1. Improving Labor Standards for the Publicly Funded Direct Care Workforce

2. PHI ~ Quality Care through Quality Jobs PHI works to improve jobs for direct-care workers in order to improve quality of supports and services PHI works with all LTSS stakeholders – consumers, workers, employers/providers, organized labor, policymakers, researchers Workplace practices and policy solutions

4. DCW at a Glance (2011) Female ~ 89% Average age in home health care is 45 47% are white; 30% are African- American; 16% are Latino Foreign born ~ 21% Some college or a degree ~ 46% One in 12 low-wage workers is a DCW Source: US Census Current Population Survey analysis done by PHI

7. United States: Median Hourly Wages for Direct-Care Workers, 2012 Source: PHI analysis of BLS/OES

8. LTSS Financing

9. Medicaid Funds for LTSS State & Federal Tax Dollars (~$134 billion in 2012) States Managed Care Plans Employers (average rate $21/hour) Workers (average wage $9.50/hour)

10. Comparing Cost of Home Care Services and Caregiver Pay, 2008 Type of Service National Average Cost of Services (per hour) National Average Starting Pay for Caregivers (per hour) Companionship$18.75$8.92 Homemaker Services$18.90$9.10 Personal Care$19.82$9.69 Home Health Services$22.37$11.78 Source: National Private Duty Association (2009) State of Caregiving Industry Survey, Executive Summary. Available at: NPDA State of Caregiving Industry – via PHI, Caring in America

11. New York City: Medicaid Redesign Spurs Action on Worker Wages –Employment relationships: LHCSAs (indirect payments from state), home attendant agencies (payment by city) –NYC living wage law; unionization –Managed care companies/Integration

12. Home Care Aide Worker Parity Law Proposed by the Governor as an amendment to the state budget Downstate metropolitan counties – NYC, Nassau, Suffolk, & Westchester Increased in three increments to $10/hour on 3/1/14. Requires $4.09 additional in benefits.

13. Maryland Maryland Minimum Wage Act of 2014 (HB 295) Requires a 3.5% increase in reimbursement rates to agencies, and requires that it be spent on wages Public funding an opportunity & a challenge

14. Public Authorities for Home Care Workers Public agency that provides an organizing framework for independent home care workers (OR, CA) –Acts as the employer of record –Collective bargaining agreement –Provides training and a registry –Fragmented workforce without a worksite and high turnover hard to organize.

15. For more information, contact: Gail MacInnes, National Policy Analyst gmacinnes@phinational.org Visit PHI PolicyWorks at: www.phinational.org/policywww.phinational.org/policy