $500 retention bonuses and a 15 percent temporary wage increase for personal care and adult day health care services.

Several states made investments specifically tied to recruitment, retention, or quality-improvement initiatives. For example, Maine provided a $1,500 recruitment incentive and a $2,000 retention bonus for Direct Service Professionals (DSPs). In addition, Utah increased pay by 5 percent for high performers on quality incentives. Minnesota increased wages for Personal Care Assistants (PCA) by 9.7 percent and reinstated a kin-care program that reimburses people who provide home care services to a member of their own household.

More workers will see increases to compensation as the Centers for Medicare and Medicaid Services (CMS approves state spending plans.

Additionally, as the map above demonstrates, investing in the home care workforce enjoys robust bipartisan support. The diversity of states showing leadership on this issue lays a strong foundation for future investments, with communities across the country eager for resources to provide excellent care for older adults and the disabled residents.

Early results suggest that future legislative design tweaks could speed implementation of future home care investments. Specifically, federal legislation can help higher wages reach home care workers faster by encouraging states to set higher base rates, ensuring that funding reaches workers quickly and effectively. States could be required to examine rates and determine if they are sufficient to sustain this workforce, as currently, it is unclear if wage increases will be sufficient. Additionally, making pay increases permanent (as opposed to relying on temporary increases) would help bolster this workforce for the long-run, as opposed to temporary measures that will run out.

For home care workers who received a recent bump in compensation, help could not have come soon enough.

Kate Jones in Parkersburg, West Virginia, received an incentive bonus just before Christmas in 2021:

“They told us if we didn't call up for the whole month of November each week, you got a hundred dollars extra that week and then [the] same way for each week. And then if [you] didn't call off all four weeks, you got …another hundred [dollars]. So you got the potential to make $500 bucks. That was very helpful. Right before Christmas. Definitely.”

Jones began working in home care three years ago after her divorce. She makes $10.25 per hour with no benefits as a contractor with a private home care agency. Jones herself has a disability, which sometimes makes working difficult. However she enjoys being a home care worker. “It is just amazing to feel needed.”

With the extra money, Jones says, “I was able to pay some extra on a bill and I was able to buy some Christmas gifts with it. And then I saved some [because] I knew I was going to need two new tires in January.” She ended up needing four new tires and a new battery. “So that was all $580, but I had some of that money from the bonus where I saved it, because you know, you never know what's going to happen. It definitely helped.”

Denzel Norwich in Kenova, West Virginia, also got higher wages through the American Rescue Plan. “This money was given to the company and they were permitted to distribute this money any way they wanted to. They were permitted to take the money and give it to the employees in one lump sum,” Norwich said. “[If] you don’t miss any days, you come to work on time, and so on and so forth, then you do get the extra $3 on the hour. Which is really nice, but how long is that going to last?”

In Minnesota, Andrea Hanek, cares for her three children with disabilities through Minnesota’s Personal Care Attendant Choice Program, a new family caregiver program which allows people providing home care in their own household to receive reimbursement for their work. Hanek’s children, ages 9, 10, and 17, need assistance with activities of daily living.

Before this program, Hanek said she and her family were living “so poor.” “I didn't even know how little money I had. I mean, I didn't even know … I was getting no essentials before. I was having to do food shelf [at] every opportunity. Like I was counting down the days to do food shelf.” The family care program passed, it was just before Christmas 2020 and provided funding through February 2021. American Rescue Plan funds enabled it to be reinstated in August 2021.

“When this got passed [and] we were able, because of the pandemic [funding], to have this. . . I have to say it was like one of the best Christmas presents I've ever gotten,” said Hanek. “It happened shortly before Christmas. It really has been a life changer. I mean, it really has changed so many things in my life.”

Sumer Spika also benefits from Minnesota's new family caregiving program. In addition to working as a home care worker and a union organizer advocating for home care workers, Spika provides home care for her husband, who has multiple sclerosis (MS). Like Andrea, she also began receiving reimbursement for her work through Minnesota’s Personal Care Attendant Choice Program, including the extension funded through ARPA.

“Before we got this ARP money, I was not able to get paid for caring for [my husband],” Spika said. Before the program, she said the prevailing view was that you were on your own if you were caring for a family member. “Unless they're on a specific program, the government says 'well, it’s your moral obligation to take care of these folks, even if you can't work a full-time job, so why should we pay you?'” said Spika. Under the new program, “it's been pretty amazing to be able to get paid for some of the work that I'm doing even though it's in my own home.”

