Raw Deal for Health Care Workers

Article and Video by Lynnette M. Booker

Dorothy Fraser-Laird, a home health aide, has a demanding job, gone from home four nights a week, taking care of patients across the metropolitan area. One night she could be in Harlem, another night in the Bronx, another in Westchester County.

Despite her hard work, Fraser-Laird, 55, finds it difficult to make ends meet. Making $10 an hour, she struggles to pay $850 a month in rent for her East Flatbush, Brooklyn, apartment. In addition to her other living expenses, she sends money back home to her family in Kingston, Jamaica.

“I have to do what I have to do to survive in this country,” Fraser-Laird said.

Fraser-Laird is one of two million home health aides in one of the fastest-growing occupations in the country. The industry has grown dramatically over the last several decades as more Americans choose to receive long-term care at home instead of in nursing homes. From 2004-14, total employment of home health aides-including the self-employed grew by 56 percent, according to the Department of Labor.

In order to better serve their growing clientele, home health care workers increasingly receive skills training to provide services similar to those provided by registered nurses. Yet despite the industry’s growth and their increased preparedness, home health aides remain among the lowest paid in the medical field.

“When a direct care provider possesses quality, knowledge, skills and value, they should earn higher wages,” said Joseph M. Macbeth, the executive director of the National Alliance for Direct Support Professionals, an organization that works to enhance the support provided to people with disabilities and in the aging sector.

Macbeth works with national organizations to influence policy changes that will improve the working conditions for home health care workers.

“If all of us live long enough, our common destiny will be the need for direct professionals in our lives. It’s a fact, we have to make sure we build professions on sound research, universal skills and professional skills as other professions do.”

An immigrant from Jamaica, Fraser-Laird enjoys being a home health aide. Her problem lies in the substandard wages. “I love my job, I love taking care of people, but the pay is not up to standard,” said Fraser-Laird.

Over the course of a day, Fraser-Laird commutes 45 minutes on public transportation to help the elderly and disabled with their most basic needs.

Ella Johnson, one of her clients, has first- stage dementia. Unable to care for herself, she requires around-the-clock care provided by her two home attendants. Fraser-Laird is Johnson’s overnight aide, from Friday to Tuesday, feeding, bathing, cooking and cleaning her house.

“Not a lot I am asking for but based on my pay and my performance, I should be to live more comfortably,” said Fraser-Laird.

Low-pay is a systemic problem in home health care. The average annual earnings are just over $17,000, and the median hourly wage is $9.38, according to the Paraprofessional Healthcare Institute’s February 2014 report. The report also says that more than one in three home health workers are without health insurance.

For the past 20 years, Fraser-Laird worked as a home attendant, predominantly for private cases due to her immigration status. In 1955, she came to America on a tourist visa that did not allow her to work. In June 2013, she received her permanent residency green card in June 2013.

Immigrant women in United States (documented and undocumented) account for more than half of all immigrants, and many of them work as home health aides. According to the Paraprofessional Healthcare Institute, 24 percent of home health aides are foreign-born.

For nearly 40 years, direct care workers have been exempt from federal minimum wage and overtime laws. The Obama administration tried to end that, publishing a new rule that narrowed the “companionship” exemption of the Fair Labor Standard Act. But in October 2014 and January 2015, a federal district judge blocked the rule, saying it would require action by Congress to make such a change.The Labor Department said it would appeal the ruling.

A large proportion of home care services is financed through government programs like Medicare and Medicaid, which together provide 73 percent of home care services in an industry with $61 billion in annual revenue.

Despite low wages, the home health care occupation is projected to grow 48 percent between 2012 and 2022, nearly five times as fast as for overall job growth. This growth is expected to result in more than a million new jobs in home care over the coming decade.