Improving Labor Standards for the Publicly Funded Direct Care Workforce

PHI ~ Quality Care through Quality Jobs

• PHI works to improve jobs for direct-care workers in order to improve quality of supports and services

• PHI works with all LTSS stakeholders – consumers, workers, employers/providers, organized labor, policymakers, researchers

• Workplace practices and policy solutions

DCW at a Glance (2011)

• Female ~ 89%• Average age in home health care is 45• 47% are white; 30% are African-

American; 16% are Latino • Foreign born ~ 21%• Some college or a degree ~ 46%• One in 12 low-wage workers is a DCW

Source: US Census Current Population Survey analysis done by PHI

United States: Median Hourly Wages for Direct-Care Workers, 2012

Source: PHI analysis of BLS/OES

LTSS Financing

Medicaid Funds for LTSS

State & Federal Tax Dollars (~$134 billion in 2012)

States

Managed Care Plans

Employers (average rate $21/hour)

Workers (average wage $9.50/hour)

Comparing Cost of Home Care Services and Caregiver Pay, 2008

Type of Service National Average Cost of

Services(per hour)

National Average Starting

Pay for Caregivers(per hour)

Companionship $18.75 $8.92

Homemaker Services $18.90 $9.10

Personal Care $19.82 $9.69

Home Health Services $22.37 $11.78

Source: National Private Duty Association (2009) State of Caregiving Industry Survey, Executive Summary. Available at: NPDA State of Caregiving Industry – via PHI, Caring in America

New York City: Medicaid Redesign Spurs Action on Worker Wages

– Employment relationships: LHCSAs (indirect payments from state), home attendant agencies (payment by city)

– NYC living wage law; unionization

– Managed care companies/Integration

Home Care Aide Worker Parity Law

• Proposed by the Governor as an amendment to the state budget

• Downstate metropolitan counties – NYC, Nassau, Suffolk, & Westchester

• Increased in three increments to $10/hour on 3/1/14. Requires $4.09 additional in benefits.

Maryland

• Maryland Minimum Wage Act of 2014 (HB 295)

• Requires a 3.5% increase in reimbursement rates to agencies, and requires that it be spent on wages

• Public funding an opportunity & a challenge

Public Authorities for Home Care Workers

• Public agency that provides an organizing framework for independent home care workers (OR, CA)– Acts as the employer of record– Collective bargaining agreement– Provides training and a registry– Fragmented workforce without a worksite

and high turnover hard to organize.

For more information, contact:

Gail MacInnes, National Policy Analystgmacinnes@phinational.org

Visit PHI PolicyWorks at: www.phinational.org/policy