Home-Care Aides at Poverty’s Edge Are Hottest U.S. Jobs

Nov. 21 (Bloomberg) -– Malrissa Perkins, a home-care worker in Boston, talks about her routine and the physical and emotional hardships that come with America's fastest-growing job. The 21-year old spends each weekday morning waking, washing and feeding Alan Smith. Parkinson's disease and a brain injury have left the 81-year old unable to care for himself. (Source: Bloomberg)

The yellow squash has an ugly rotten spot. “Mommy’s little secret,” Amanda Sheppard says as she surveys mounds of produce at the local food pantry. She’ll take the handout, knife away the rot and her family will never know.

Sheppard’s survival tricks are finely tuned after seven years as a personal care aide, the fastest growing job in America. Selecting a box of Cheerios, she spies a six-pound can of tomatoes; she’ll divvy it into glass jars and it’ll last weeks. Between what she’s picked up today, free school lunches for her 8-year-old and suppers at the Congregational Church off the common in Middlebury, Vermont, her family won’t go hungry.

Supermarket shopping can be a luxury because of what she does for a living, making $9.78 an hour, with no benefits or guaranteed hours. She’s one of more than 900,000 personal care aides, caregivers who provide comfort and companionship for the elderly and disabled and perform daily chores so they can remain in their homes. It’s a signature occupation of a post-recession economy creating mostly low-wage jobs.

The number of PCAs, as they’re called, will increase 70 percent between 2010 and 2020, making it the fastest-growing job in the country, according to the U.S. Department of Labor. The trade is exploding as the country ages and Medicaid focuses on keeping people out of nursing homes and other facilities. That saves money, and requires an army of caregivers like Sheppard who are helping fill the growing ranks of the working poor.

Photographer: Scott Eells/Bloomberg

Home-care aide Malrissa Perkins with Alan B. Smith, 81, in Lincoln, Massachusetts, on June 13, 2013. Close

Home-care aide Malrissa Perkins with Alan B. Smith, 81, in Lincoln, Massachusetts, on June 13, 2013.

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Photographer: Scott Eells/Bloomberg

Home-care aide Malrissa Perkins with Alan B. Smith, 81, in Lincoln, Massachusetts, on June 13, 2013.

Declining Income

Five-feet-four with blond hair, Sheppard, 31, is a combination groomer, cook, housekeeper, guardian and friend. Her schedule is typical for a PCA: spotty and unpredictable. She has one full-fledged client, and two who can’t pay her at the moment. She tends to them anyway. It’s a generosity Kent State University sociologist Clare Stacey found was common among the home-care workers she studied for her 2011 book, “The Caring Self.” They spend extra hours with their charges knowing they won’t be reimbursed because, as Sheppard says, “What am I supposed to do, just leave them?”

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As an independent contractor, not on the payroll of a home-care company, Sheppard isn’t in the Bureau of Labor Statistics tally. While the government counted 985,230 PCAs in 2012 -- a 44 percent increase from 2010 -- there were an additional 800,000 like Sheppard who weren’t included in the category, “and that’s a very conservative estimate,” says Abby Marquand, an associate director at the New York-based Paraprofessional Healthcare Institute, an advocacy group for direct-care workers, 90 percent of whom are women.

Photographer: Mike Kepka/San Francisco Chronicle/Corbis

A home health care worker with her 87-year-old disabled client in San Francisco. Close

A home health care worker with her 87-year-old disabled client in San Francisco.

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Photographer: Mike Kepka/San Francisco Chronicle/Corbis

A home health care worker with her 87-year-old disabled client in San Francisco.

Working Families

The average hourly pay for the PCAs the government tracked in 2012 was $10.01, according to the BLS. Adjusted for inflation, their wages fell 5 percent over a decade. Sheppard has earned the same state-set rate since she started in 2006, and inflation means her real wage has dropped 14 percent. Vermont will give some PCAs a raise this month to $11 an hour.

