Home Care for people with disabilities : How direct care wages negatively affect quality of care

From the PHI Chart Gallery

PHI (Paraprofessional Healthcare Institute) issued a report in February 2015 showing how the home care workforce is negatively affected by poverty-level wages, thereby degrading the quality of care for millions of elders and people with disabilities.

This is an especially timely topic with the federal government and federally-funded advocacy groups for people with developmental disabilities aggressively pressuring states to close institutions and other types of congregate care and services, often against the wishes of the people receiving this care and their families. The new rule for Home and Community Based Services (HCBS) from CMS, the federal agency that regulates Medicaid and Medicare, as it is currently written, will inevitably lead to people with DD moving to less regulated settings, cared for by workers who are paid less with fewer benefits or other incentives to remain in their jobs.

The PHI Website explains the effect of low wages on care quality as reported in “Paying the Price - How Poverty Wages Undermine Home Care in America”: 

Poor wages and nonexistent benefits are tied to high turnover rates within the home care workforce, Paying the Price reports. Roughly one out of every two home care workers leaves her job every year.

High turnover correlates with poorer care outcomes for elders and people with disabilities, who come to rely on home care workers to ensure their quality of life.

"When people can't find the care they need for the family members they love, it is a genuine family crisis," the report says. "The outsized growth in our population of elders is going to make this problem far worse in the decades to come."

The report notes that demand for home care jobs is expected to grow by approximately 50 percent between the years 2012 and 2022, a rate five times higher than overall job growth during that span.

The wages of people working in the three main categories of direct care (personal care aides, home health aides, and nursing assistants) have fallen from 2003 to 2013 overall with only a small number of states showing an increase in wages.

This is from a PBS Newshour Special, 3/16/15: