Why Are Home Health Care Worker Wages So Low?

Despite the demand for home care workers, wages are low: a median $11.52 an hour in 2018. (The average went up in 2020 because of temporary Covid-19 hazard pay increases.) More than half of home care workers qualify for public benefits. And the people who make up the work force for these jobs are often vulnerable and marginalized: Nine in 10 home care workers are women, and nearly two-thirds are people of color.

This profession of mostly women and women of color was left out of the Wagner Act in 1935 and the Fair Labor Standards Act in 1938 — exclusions that many scholars believe were designed to reinforce white supremacy and patriarchy. As a result, home care workers were denied the federal right to organize and collectively bargain, and the right to a minimum wage and overtime pay.

But in recent decades, home care workers have won important victories. In 2001, home care workers in Washington won the right to collectively bargain. One necessary tool for enabling independent providers to come together is designating an employer of record. Without one, each worker is simply an independent contractor, unable to force the state to negotiate.

Washington State created a Home Care Quality Authority to serve as the employer of record, and in 2003, the workers represented by the S.E.I.U. negotiated their first contract with the state. Since then, they have successfully renegotiated their contracts several times with the state.

According to Peter Nazzal, the director of long-term care at Catholic Community Services of Western Washington, these changes have helped stabilize the care work force, where turnover is high. It’s also improved care for people by keeping them at home and lowered costs for the state. “It’s a fraction of the cost of nursing homes,” he said in a podcast interview last year. “Taxpayers like it.”

Other states, including Illinois, Minnesota and California, have formed some kind of home care authority to help families find care and ensure that independent workers have an employer of record. In states where workers can bargain for their wages with home care authorities, nearly all earn above $15 an hour or will in their current contracts.

In Arkansas, however, home care workers do not have the right to collectively bargain. They must accept the wages the state decides on, and they do not have a voice in those negotiations. Danielle made $9 an hour when she moved to Arkansas in 2018. In January, when a voter-driven effort to raise the minimum wage kicked in, she began making $11 an hour