That’s in the lower-wage category of most of the jobs produced in the labor market recovery after the 2007-2009 recession, according to a study by the National Employment Law Project in New York, which receives funding from foundations and unions. The study found 58 percent of those created between 2010 and 2012 paid $13.83 an hour or less.

Two years after the recession was over, 32 percent of working families didn’t earn enough to cover basic necessities, up from 28 percent in 2007, according to a report by the nonprofit Working Poor Families Project that analyzed 2011 U.S. Census data. In the home-care sector, workers make so little that 50 percent depend on some form of government assistance, according to Dorie Seavey, PHI’s policy research director.

Poverty Threshold

Sheppard’s four-member family receives help with utility bills and gasoline from Addison County social services agencies and qualifies for the U.S. Department of Agriculture’s Women, Infants and Children program, which sends a shipment of milk and cheese twice a month because of four-month-old Gabriel.

Last year, before her partner, Greg Sands, found a full-time job, they managed on the $14,790 she made and qualified for food stamps. Now Sands, 29, earns $12.30 an hour at the Goodwill Industries store in Williston, 42 miles away. This year, the family could cross the federal poverty guideline of $23,550 that’s used to determine eligibility for assistance. Sheppard won’t be turned away by the food bank; its doors are open to households whose gross income is less than 185 percent of the U.S. poverty level.

Still, the budget is tight for Sheppard and Sands. There’s $199 in a fund for winter tires that will cost $500, and they owe the electric company $500. The 8-year-old, Kaleb, Sheppard’s son from a previous relationship, is allowed to pick one sport, which this fall was soccer. “He’s a fish, he loves to swim,” his mother says, but they can’t swing the $30 monthly pool fee.

‘Sweet Pea’

The day starts when Sheppard packs Gabriel into the back seat of her 218,000-mile Subaru at their rental off a dirt road in Bridport, bordering the college town of Middlebury, beneath the dark silhouettes of the Green Mountains. They can’t afford day care, so where she goes the baby goes.

She can cover 200 miles on a busy day. Twice a week she drives to Weybridge, to Judy Trudeau’s house. Trudeau, 54, has emphysema and chronic bronchitis, and answers the door in her black wheelchair. She reaches out. “My sweet pea!”

Sheppard supplements the round-the-clock care provided by Trudeau’s daughter, Eva. She does light housekeeping, washes Trudeau’s hair and holds her hand. For a year, Sheppard says she came several times a week even though Trudeau’s Medicaid benefits covered only about two of those months. Starting two weeks ago, she says, Medicaid began paying for PCA care for at least six hours weekly. “It’s only going to get worse for me, not better,” Trudeau says, and she wants Sheppard to be there.

Frequent Topic

Sheppard’s often not compensated for the work she does, usually because funding for her mostly low-income clients has fallen through. More than half of direct-care workers in Vermont are paid by Medicaid, the joint state and federal insurance program for the poor and disabled. The rest are paid out-of-pocket by clients or by Medicare or long-term care insurance.

So there’s no telling what she’ll earn month to month, and the uncertainty creates tension at home. Sands says that while he fell in love with Sheppard because of her compassion, there are times “I can’t handle it.”

“I’m full-time 40 hours a week,” he says. “I know what’s going to happen with my paycheck and we never know what’s going to happen with hers.” It’s a frequent topic. “He doesn’t understand why I just don’t get a job like his,” she says.

‘Nobody’s Happy’

She concedes regular hours and steadier pay would provide her family with more financially. But she says she learned when she was younger -- as a farm laborer, a car salesperson, a clerk at an ice-cream stand and the manager of a sporting goods store -- that she wasn’t cut out for a conventional job.

“I’ve done the 9 to 5 and I’ve come home miserable,” she says. “If the momma ain’t happy, nobody’s happy.”

Sheppard traces her desire to help others to when she was 19 and a former boyfriend committed suicide. She says she’s haunted still by the regret she didn’t do more for him. “That’s why I find it hard to walk away from people.”

Her longest-running client is Avery Ecklein, 19, who’s deaf and doesn’t speak. He also has Asperger’s syndrome, a form of autism. The two met when he was 7, and she was giving horseback-riding lessons to people with emotional and physical disabilities. She still teaches once in a while -- she calls the six college credits she earned related to horses her “secret pride” -- and says her dream is to open a riding school that boards the disabled youngsters she instructs.

Sudoku Puzzles

In 2006, she became Ecklein’s personal care aide. His mother, Ingrid, manages the time and money, submitting invoices to the state, which mails out checks. If she’s late with the paperwork, which she acknowledges she sometimes is, Sheppard’s pay is late too.

A PCA’s job is to assist the elderly or disabled with “daily living activities,” according to the Vermont Labor Department website. Sheppard says she thinks her most important duty is helping him overcome what she calls his “social barriers.” He’s shy, and can be impulsive. At times, he’s locked himself in her car, refusing to open the door. She carries an extra shirt in case his gets wet, because he’s furious if he spills a drink on himself.

They work on Sudoku puzzles, read books or watch his favorite movies, including “Avatar.” She takes him swimming and to the park, inviting her cousins and friends for games of soccer or volleyball. If he crosses his arms and walks away in the middle of action, Sheppard steps in. “I say, guys, pass him the ball.’ I tell them to give him a thumbs-up or tell him he can do it.”

Expired Benefits

Ecklein uses sign language, sometimes in furious bursts. Sheppard finds it easier to communicate by passing notes back and forth. On a recent Friday, she drives 84 miles to pick him up at his boarding school for the deaf in Brattleboro. In the car, she writes, “You want to sit in front or with baby?” then hands over paper and pen. Ecklein circles “with baby.”

Gabriel begins to fuss. Ecklein puts his hand over the baby’s mouth. Sheppard pulls off the road and signs with Ecklein, explaining the danger. “He loves Gabriel but sometimes he doesn’t know what’s appropriate,” she says.

Sheppard spends 21 hours with him over this weekend, and in the middle of it Ecklein’s mother reveals her son’s Medicaid benefits have expired -- she neglected to complete paperwork for the annual renewal.

Now the forms are being processed, and the women are drawing up a schedule. Those 21 hours go unpaid, though Ingrid gives her cash for meals and gasoline. “I can’t be angry,” Sheppard says. “I have to remember to have patience. That’s a huge part of being a care provider right there: patience.”

Extra Money

One of her non-paying charges is Annette Adams, a 55-year-old Sheppard met through friends and grew close to. When Adams was recently in the midst of a seizure, it was Sheppard she called for help. Sheppard dialed 911 and raced to Adams’s house in nearby New Haven. She was taken by ambulance to the hospital, and Sheppard followed and stayed with her until 12:30 a.m.

At the hospital, she took a video of Adams convulsing, which she says she’ll use to help her with the process of nailing down Medicaid funding for a PCA.

This summer, Sheppard made extra money as a speaker and organizer for the American Federation of State, County and Municipal Employees, which is forming a union for independent home-care providers in Vermont. Her peers elected her to the 20-member bargaining committee, and she’d like to be its president. “Since I’d be pushing for a livable wage for members, I wouldn’t take anything less than $15 an hour,” she says.

Clothing Vouchers

She’d be happy to shop more at Wal-Mart and never at the food bank, which is run by a county agency called HOPE, Helping Overcome Poverty’s Effects. She goes twice a month, the maximum allowed. On a recent visit, the receptionist hands her a clothing voucher to use at HOPE’s thrift shop next door: $25 for each son and $30 for her.

Pulling onesies and print pajamas from the racks for Gabriel, she points to the shelf where she found worn soccer shin guards for Kaleb. He was embarrassed they didn’t have heel straps until his coach said socks would hold them up just fine.

Then she takes a moment for herself, heading to the women’s department for dress slacks, coming up empty. “I won’t spend it all today,” she says of the $80 voucher. “We need so much.”

To contact the reporter on this story: Tom Moroney in Boston at tmorrone@bloomberg.net

To contact the editor responsible for this story: Gary Putka at gputka@bloomberg.net

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