As Pa. faces home-care worker ‘crisis,’ lawmakers set the stage for a small wage increase

Lolita Owens has been a home-care worker, on and off, for 15 years in Philadelphia.

She feeds, bathes, changes, and cooks for people she calls “consumers.”

Her current consumer has multiple sclerosis, a disease that attacks the central nervous system and leaves people unable to care for themselves, as well as type 2 diabetes.

“I do everything,” Owens says.

For this work, she’s paid about $12 an hour. And like many home-care workers, she lives paycheck to paycheck. An estimated 46 percent of this workforce depends on some sort of public assistance like food stamps.

“A lot of us are just surviving,” she said.

Home-care workers like Owens — also referred to as direct-care workers — scored a small victory in the budget passed by the General Assembly and signed by Gov. Tom Wolf in June.

Lawmakers approved a 2 percent bump in Medicaid reimbursements to home-care agencies, effective in January 2020. Currently, these agencies receive $17.52 to $19.52 per hour of care provided, based on location (the state is divided into four regions).

But that doesn’t mean home-care workers are making almost $20 an hour. In fact, most are making a lot less.

The median hourly wage for these workers is $11.17, an April report from the state-sanctioned Long-Term Care Council found. The vast majority — nearly 90 percent — are women.

Vicki Hoak, chief executive officer of the Pennsylvania Homecare Association, said agencies have to use reimbursement dollars for payroll taxes, background checks, tuberculosis tests, and more. The industry group estimates that agencies on average lose between $1 and $4 each hour.

That’s one of the reasons the association asked the Legislature for a 10 percent increase to the reimbursement rate.

“We fully recognize fiscal restraint, the need to balance the budget,” Hoak said. “But we also want to stress the value of these folks. They could go to McDonald’s or retail and probably make more money. I think people stay in this field despite the low wage because it’s so nice to be able to help someone.”

Hoak said the small bump will “allow agencies to provide better wages.” That’s not a requirement, but the budget bill passed in June states that the intent of the increase is to raise wages.

“I’m optimistic this is only the first step,” Hoak added.

That optimism comes at an increasingly dire time for the profession.

Pennsylvania is facing a “paid caregiving crisis due to a shortage of direct care workers and high turnover,” the council’s report found — and the situation is projected to get worse. It’s estimated that the state will need more than 37,000 additional direct-care workers by 2026 to handle Pennsylvania’s rapidly graying population.

The Long-Term Care Council made several recommendations this spring, including raising the base wage for these workers to $15 an hour by 2025. That’s a main priority for United Home Care Workers of Pennsylvania, an organization backed by two unions that represents 20,000 caregivers including Owens.

That home-care workers have a quasi-union at all is the matter of some controversy.

Wolf created the group through a 2015 executive order that was unsuccessfully challenged in court by the Pennsylvania Homecare Association and the Fairness Center, a Harrisburg-based law firm that “provides free legal services to those hurt by public-sector union officials.”

The Pennsylvania Homecare Association claimed the order violated the privacy of both workers and consumers. The Fairness Center, meanwhile, noted donations from the Service Employees International Union, one of the unions backing the home-care workers, to Wolf’s campaigns.

United Home Care Workers of Pennsylvania cannot collectively bargain on behalf of home-care workers — that’s something banned under state law — but it can serve as an intermediary between them and the state Department of Human Services.

In June, some home-care workers from the group rallied in the Capitol rotunda with Human Services Secretary Teresa Miller for a $15 minimum wage  — something Wolf called for in his February budget ask.

His administration proposed appropriating $45 million to get direct-care workers to $12 an hour — the first step on the path to $15 — according to a Human Services department spokesperson. Instead, the state will spend $12 million this fiscal year to account for the 2 percent bump.

Hoak noted that keeping seniors and people with disabilities in their homes, as opposed to in an institutional setting, is more cost effective for Medicaid. It’s also what they deserve and prefer, she said.

“You don’t get that a lot government,” she said. “In this case, it’s a win-win. They can stay home if they want and government is paying less for them.”

But to do that, the industry needs to attract and retain workers.

“You can look at it this way: These workers who are making this low wage are saving the state quite a bit of money,” Hoak said, both by preventing admissions into nursing homes and hospitals.

Owens, who first became a home-care worker because of her grandparents, said she stays in the profession because she has a passion for it.

“I love helping people who can’t help themselves,” she said.

While the Legislature declined to raise wages for Pennsylvania’s workers, Owens said United Home Care Workers of Pennsylvania will continue to push for an increase.

“We’re definitely still on the path to getting $15,” she said. “We’re not going to stop.”