In July 2022, home care wages in Minnesota will increase from $14.40 to $15.25 under a new union contract. Talking about what the increase will mean, Spika said, “I am very privileged” because “I'm in a position where I'm working multiple jobs. So for me it just means like a little more. Maybe I can put a little more money into my life insurance plan, or maybe I can set a little money aside to maybe take my kids on a vacation this summer.” She said that “for most people doing this work, it [means] much, much more.”

The upcoming wage increase will begin just in time for Hanek and her family. “School supplies … that one hits me hard every year. It comes out of nowhere,” she said. “You have to have a nice pair of shoes for gym shoes and to start the school year and you have to have boots and rain boots. Hopefully that will help.”

Recommendations for Future Interventions

• States can enhance family economic stability and access to care by ensuring that workers who provide home care to people in their own household are eligible for reimbursement.

The home care workers interviewed described how difficult it is to get by on home care wages and articulated key investments that would make staying in the field more likely.

Low wages relative to entry-level jobs in food service, a lack of benefits, and unpredictable hours pose challenges to home care workforce recruitment and retention. These problems fall disproportionately on women of color, perpetuating economic insecurity.

Low Wages and Long Hours

“I just feel like they need to step up and recognize what we're sacrific[ing] to make sure other people are okay. And they are not making sure that we are ok.” — Amina Nash, home care worker, Toledo, Ohio

Low wages drive caregivers to work unsustainable hours to make ends meet.

Jacinth Finch, age 62, is originally from St. Kitts and has lived in Miami since 2019. She typically gets $11 per hour and says $14 per hour is the highest wage she’s heard of in the area. She works for five private home care agencies trying to get by and averages a total of 86 hours per week.

“I work like this morning, where I came off one job that I worked from last night from 7 [pm] to 7 [am]. went to give a lady a bath with another company. And then went to do another job from 9 to 12 at another company. And now I came home to get a little rest. And I go back to work again tonight at 7 pm to repeat the cycle all over again tomorrow. It's not easy. We are overworked and underpaid.”

Asked how she managed to sustain working so many hours, Finch said, “It’s just God.”

In addition, home care workers frequently stay later or come in earlier to get the job done but are not paid for their work. “You are only paid for what you’re scheduled for – if you go in or stay late, you're not paid,” said Kate Jones from Parkersburg, West Virginia.

Several home care workers reported cobbling together 80- and 90-hour work weeks to make enough money to survive. Home care agencies appear to be averting overtime pay requirements by capping workers hours at less than 40 hours per week. As a result, workers are patching together intense schedules from multiple agencies.

Yet, many workers still barely scrape by.

Jones from West Virginia said her supplemental income from disability and alimony allow her to cover the basic living expenses that her home care wages do not. “I am blessed to still have alimony right now, and I am blessed to have disability.” Even so, she is doing what she can to help increase compensation. “I am not actually fighting this fight for myself … I'm in this fight for that single mom that I used to be,” she explained. “I'm really doing this more for my coworkers who this is their only source of income.”

Like Jones, Norwich in West Virginia is able to make home care work because of supplemental income. He earns a base of $9 an hour plus incentive bonuses for being available for key shifts, and for coming to work on time. His social security payments help to cover what his wages do not.

Workers without additional sources of income reported having to work around-the-clock. “Being paid $10 an hour is not right,” said Amina Nash, a 42-year-old home care worker in Toledo, Ohio. “I work 96 hours a week. I have to, because I have to make ends meet with the nine kids.” In addition to her own five children, she has legal custody of four children from her cousin. Her children range from age 6 to 23. A home care worker since 2005, Nash also recently graduated from nursing school in the hopes of advancing her career as a caregiver more sustainably.

“Better wages takes that fear. I don't ever want to be in a position where my son needs me and I can't help him. You know, but if you don't have to have security and you don't have good wages and you don't have benefits, you are holding your breath for an unexpected expense.” – Kate Jones, Parkersburg, West Virginia

Gloria Alborzian-Hugh in Buckeye, Arizona, has three big jobs during the week: providing care for her adult sister with disabilities who lives with her; working for two home care agencies; and spending her weekends assisting Special Olympics athletes. “I've always been an essential worker. Biggest part of my life. And I enjoy helping people, I enjoy working with people. But like I said, it's not because of the pay because the pay doesn't pay me what I'm worth.”

Alborzian-Hugh has spent three decades in the essential services industry, with 14 years as a caregiver. She currently makes $12.50 to $13 per hour depending on the type of home care she provides. “The challenge is the struggle to keep me afloat and not having to worry about paycheck to paycheck,” she said. “We’re very underpaid, very much underpaid. And we also need benefits.”

