The plight of American Health Care aides

-“Doctor…Now I get why all aides get fed up with my Mom—she’s impossible.”

Dianne X. is a successful corporate lawyer with a beautiful family that, due to the Social Distancing and sanitary measures of the pandemic, had to take her mother out of an assisted living facility and re-settled her in her home temporarily. She has a large house, with plenty of help, good resources, but all those accoutrements of a wealthy lifestyle are often not enough to make her mother comfortable as she has Alzheimer’s Disease. She had to change several times her live-in aide, but she lately found a middle-aged Haitian lady that seems to have “connected well” with her Mom. Appreciating the great help she represents, she willingly raised her salary. She can’t live without her.

Unfortunately, many workers in the USA that are engaged in the care of vulnerable individuals—teachers, day care workers, social workers and health care aides—do not receive the proper financial and labor consideration, even though many are well educated and trained. The large majority of them are women from Minority groups. The recent spate of adulation for all those that stayed in the first lines of care during the pandemic, even though many got infected, did not come along with a just raise in their wages, which has remained stuck at U$ 7.25—the Federal Minimum wage.

Kathryn E.W. Himmelstein and Atheendar S. Venkataramani published an article in the American Journal of Public Health that discussed “the racial/ethnic and gender inequities in the compensation and benefits of US health care workers and assess the potential impact of a $15-per-hour minimum wage on their economic well-being.” They studied the 2017 Annual Social and Economic Supplement to Current Population Survey to compare the wages, job benefits, and labor distribution of both the male and female health care workers of different socio-ethnic communities.

They found that: “of female health care workers, 34% of earned less than $15 per hour. Nearly half of Black and Latina female health care workers earned less than $15 per hour, and more than 10% lacked health insurance. A total of 1.7 million health care workers and their children lived in poverty. Raising the minimum wage to $15 per hour would reduce poverty rates among female health care workers by 27.1% to 50.3%.” During our medical practice, we have seen numerous women who, in spite of working full time, do not qualify for basic insurance coverage, including Medicaid. Their children might qualify for state and federal aid but they do not. This has been discussed in a previous article of this series called The Medicaid Coverage Gap.

The researchers studied the possible effects of raising the minimum wage to $15 of these workers and they considered two scenarios. In the first scenario, they assumed that there is zero elasticity for labor demand (meaning that raising the wages will not decrease the labor opportunities)  One of the most discussed issues in the challenge of raising the minimum wage to enable workers a better quality of life is that employers will either start laying off workers or simply stop hiring them. However, there is strong empirical evidence that in Health Care, due to the increased needs of an ageing population and the rising sophistication of medical services, that might not apply. There are much less incentives for dis-employment.

In the second scenario, they assumed that there was great elasticity of the demand for low wage-health care labor, based on a study done in Seattle, Washington state, that showed that raising the minimum wage to U$13 per hour produced a 9.4% loss of work hours for them.

In the first scenario, that increase in hourly wages would increase their average annual income by $7653 ($7682 for all women, and $8236 for Black, Latina and native American women) for an estimated value of almost U$ 45 billion, or the equivalent of a meagre 1.3% of the total health care spending in the USA. Moreover, it would lift almost 900,000 women and their children out of poverty and into the lower middle class.

In the second scenario, the socio-economic gains were more subdued as the average concerned worker would only get an increase of U$5103 ($5152 for all women and U$5769 for Black, Latina and Native American women) The total cost for the system was calculated to be U$24 billion; only 215,476 workers and 163,472 children were taken out of poverty.

It is clear that in both scenarios, there would be an improvement for those hard-working women and their children. Don’t we owe them, as a grateful society that appreciates their work, at least the gesture of discussing a wage raise?

Justice now for American Health Care aides!

Stay distant. Stay safe. Stay beautiful.

What do you think? Please tell us.

Don’t leave me alone.