Raise Pay for Home-Care Aides? Disability-Rights Groups Say No Way

The disabled and elderly may have to pay more or get less care

Republicans crowed in early October when the Department of Labor said it planned to hold off enforcing a new regulation requiring home-care workers who look after elderly and disabled people to be paid minimum wage, overtime, and travel time. “The fact that the department plans to ignore its own rule after it goes into effect should be proof enough that it should be scrapped altogether,” Senator Lamar Alexander of Tennessee said in a statement after the department announced the delay.

Alexander’s comment was echoed by a group usually less inclined to criticize the Obama administration: disability-rights advocates. Critics of the new rule include Ari Ne’eman, a White House appointee to the National Council on Disability, who argues that raising wages for home-care workers without increasing the amount of government money available to pay for them will cut the number of hours disabled and elderly people spend with aides. “In the absence of an increase in Medicaid funding to cover those costs, we are going to see people with disabilities have our services reduced in quantity and quality,” says Ne’eman, who is president of the Autistic Self Advocacy Network.

Several groups, including the Center for Disability Rights and the grass-roots organization Adapt, joined Senate Republicans in urging the Labor Department to suspend the new pay rule. “We support the right of workers to be paid fair wages,” says Bruce Darling, an organizer with Adapt, which held a protest outside the home of Labor Secretary Tom Perez. “To pay those wages, people with disabilities are going to lose their freedom.”

Home-care workers help with daily activities like bathing, moving around the house, and eating meals, and with tasks like paying bills. They can also assist with medication, change surgical bags, and help with rehabilitation exercises. The industry is the fastest-growing in the U.S. The Bureau of Labor Statistics projects the number of home-health and personal-care aides will grow to 3 million by 2020. Right now the average home-care worker makes about $17,000 a year. Higher wages mean higher costs for the government, because much of the industry is funded by Medicaid and other public programs.

In January, California’s Democratic Governor Jerry Brown proposed limiting the 385,000 workers employed through California’s In-Home Supportive Services program to 40 hours a week to prevent the state from having to pay overtime. Disability rights groups, domestic worker activists, and unions successfully lobbied to defeat the proposed cap. Aides will be allowed to work up to 66 hours a week. Complying with the new rules could cost California as much as $172 million in the first six months of next year, according to the state legislative analyst’s office.

One way to minimize overtime costs would be to hire extra workers. But weakening the relationships between aides and the people they take care of, says Darling, comes at a price. “The question comes down to basically: How many strangers do you want coming into your home, seeing you naked, wiping your ass?” Darling says.

Groups like the American Association of People With Disabilities say the pay increases are crucial for attracting reliable workers. In Kansas, Medicaid offers just $25 a night to workers who provide “sleep cycle support,” which can involve turning clients and emptying catheter bags overnight. “If we don’t solve this now, we’re going to really be facing a crisis,” says Abby Marquand, director of policy research for the Paraprofessional Healthcare Institute.

Yet cutting care to raise pay is “just as unfair as workers being paid less than the minimum wage,” says Seth Harris, who served as acting Labor secretary in 2013. “The better choice is for legislatures to provide the amount of money that is required to provide all the care that people with disabilities and seniors need.”


    The bottom line: Labor advocates argue higher wages are needed to attract better workers to home care for disabled people.

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