For those without advanced technical skills thinking of a career change, there's only one problem: Though demand for home care aides—who do everything from cooking and cleaning for home-bound patients to bathing and dressing them—is soaring, wages remain dismal. The average wage for home health aides nationwide, according to a recent study by the National Employment Law Project, is only $10 an hour, less than what's needed to clear the poverty line for a family of four with full-time work—and many home care workers are limited to part-time hours. Furthermore, according to NELP policy co-director Annette Bernhardt, that's not counting a huge "grey market" of home aides working off the books after their state-funded hours have run out, who can earn as little as $2 an hour.
"When you look at occupations, I think home care workers and child care workers are really rock bottom," says Bernhardt. Home care, she notes, is the only occupation that annually appears on both the lists of total jobs added and the percentage rate of increase. "This is such an incredibly critical sector—and it's got some of the worst jobs in the economy."
In many ways, home care aides are the poster children for New York's new working poor. One in seven low-wage workers in New York City is currently a home care worker, according to Carol Rodat, New York policy director for the Bronx-based direct-care advocacy group PHI National. It's also one of the most frequent referrals for welfare-to-work programs: According to the city Human Resources Administration, 12 percent of its job placements are as home health aides, narrowly trailing "sales" for the number one spot.
Yet despite the ubiquity of home care jobs in a still-weak employment market, some job developers try to avoid placing their clients there, because of the often-dismal working conditions and wages. The median wage for home health care in New York state overall is $10.66 an hour, slightly above the national average. According to Rodat, however, most workers in the city—where the living wage law enacted in 2002 applies only to personal care workers, not health aides—earn $8.50 an hour or less, and many must resort to food stamps and other benefits to make ends meet. And assigned hours may fluctuate wildly from month to month, with the result that even a living-wage job can sink to poverty level in an eyeblink.
The reasons why are buried deep in the bureaucratic tangle of Medicaid reimbursement rates and home health licensees and subcontractors that are particular to New York state. Following the nursing-home scandals of the 1980s, New York state ramped up its licensing and funding of home care agencies as an alternative way of providing care for the elderly. "For years, running a licensed agency was viewed as a small business opportunity in this state, and the Department of Health used to help people open these agencies," says Rodat.
