The fastest-growing occupation in the U.S. is also among the lowest paid.
The aging of America's baby boomers has led to a surge in demand for home care workers to look after the nation's elderly, as well as the disabled and chronically ill. The work is as essential as it is poorly paid. Home health aides do everything from checking a client's vital signs and administering medications to looking after people's dietary needs and even operating life-sustaining equipment, such as ventilators.
"We're talking about the people caring for the most important relationships you have," said Ai-Jen Poo, director of the National Domestic Workers Alliance and author of 'The Age of Dignity: Preparing for the Elder Boom in a Changing America.' "When you have a situation where the people we count on to take care of our families can't take care of their own, there is something fundamentally wrong."
Despite the growing need for home health services, in 2012 (the latest year for which data is available) the median annual wage for the country's nearly 2 million so-called direct care workers was about $10 an hour, or less than $21,000 per year, according to the U.S. Department of Labor. The money can be even worse, industry data show, since many people in the field are paid a part-timer's hours despite putting in a full work week.
Among the factors combining to keep a lid on pay, experts say: a large pool of low-skilled workers, most of whom are minority women; weak union representation; and federal laws that exclude home health personnel from the wage protections common in other professions.
"Perhaps the largest reason for aides' low wages is because care work, which makes up the majority of home health care aides' duties, has been traditionally undervalued in our society," said Robert Hiltonsmith, a policy analyst with Demos, a left-leaning think tank, in a 2014 report.
The poverty line is $24,250 per year for a family of four and $11,770 for an individual, according to the U.S. Census Bureau.
Another oddity, given the growing demand for home health workers: Over a 10-year period, their hourly pay has seemingly defied the laws of supply and demand and fallen roughly 50 cents, according to the Paraprofessional Healthcare Institute, which represents direct-care employees.
The low pay leaves many home health workers struggling to make ends meet, with only fast-food workers earning less. And like those employed in the restaurant and retail sectors, where financial insecurity is the norm, home care workers often face unpredictable schedules that can wreak havoc with family life or other priorities.
"I feel my job is a real job and it should be treated like a real job. Treat me with the respect it deserves," said Roxanne Trigg, a home care provider in Milwaukee. "It's hard to the point where sometimes I have to make a decision which bill I can pay this month, or something gets cut off or cut out."
For home health firms, meanwhile, the measly wages result in turnover ranging from 50 percent to 70 percent annually, according to PHI. It also makes recruiting and retaining workers difficult, affecting quality of care.
Demand for home care is only expected to escalate, and sharply, as boomers get older -- about 10,000 Americans turn 65 each day. This is increasing the national appetite for home care, a less costly and often preferable alternative to nursing homes and hospitals. As Americans age, the federal Bureau of Labor Statistics projects a 48 percent hike in employment of home health aides from 2012 to 2022, far faster than the average for all jobs.
"Home care is expected to add more jobs than any other occupation or industry in the next 10 years," said Abby Marquand, director of policy research at PHI. "It's really booming. Even when our economy was in decline, the demand didn't go away. It's a recession-proof industry."
Proponents of the rapidly expanding home health industry argue that boosting wages would raise their labor costs, resulting in price hikes to the elderly and disabled, often financially disadvantaged themselves.
"We understand the conversation about compensation, and obviously there are two sides to the story, but we want to make sure folks know that raising the costs will put [home care services] out of the financial reach" of many users, said Robert Cresanti, executive vice president of government relations at the International Franchise Association.