New Hampshire Analyzes the Needs of—and the Need for — Home Care Workers

From Home Care Workers: Keeping Granite Staters in Their Homes as They Age.

From Home Care Workers: Keeping Granite Staters in Their Homes as They Age.

As Terry Lynch pointed out in his most recent blog post, the popular – and federally mandated – trend of using Medicaid to pay for less nursing home care and more home care cannot continue unless states can attract and keep more home care workers. A pair of recent papers from New Hampshire looks at just what that means for the state of New Hampshire.

In Home Care Workers: Keeping Granite Staters in Their Homes as They Age, (PDF) Kristin Smith of the University of New Hampshire’s Carsey Institute profiles home care workers. The 12-page policy brief provides a demographic and economic overview of the state’s licensed nursing assistants, personal care service providers, personal care assistants (PCA), and homemakers and companions. It also discusses the implication of low pay and high turnover among direct care workers for those who rely on their services.

After outlining the dismal state of affairs, which includes median wages of less than $10 an hour, the brief concludes: “If New Hampshire is serious about its desire to reduce turnover among the home care workforce, meet the projected needs of the aging population, and provide the quality care necessary to help keep Granite Staters in their homes as they age, then the road map is clear and adeptly articulated by the home care workers themselves: increase wages, increase hours, increase access to health insurance and paid leave, and increase opportunities for advancement.”

Strategies to Invest in the Future of the Direct Care Workforce (PDF) builds on that foundation by recommending strategies that state agencies, employers, and other stakeholders can adopt to build and support a stable home care workforce. Its recommendations:

  •   The state should establish “a rational rate setting and reimbursement process” that allows home care agencies to pay their direct care workers “a livable wage.”
  •   Stakeholders should work with their elected representatives to create federal reimbursement for the training of home and community‐based workers, like the funding now provided to train nursing home CNAs.
  •   Home care agencies should implement a steady work week, create loan repayment programs, and improve the quality of staff supervision for their direct care workers.

The paper was published by the New Hampshire Coalition for the Direct Care Workforce.

Elise Nakhnikian
Communications Director
Direct Care Alliance

3 Responses to “New Hampshire Analyzes the Needs of—and the Need for — Home Care Workers”

  1. Lori Michael says:

    I read your study with great interest as New Hampshire’s issues regarding the direct care workforce are the same as those we have here in Pennsylvania. As for your suggestions for turning around the problems I have the following comments:

    I wholehartedly agree that wages need to be increased and would love to see help from the state/federal government as they are the primary payors for services. Everyone needs to keep in mind though that while the upper 1/3 of society can pay for services even if rates are increased, the bottom 1/3 gets services paid through government programs that should increase rates to reasonable amounts, but what about the 1/3 that are in the middle? They can’t afford much care with the rates as they are and could not afford service if they are increased! Private pay rates need to be lower than the waiver rates (not equal to or higher) or a lot of citizens will lose out on HCBS. Think prevailing wage laws.

    At my agency we provide paid training opportunities for all of our employees and it is like pulling teeth to get many of them to come in for them. I would love financial help in paying for training programs and for paying my employees to attend. (We don’t get paid for trianing time but we have to pay our employees) According to the Federal Dept of Labor, wage and hour division, if I allow my employee time off to attend a training–I am required to pay their time. If I allow an employee to take a CNA course, I am obligated to pay for their time in the class. How can I do that when they already receive 70% of our hourly rate for the time they provide hands on care to consumers? There isn’t much left over for anything else. As an aside, if I could pay my direct care staff $15 per hour, I could hire all Licensed practical nurses to do the job.

    I applaud Quality Care Partners on their program however we have not had that level of success. I have made interest free loans to many employees and have lost over $3000. In a very low profit business, I have found it to be bad business. Also back to the Federal Labor Law, you can’t take money out of an employees pay check if it drops them below minimum wage.

    All of the organizations and individuals claiming that direct care workers are underpaid and under respected need to stop pushing that line. What that is doing is pushing workers away from our field not fixing the problem at all. I can say with honesty that we pay our workers as much as we possibly can with the reimbursements we get from waivers and private pay consumers. We have the utmost respect for them and the work that they do. Their consumers also respect them and appreciate them. We need to stress the good aspects of direct care work if we truly want to address our shortage problem. Let supply and demand set the rates for waiver services not government. Meet my price if you want qualtiy care (so that I can reward the quality caregiver).

    Unionization isn’t the answer either. Owners are not trying to make a killing on the backs of the DCWs. Why take more money out of the already low wage earners pay check? There isn’t enough for health insurance and paid vacations when they are already getting 70% of the money in direct care wages. That leaves only 30% for all administrative expenses, record keeping/payroll/billing, scheduling, on call services, nursing supervision (care planning, consumer issue interventions, aide trainings), collections, personal protective equipment, training of new workers, in-services, marketing (to keep new consumers coming into the agency to keep DCWs working)…..and don’t forget business taxes!

  2. Bob Stevens says:

    Good job Lori. Making a buiness a losing proposition does no one any good, especially the employees. Thanks for the reality check.

    I might also add that implementing a steady work week will drive many quality direct care workers away, including me. Many are attracted by flexible work schedules. A good home care provider will also do their best to match home care workers to clients, which also requires flexibility. Nursing homes and assisted living facilities have steady work weeks…how’s it working?

  3. Lori Raymond says:

    Thank you for all the wonderful work you are doing I will share this information with others in my state of NH. Together we can bridge the needs of our workers and the people they provide quality supports to.

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