JUDY WOODRUFF: Many of us will want to stay at home as we grow into old age.
But as the baby boom generation matures, the country is facing a shortage of home care
workers to make that possible.
Our economics correspondent, Paul Solman, has the first of two reports on this issue.
It's part of our series Making Sense, which airs Thursdays on the "NewsHour."
Monica Poremba works 75 to 95 hours a week as a home care worker, and that's not even
counting commuting time.
MONICA POREMBA, Home Care Provider: It's not very often that I get a client right in town
where I live.
So, there is a lot of driving involved.
PAUL SOLMAN: Unpaid driving time she spends getting to her clients in rural areas outside
summer vacation hot spot Traverse City, Michigan.
MONICA POREMBA: I'm going to make it some real breakfast, OK?
PAUL SOLMAN: Poremba never knows what she will find when she arrives to care for Tom,
who has advanced dementia, and needs her care desperately.
MONICA POREMBA: One day, a couple of weeks ago, he wanted me to come out to the garage
to look at something.
And he had taken brick red spray paint to the wheel of his leisure van, thinking it
was a cleaner of some sort.
So, now he has one wheel of his leisure van that is painted brick red, when he really
meant to just clean it.
Your pills are right here.
Don't forget to take those.
PAUL SOLMAN: After six to eight hours here with Tom, Poremba will head to another client.
MONICA POREMBA: Everybody is always calling you.
Can you pick up this shift, that shift?
It's hard to have a life when you work that many hours.
AMY NORTHWAY, Monarch Home Health Services: Every year, there is just an increased demand
for our services.
PAUL SOLMAN: Amy Northway is Poremba's Boss at Monarch Home Health Services.
AMY NORTHWAY: I literally get calls daily for clients that we have to turn away because
we just cannot staff them.
PAUL SOLMAN: Michigan, like the rest of the country, is facing a critical shortage of
home care workers to assist older adults and people with disabilities who live at home
with daily tasks like eating, cleaning, bathing.
Gerontologist Clare Luz.
CLARE LUZ, Michigan State University: In Michigan alone, we're going to need 32,000 more direct
care workers by 2020.
PAUL SOLMAN: Twenty-twenty is...
CLARE LUZ: A year-and-a-half.
PAUL SOLMAN: Yes.
CLARE LUZ: Right.
PAUL SOLMAN: With about 10,000 baby boomers retiring every single day, home care is one
of the fastest growing occupations in America.
With some 50 percent more workers needed by 2026, these are among the most-needed jobs
of the future.
Problem is, in the present, the median pay is just $10.49 an hour.
BEA KUREK, Home Care Provider: People like myself make between $8 and $11 an hour.
I think $11.50 is the high range.
PAUL SOLMAN: Last year, single mother Bea Kurek supplemented her home care income with
nursing home work.
Can you say how much you made in the last year, let's say?
BEA KUREK: I would have made somewhere around 19.
But, I mean, I...
PAUL SOLMAN: Nineteen thousand?
BEA KUREK: Yes.
I was really proud of myself for making that much.
PAUL SOLMAN: For making it to $19,000.
BEA KUREK: Yes.
PAUL SOLMAN: So, if you just do home care in a year, how much can you make?
BEA KUREK: I am not quite sure.
I haven't ever been brave enough to try that.
PAUL SOLMAN: Kurek and her daughter, Evelyn (ph), rely on help from family and public
health coverage.
BEA KUREK: She's got Michigan Child and I have got Medicaid.
If I didn't have the government medical, I really -- I would be in a bad spot, especially
because I have migraines and I have epilepsy.
And I would lose my medication.
And my medication costs $2,200 a month.
PAUL SOLMAN: Kurek recently quit the nursing home.
Now she will have to manage with home care as her sole income.
But you really can't make ends meet without family help doing that, right?
BEA KUREK: No, I can't, which is why I might also have to pick up a night job as waitress.
PAUL SOLMAN: A quarter of home care workers live in households below the poverty line.
And more than half rely on some form of public assistance.
Why the low pay?