Alborzian-Hugh and her sister are now facing a $100 per month rent increase, a hardship she described as a “blessing” because it was not higher. Increasing housing prices are putting pressure on home care workers elsewhere too.

“The housing market is skyrocketing,” said Kate Jones from West Virginia. “The price of everything [is] going up except for wages.”

No Benefits

The vast majority of home care workers get no employer-based benefits. This means no paid leave, no health care, no retirement, and no childcare.

“I don't ever want to be a burden to my kids,” said Kate Jones from Parkersburg, West Virginia. Yet, “I don't have any retirement.” Similarly, Jacinth Finch of Miami, said one of the three private home care companies she contracts with provides a 401(k), but only after workers put in 1000 hours.

The home care workers interviewed most frequently obtained health coverage through the individual marketplace, a feat that was nearly impossible before the Affordable Care Act banned discrimination against people with pre-existing conditions, and provided subsidies to lower monthly premiums. “I pay for my own health insurance, so they're not paying my health insurance. I have to pay out of pocket for my health insurance. And I go through the Affordable Care Act,” said Gloria Alborzian-Hugh, Buckeye, Arizona).

No Paid Leave

“I tell myself, when I’m getting older, if home care’s not giving me benefits, I want a job that gives me benefits. I want stability. And I made it happen. You get sick time, you can get the day off and all of that.” — Antonette Quintyne, a home care worker who now works in food service, Miami, Florida

The physical nature and difficulty of home care work means being out sick is inevitable, with home care workers bearing the entire cost.

“I just fell in January. I broke my wrist, fractured my wrist up into the elbow and the shoulder. I fell on the ice. I was off with the wrist for five weeks. And then I went to see my daughter. So there was six weeks without pay,” said Kate Jones from Parkersburg, West Virginia.

Jacinth Finch in Miami needs knee surgery but cannot get it. She has health insurance, which she pays for herself through the individual marketplace. Despite working 86 hours per week for five home care agencies, she cannot afford the operation because she does not have paid leave:

“I am supposed to have surgery on my knee. Which insurance said that they will pay for if I do get surgery. But I can't afford to get surgery because if I get surgery, I have to stay at home. My doctor told me at least 3 to 6 months. They are only paying for the operation. Who is going to pay my bills? Who is going to pay for my car? Who is going to do these things? So I'm taking a big chance. My doctor gets angry with me, she said, ‘you should be doing this because you're not doing any good,’ said ‘you're doing more harm,’ but actually I cannot. I cannot do surgery. I'll be on the street, and then I won’t even have a car because my car will be taken from me also.”

Finch explained that “unless you work in a facility, you do not get vacation with pay. When you work with an agency like I work with agencies, you only get paid when you work. You could work 10 years and if you take off a week, you are taking that week without pay.”

Lack of benefits is also draining the home care workforce.

After her longtime client passed away, Antonette Quintyne in Miami, Florida, worked for a number of other clients until her older mother got sick and it was too much. “Somebody told me about the food service, and I went for the interview and I got the job. But my heart is still with health care. Because I love to take care of the older adults.”

Even so, after so many years with no paid time off Quinteyne marveled at the change in stability. “Now I get my day off — [I work] towards my day off. I tell the girl there. I said, ‘Oh my God, I don't know what day off is like!’ Now, I can say ‘I'm going on my day.’ It’s so funny,” Quintyne said.

Fluctuating Hours and Difficulty Accessing Public Benefits

“There's a lot of home care workers that — especially now with the wage increases, which are wonderful — but then their wages increase, and they're making a little bit too much money and so they get kicked off their medical assistance and there is no health care insurance. So then they have no health insurance and then they're stuck figuring that out and a mess.” — Sumer Spika, home care worker and union organizer, Minnesota

For most workers in industries with extremely low wages, public benefits allow them to bridge the gap. Public benefits, such as the supplemental nutrition assistance program (SNAP) and Medicaid, can provide stability and cushion the impact of low wages. However, fluctuating and unpredictable hours makes proving eligibility difficult for home care workers.

The nature of home care work means that workers often have hours that vary from week to week. In addition, for those providing end of life care, new clients are not always available immediately. For others, being able to lose a patient one day, and start with a new patient the very next day is unrealistic. Those who do say it takes a toll.

“The knowledge I have [from] 30 years of caring for [people in] hospice makes it so that I can lose someone on Monday and go start with the new person on Tuesday. But it tugs at my heart. A month with somebody, five days a week … you fall in love with them, their dog, their children, and then you move to a new place,” said Joan Steede, Phoenix, Arizona.

The pandemic has exacerbated the unpredictability of hours and pay, making accessing public benefits even harder.

