Home health aides work for low wages, but they're critical for elderly and disabled people. A proposal to inject billions of dollars in federal funding may be an opportunity for sweeping change.
LULU GARCIA-NAVARRO, HOST:
For years, advocates have been calling for changes in training, wages and supports for home health aides. They're the ones who assist elderly and disabled residents, allowing them to remain at home. But they're among the most invisible health care workers. The American Jobs Plan, the infrastructure bill currently being negotiated in Congress, calls for a $400 billion infusion of federal dollars into the nation's care economy. This could help transform the industry. Kavitha Cardoza reports.
KAVITHA CARDOZA, BYLINE: Most older Americans want to age at home. Many can do so only because of the more than 2 million home health aides who provide day-to-day support and fill in for overwhelmed or absent relatives. But there's a severe shortage of these workers that's expected to grow far worse. Kezia Scales with PHI, a nonprofit that advocates for home health aides, says that's because the jobs are exhausting with low wages, little respect and almost no career growth.
KEZIA SCALES: And so we end up having a fairly unstable workforce with high levels of turnover and job vacancies not because people don't want to do this work but because they can't afford to do this work.
CARDOZA: Scales points to a model that PHI helps fund that she says has been very successful. It's called Cooperative Home Care Associates in New York, where Tashawna Vivas is filling up a plastic basin of warm water.
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CARDOZA: She's one of a dozen students in this class training to be a home health aide. Yesterday, they watched a demonstration of a bed bath. Today, students fully clothed are practicing on each other.
TASHAWNA VIVAS: Nervous - I'm nervous. Just to do the whole procedure. I stayed up till 2 o'clock studying.
CARDOZA: Vivas works her way down the body with a yellow washcloth.
VIVAS: OK, washing the legs now.
CARDOZA: Instructor Andria Sharper watches carefully as Vivas cleans a body part, wipes it dry and covers it back up with the towel in between.
ANDRIA SHARPER: In between the toes is very important, right? Especially in diabetic clients.
CARDOZA: Bed bath is a basic skill for home health aides. They also learn how to safely turn someone to prevent bedsores, what a normal blood pressure reading is, and when changes in urine color might indicate a health problem. At the end of class, Vivas looks proud of herself.
VIVAS: I'm OK. My back is a little busted, but it'll be OK (laughter).
CARDOZA: This training program is considered one of the best in the country. It's also free, funded by private and government money. Student Juhaleya Abraeu says other programs were all insanely expensive, often run by for-profits charging $1,000 or $2,000.
JUHALEYA ABRAEU: The classes cost so much money, and I was like, OK, I can't afford that because not everybody has that kind of money.
CARDOZA: Like students in this program, the vast majority of home health aides are women, people of color and immigrants. Matt Sigelman, CEO of the job market analytics company Emsi Burning Glass, says the median wage for a home health aide is $24,000 a year.
MATT SIGELMAN: For perspective, that's only about $500 more per year than your average fast food cook. So the notion of taking out a loan, going into debt to get into a job that pays you the same as you would make in a fast food restaurant is pretty hard to swallow.
CARDOZA: He says it's unlikely students will be able to pay back those loans even after they start working, trapping them on a low-wage treadmill. Abraeu was delighted to learn she could get a job with this organization as soon as she graduated the one-month course.
ABRAEU: Literally the week after, you're already working. So that's also something that made me want to choose this company.
CARDOZA: She would also receive paid leave and health insurance, benefits that are virtually unheard of in this field. But home health aides even here make only minimum wage, primarily because of the reimbursement rates for Medicaid and Medicare. Paul Osterman - an MIT professor and author of the book "Who Will Care For Us?" - says home health aides are very restricted in what they can do for their elderly and disabled clients. By law, for example, they can only remind a client to take their medication. They can't actually give it to them. Osterman argues for better training and expanded duties for home health aides, which he believes will help the elderly manage chronic conditions and stay out of hospital.
PAUL OSTERMAN: That would also save money and, to some extent, taking over some of the work from much higher-paid nurses. So that would then create savings, which could then be used in part to pay for the higher wages.
CARDOZA: Every student in this class wants to move up in the health care field. And unlike their counterparts in private agencies, they have career counselors here who can guide them. And their union will pay for additional training. Student Tawshana Vivas hopes one day, she'll be a nursing assistant.
VIVAS: I enjoy helping people, taking care of people because I'm going to need somebody that needs to take care of me, too (laughter).
CARDOZA: For NPR News, I'm Kavitha Cardoza.
(SOUNDBITE OF MO ANDO'S "EASY NOW")
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