V. Making Home Care Work: Why Higher Compensation is Needed

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.