DAVID ROSMAN: Home health care workers are not fairly compensated

Wednesday, September 3, 2014 | 6:00 a.m. CDT; updated 7:35 a.m. CDT, Wednesday, September 3, 2014

What is a fair working wage? More important, what is a fair minimum working wage?

The president and many of his supporters are suggesting $10.10 per hour. The problem with that number is twofold.

First, it does not guarantee a full-time job at that wage level and, second, it still equates to an approximately $21,600 annual salary without any health benefits, sick leave or vacation pay.

Yet we rely on low-wage earners to take care of our disabled and elderly in the patients' homes. In-home care workers are the women and men who provide a full range of daily living assistance, short of medical assistance, for many of Missouri’s elderly and disabled.

Many assume the duties of home and personal care so patients can better take care of themselves and "keeps thousands of Missourians out of nursing homes," according to the Missouri Home Care Union.

Today, the average home care worker is paid $8.60 per hour, or just over $17,000 if that person works full time or 2,080 hours annually. That means a large number of workers are currently being paid the minimum wage of $7.50 per hour, or $15,600 annually. The current poverty level for a family of four is $23,850.

The Missouri Home Care Union is asking for a minimum salary of $11 per hour, or $22,880 annually. Still under the poverty level for a family of four, but the additional $6,000 certainly would help. That is, if full-time work is available.

What the in-home caregiver does not do is administer medications or provide services that require a licensed practical nurse or registered nurse. These caregivers are rarely paid directly by the patient or the patient’s family. Medicaid is the primary source of remuneration.

A prominent labor leader once said that no industry in America is unionized without deserving it. It appears that in-home health care workers need their union and its collective bargaining power to help raise their wages.

Bargaining representatives for health care workers assert that, technically, additional costs would not come from taxpayers' pockets but from the $15.56 per hour the agencies already receive from Medicaid for each home health care worker.

Here is the rub: Additional costs for the health care agencies are not being considered, including the cost of workers' compensation insurance and the company’s share of the Federal Insurance Contributions Act taxes, not to mention other administrative fees.

That adds approximately 50 percent to the money paid for each worker, which would bring the current average salary, plus expenses, to $12.90. That leaves a profit margin of just under $3 per hour for the providing agency.

For agencies to pay higher wages and still make a reasonable profit, they would need at least $18 per hour from Medicaid.

In Missouri, in-home health care aides must attend classes, receive on-the-job training and pass a series of tests. They are professionals by definition and should be treated as such. They are an important part of the medical care team and need to be compensated accordingly.

They are providing home-care chores and personal-care assistance, respite care and adult day care. Although the vast majority of in-home care providers are competent and honor their profession, they are not paid fairly for the job they are doing.

The late Robert Townsend, president and CEO of Avis, strongly suggested in his book, "Up the Organization: How to Stop the Corporation from Stifling People and Strangling Profits," that higher wages meant better employees.

According to Townsend: Don't pay at the low end of the wage scale; pay at the high end.

If we want more than simply adequate care for our disabled and elderly, then caregivers need to be paid better and offered full-time work when possible. They need to have benefits suitable for professionals in the medical industry, and Medicaid needs to recognize this as a factor in reimbursement for services rendered.

As members of the boomer generation stretch into their 70s and 80s, more and more individuals will need in-home care services.

I would want my caregivers to be paid a living wage so they could concentrate on my care and not worry about how to feed their family or buy clothes for school.

David Rosman is an editor, writer, professional speaker and college instructor in communications, ethics, business and politics. You can read more of his commentaries at and and New York Journal of

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Ellis Smith September 3, 2014 | 10:33 a.m.

Fine, and the additional funding to make this proposal work will come from...[where]? Yet more unfunded national debt? Of course! The sky's the only limit, isn't it? Baby Boomer magic.

Finding and stating problems is easy (obviously, since we now have so many experts at doing that); finding workable, adequately funded, efficient and lasting solutions requires more investment than mere words.

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