Luz ticked off the usual explanations.
CLARE LUZ: We are an ageist society.
We don't place a lot of value on older adults or the people that take care of them.
It's invisible.
And it's historically women's work.
PAUL SOLMAN: Sure.
CLARE LUZ: And, as we know, a lot of women's work has never been compensated financially.
It's done in the home.
It's not paid.
PAUL SOLMAN: And even when it is paid, this job is often disrespected.
ALYSSA LAWRENCE, Home Care Coordinator: I have had clients call, "My girl's are not
here yet," meaning the home health aide or the personal care aide isn't there yet.
PAUL SOLMAN: Alyssa Lawrence has been in home care for 10 years.
ALYSSA LAWRENCE: My clients have called and said, "Hey, my cleaning lady isn't here yet."
It's not just a cleaning lady.
You know, you have somebody in their home that relies on somebody for showering, bathing
and toileting, and their family members won't even go in and do it.
PAUL SOLMAN: But in Traverse City, even the maids make more than the home care workers.
We passed a sign outside a hotel hiring housekeepers at $15 an hour.
No surprise it's so hard for Amy Northway to find workers.
AMY NORTHWAY: A lot of our employees or potential employees take those housekeeping positions
because they sometimes pay $25 an hour, and there's absolutely no way I can compete with
that.
For instance, McDonald's, they're hiring $11 an hour.
The employee can stay there for eight hours or whatever her scheduled shift is, and be
done, whereas, in home health care, we're asking this caregiver to show up at one client's,
work for a specified amount of time, get in her car, drive across town.
That's gas.
That's wear and tear on her car.
It's time that she's maybe not getting reimbursed for.
And that makes it very difficult for us.
PAUL SOLMAN: So, why don't you pay them more?
AMY NORTHWAY: I can't.
I wouldn't have a business if I paid them more than that.
PAUL SOLMAN: But with growing demand, not enough workers, basic economics says wages
simply have to go up.
The catch, home care is dominated by one payer.
Yes, some is paid for privately through long-term care insurance or personal savings.
But 70 percent is paid for by the government.
Medicare only pays for short-term home care.
So, Medicaid is the primary long-term home care payer, channeled through local area agencies
on aging.
AMY NORTHWAY: Our area agency clients reimburse us right around $17.50 an hour.
PAUL SOLMAN: Seventeen-fifty, so roughly...
AMY NORTHWAY: There's very little margin, yes, in those clients.
And our private pay clients, of course, do pay more for that, but they really do kind
of offset our other clients who aren't able to afford to pay that.
PAUL SOLMAN: With government doing the bulk of the paying, it effectively dictates how
much employers can pay their home care workers.
What's the point at which ,if you were paying caregivers that much, you would go out of
business?
AMY NORTHWAY: Fifteen or 16 dollars an hour.
PAUL SOLMAN: You would go out of business, you would go bankrupt?
AMY NORTHWAY: If I did that continually, yes.
PAUL SOLMAN: Northway's tax, insurance and office expenses don't leave much wiggle room.
Despite the low pay, however, Bea Kurek says home care is her passion.
BEA KUREK: It's a relationship.
You have to take care of these people, get to know them.
They're part of your family, they're part of your heart.
PAUL SOLMAN: But she plans to return to college, so she can get a higher-paying job, hopefully
as a nurse.
BEA KUREK: I don't really have a choice at this point.
If I want to be able to make enough money to support my child, I'm going to have to.
PAUL SOLMAN: But as more and more of us grow older and want to stay in our homes, Clare
Luz warns, we're going to have to find a way to retain home care workers.
CLARE LUZ: It's the direct care work force that's in the house day in, day out, doing
the kinds of tasks that we all need to do in order to stay at home.
This is going to impact every single person.
The aging of the population, the critical shortage of elder care workers is going to
affect every one of us.
PAUL SOLMAN: So, what can be done?
We will explore possible answers in part two of our look at the simmering home care crisis.
For the "PBS NewsHour," this is economics correspondent Paul Solman, reporting from
Michigan.