— Yes, James Guyton is tethered to an oxygen line half as
long as his rowhouse in North Philadelphia’s Olney
neighborhood. And yes, he’s a little unsteady on his feet.
But nobody knows how to mop better than Guyton, 69, now
suffering from chronic obstructive pulmonary disease.
wants to outdo me in cleaning," said home health aide
Antwanette Hill, 28, laughing. Hill visits Guyton every day to
help him bathe and make sure he eats.
told you he was stubborn," she said affectionately, as
the bucket toppled, sending a puddle of cleaning solution onto
at first sight" is how Hill describes her relationship
with Guyton. It has to be love, because what the agency pays
her isn’t much — $10.50 an hour. She works 39 hours a
week, over seven days, for two clients, struggling to earn
enough to raise her two children, 10 and 4.
boomers, as they grow older and more infirm, will need more
people like Hill — home health aides, and personal care
aides — jobs that overlap, the latter often doing more
housekeeping. The U.S. Bureau of Labor Statistics says both
categories will be among the fastest growing in the next seven
years, adding just over a million jobs.
baby boomers are driving the demand for more health services,
but how that care is delivered is not just about demographics.
It’s also about who can do it more cheaply, said labor
economist Paul Harrington, director of Drexel University’s
Center for Labor Markets and Policy.
he said, the trend is moving from care provided in expensive
facilities such as hospitals and nursing homes to less-costly
places — outpatient clinics and rowhouses in cities and
also are shifting from expensive professionals, such as
doctors, to nurses and ultimately to caregivers such as Hill.
3.1 million people may be employed in these fields by 2022, so
it’s not surprising that their pay, prospects and working
conditions are stirring concern and controversy.
in part because of the complex way these workers are paid.
typically hire the workers, assign them to case, and pay them;
but the underlying funds often come from the government, with
Medicaid being a major payer. Other aides are employed
directly by the people they help if those clients do not
qualify for a government program.
recently, home health aides in most states were not entitled
U.S. Labor Department set out new rules allowing overtime as
of Jan. 1, industry groups, including the Home Care
Association of America, sued successfully to block their
21, a federal appeals court overturned the block. The
association said it plans to appeal to the U.S. Supreme Court,
but the appellate decision now clears the way for home health
workers in New Jersey to get paid for overtime. Pennsylvania
law had already required overtime pay.
be willing to provide the pay," said David Totaro, chief
government affairs officer for Bayada Home Health Care, and an
association board member. "However, reimbursements have
not kept up with increased costs."
Jersey, where Bayada is based, hourly compensation from
Medicaid rose on July 1 to $18 an hour, from $15.50, he said.
In Pennsylvania, it’s $19.19. Delaware pays $26.52. North
Carolina, at $13.88 an hour, hasn’t had an increase since
have 1 to 2 percent profit," Totaro said, "after all
the expenses: wages, taxes, training, overhead."
state has its issues, Totaro said.
Jersey, as of July 1, managed-care providers gained contracts
to oversee Medicaid reimbursements, and they take a slice of
the $18 an hour.
slice actually drives hourly reimbursements below what they
were before the July 1 increase, he said.
Pennsylvania, the issue is the specter of unionism. On Feb.
27, Gov. Tom Wolf issued an executive order setting up an
advisory council on home health care, which was not
controversial was his proposal for home care workers to elect
an organization to represent them before state officials and
create a "memorandum of understanding" about wages
sounds like collective bargaining," said Harrisburg
lawyer Jim Kutz, whose agency clients quickly gained an
injunction preventing Wolf from drawing up any
"memorandum of understanding." The case is pending.
home care workers have elected a representative, United Home
Care Workers of Pennsylvania, a partnership of the SEIU and
law bars unions for these workers when they work directly for
their clients in their homes. Agency workers can unionize.
Hill, employed by Liberty Resources Inc., is a union member.
industry side, with turnover running above 40 percent a year,
recruitment is always a challenge, as the work is hard and
wages are low.
economy, bad economy, it’s still hard to find people,"
said Kevin Campbell, a director at Bayada.
recent Monday, when Bayada’s Philadelphia home care
director, Megan Miller, got to work, she found 40 new
applicants awaiting review on Bayada’s online system.
25, lacking qualifications, were eliminated on the spot. Of
the 15 contacted, only seven returned calls. If two pass the
interviews and reference checks, that’s a good week, she
a really frustrating system on multiple levels," agreed
Martha Ross, an analyst who studies these workers for the
educational requirements for these jobs are very low,"
Ross said, "so that’s good, because there’s a low
barrier to entry. But in order to move up to positions with a
higher earning potential, you need a significant amount of
years ago, Antwanette Hill landed a scholarship to pursue a
two-year degree to become a registered nurse, which would have
more than doubled her annual income of $21,300, lifting her
out of near-poverty.
scholarship would have paid half her tuition. But she had to
turn it down because the balance was beyond what she could
afford, considering that her children get medical assistance
and she qualifies for food stamps.
still hoping to better myself," she said. "Only
quitters will say it’s impossible."