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Cracks In The Elderly Home Care System

elderly, care, health, nurse, home care

“The Massachusetts home care system is beginning to crack,” says a new report from the Home Care Aide Council of Massachusetts, “and will crumble if nothing is done to address the major threats.”

By Al Norman

“The Massachusetts home care system is beginning to crack,” says a new report from the Home Care Aide Council of Massachusetts, “and will crumble if nothing is done to address the major threats.”

The growth in the state’s population ages 65 and over is projected to increase 46 percent by 2035. The workforce needed to serve this burgeoning population at home will not be available unless fundamental changes take place now.

One of the major threats in the elder care system today is the “diminishing number of frontline caregivers” who will go into the homes of seniors to help them eat, bathe, toilet, dress, and walk.

According to a new study released by the Council, 96 percent of these aides are women, 48 percent are immigrants, 50 percent have only a high school diploma or less, 40 percent have household income under $20,000, and 48 percent are on MassHealth. The home care system can be described as low-income older women being taken care of by low-income younger women. Today’s home care aide is tomorrow’s home care client.

This circle of poverty is based on one fact: the average wage of home care aides is $12.77 an hour. The home care aides today make less than nursing home workers, and less than personal care attendants who are hired directly by elderly and disabled MassHealth members.

The home care system is built upon the exploitation of the workers. Agencies looking to hire workers are plagued by such problems as low recruitment of new workers, high turnover rates, and a workforce that is challenged by inconsistent hours and low wages. “It is getting ever more difficult for home care agencies to patch together a system to meet the care needs of Massachusetts’ most vulnerable citizens,” the new report says.

“The  most significant impediment is stagnant rates paid to the home care agencies that provide direct care services to low-income elders and disabled individuals in the state and federally funded programs,” the Council found. There are many recommendations in the report, but the core of the problem is giving workers “enough pay to stay.” Over the years, the Home Care Aide Council has successfully lobbied for one-time worker salary reserves — but the Number One recommendation from this latest study is to “work with the Massachusetts’ Legislature to increase wages and improve the benefits offered to home care aides employed by home care agencies.”

Last spring, the Home Care Aide Council asked the Massachusetts legislature to appropriate $11 million for home care aides and home health aides. Their request was ignored by the governor and the State Legislature in the 2018 budget. Homemaker rates have not been adjusted since 2015, and Home Health Aide rates have not seen an increase since 2007.

The 2019 budget debate begins in the State House early this month. The governor’s budget, which has already been released, once again ignored these home care aide workers. It is very likely that the House and Senate leadership will also turn their backs on these workers.  It is time therefore for the people of this state to increase the take home pay of these workers. No one in the State House has stepped forward to “care for caregivers,” so now the people of the Commonwealth must get the job done.

This November, voters in Massachusetts will have the chance to raise the minimum wage in Massachusetts to $15 per hour using the ballot. The voters can make it clear that they don’t want to continue exploiting both the elderly workforce, and the elderly client. Home care aides should be making at least $15 per hour. They should also not have to rely on MassHealth for their health care.

State lawmakers might be tempted to criticize companies like Wal-Mart — which is one of the larger employers in the state — for not paying their workers enough. But these home care aides are dependent on state-funding for their wages, so there is no one to blame but state lawmakers and the governor for the terrible wages that leave these caregivers trapped in poverty.

If the governor and the General Court are unwilling to act, the voters of Massachusetts will show that they care about caregivers in November. Its time to crack open the state logjam on home care wages.

Al Norman spent 32 years as a lobbyist in the state funded home care system. He can be reached at 413-834-4284, or at:

One Response to “Cracks In The Elderly Home Care System”

  1. Kat says:

    I completely agree with this assessment. However a system for tracking responsibility and accountability needs to be part of ongoing wage increases, especially as an incentive.
    A client.


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