“[Before the pandemic] I had six clients so now I don’t,” said Gloria Alborzian-Hugh, Buckeye, Arizona. “That's a big chunk of my income gone … [T]he hard part is not being able to do what I need to do, and then hav[ing] to worry about paying a bill or bills late or my health going down.”

Jacinth Finch in Miami, Florida, did get on food stamps for the first time during the pandemic but ran into trouble when she tried to reapply. Her benefits lapsed and her application for renewal is still pending. “I tried to get food stamps, but they made it so hard. I do not get anything from the government. Nothing… [I] tried to reapply; filled out forms, gone to office, tried calling and calling and calling. Faxed materials to them. Nothing has worked.”

Others forgo public benefits altogether and work back-to-back hours to meet their basic needs. Before switching to food service, Antonette Quintyne in Miami recounted how she made it work on her home care wages without benefits: “I worked long hours to get through …I would go to work [at] nine o'clock in the night and come off [at] 10 o'clock in the morning and rush to another job from 10 to four, or 10 to five, and then go home for my kids.”

In addition, marginal wage increases can disquality workers for public benefits, without providing enough of an increase to offset the loss. Alborzian-Hugh in Arizona tried to access food stamps but was told she was not eligible because she “made maybe $15 too much. I never was one who wanted to be on the system because if I can do it myself, and I work hard, what happens is you fluctuate. Your pay scales fluctuate a lot … If you make $1 over, it's like what's the point of going through all that?”

However, those who successfully enrolled in food stamps reported significant benefits for their wellbeing.

“If it was not for food stamps, I probably would not be healthy. It is food stamps that allows me to buy good quality food. I honestly could never afford it on my salary to buy my own groceries. So food stamps is keeping me afloat,” said Joan Steede, Phoenix, ArizonaZ. “So I think food stamps is a lifesaver, but we also need a program in this country that literally government pays for your medications.”

Home care workers are clearly earning nowhere near a living wage, and programs that allow other workers to supplement insufficient earnings are not available to them. Given that the state Medicaid agency is setting the wages for these workers, this is unacceptable. Workers who are paid by the government to do an important job should not have to rely on working 90 hour weeks or the social safety net to make ends meet. And workers aren’t the only ones paying. One study found that ensuring a living wage to home care workers would lead to $1.6 trillion in savings in other social safety net programs, demonstrating that low wages have a huge cost.

“It’s a win-win-win. It's like it's a win for the employer, the employee and the client.” — Kate Jones, Parkersburg, West Virginia

Home care workers believe investing in the home care workforce will be good for patients, workers, and the economy.

“People don't realize that it's a win-win-win because it's a win for the employer [ ] because people don't call off; the turnover is not as bad. And then [there’s] an influx of people coming to that field because they can see that they pay, they see you, they value you,”said Kate Jones, Parkersburg, W.Va.

Jones continued, “The people that work in my job, that make the wages that I make, when they get a raise, they spend that money to improve their lives, to, to help their children and, to pay for a ball glove or a ballet slippers and, and to take a vacation and they spend it. And so it boosts our economy. And more importantly, it would contribute to those lives of not just the workers, but the clients, the ones that we’re taking care of.”

Analysis by Moody’s demonstrates that Kate’s point is accurate: they found that every dollar invested in home care boosts the economy by more than a dollar. This means that these investments not only benefit workers but the economy overall, supporting economic growth. These investments also increase the labor force participation of the family members of those receiving care. One stud found that daughters are more likely to rejoin the workforce if their older adults’ parents have access to care, suggesting that a lack of access to care leads women to drop out of the labor market. Overall, investing in this workforce has powerful implications for the economy at large.

The confluence of an aging America together with increased demand for supportive home services is creating a perfect storm that can only be met with long-term significant investments. The American Rescue Plan helped to lay the groundwork for lasting improvements to home care worker compensation across the country. However, significant work remains. Transformative change is necessary to make wages and benefits match the value that home care workers provide for society.

Recommendations Recap

1. States should consider setting higher base wages to help investments reach workers faster and ensure workers see increased wages. Not only would this improve the stability of the workforce, but it would also improve the quality of care.
2. Congress should provide multi-year funding streams, rather than one-time investments, to reduce state legislative and federal administrative hurdles that slow implementation and would enable states to provide a higher wage to workers.
3. State Medicaid agencies should ensure that family caregivers in every state are eligible to be reimbursement for caring for people in their own household. This would enhance economic stability of families, and increase access to care.

“They need [to] look after the [home] health care sector. We need help and we need it now. Or else, soon there'll be no caregivers. People won't be able to go to work because then they won't have anybody to stay with family members.” — Jacinth Finch, Miami, Florida