In SC, the caregivers may see half of what Medicaid pays for home care. A bill would change that.
COLUMBIA — For every hour Lisa Lee works caring for people in their homes, her employer receives $25 per hour. In 10 years of work, she has never gotten more than $15 per hour.
Lee's employer, like all home health providers in the state, gets funding through Medicaid reimbursements for home care waivers. Under state law, providers have no requirement to pay care workers more than the federal minimum wage of $7.25 per hour.
The portion of the reimbursement that doesn't go to workers is set aside for administrative costs. That often means roughly half of what taxpayers provide for services goes toward bureaucracy instead of the caregiver, and that's not right, said Maria Reyes, South Carolina's organizing director for the National Domestic Workers Alliance.
The low wages are causing health care workers to flee the field for higher-paying jobs, at a time when South Carolina's aging population needs more caregivers, not less. To stem the exodus, the state should limit how much providers can take from the workers doing the job, she said.
A bill introduced in the Statehouse last week would require providers to pass on at least 70% of their reimbursement rate to care workers. That's $17.50 per hour at the current rate of $25 per hour.
Home health workers are tasked with doing whatever a person needs on a daily basis, such as bathing them, giving them medication or helping them move around the house.
Beyond that, health workers are often a friend and source of comfort for their clients, Reyes said.
'You're not just washing someone. You're not just feeding someone. You're not just giving meds,' she said. 'You're that person's person while you're there.'
In 2023, the median wage for home health care workers in the state was $13.62 per hour, according to PHI, a national nonprofit that promotes care for the elderly and people with disabilities. For a person working 40 hours a week, that would equate to a yearly salary of about $28,300 per year.
There have been times when Lee, who lives and works in Camden, has had to choose between asking her boss for an advance to pay for gas or walking to her clients' houses because she couldn't afford to fill up her car's tank, she said.
'I shouldn't have to ask my boss for help,' Lee said, adding she should be able to pay for it herself.
Trying to make some more money, she took on more clients. But the more people she cared for, the less time she had to spend with each of them. She can't afford to take sick days or vacation, since her job offered no paid time off, she said.
'These are the sacrifices I make because I love what I do,' said Lee, who declined to name her employer. 'But home health care workers are neglecting their own needs.'
Sen. Darrell Jackson, the bill's sponsor, credits a home health care worker with keeping his father alive for an extra several years two decades ago while he was in hospice at home. Knowing his father was getting the care he needed took some stress off Jackson and his family, he said.
But with low pay driving people out of the profession and into other work, not everyone gets that chance, said the Hopkins Democrat. That was why he sponsored the bill, which has yet to receive a committee hearing. He's also pushing for a clause in the state budget that has the same effect.
'When you look at their average pay, it is pretty ridiculous,' Jackson said.
Families who can't find a home health care worker often have to take on the responsibilities of round-the-clock care themselves, sometimes at great personal sacrifice, said Reyes, who lives in Columbia.
Her father qualified for a home health worker under Medicaid in 2022 as his health declined from congestive heart failure, but no local agencies had enough workers to help him, she said. Instead, her niece quit her job and moved from North Carolina, and her brother retired early to take care of him, Reyes said.
'The whole point of us applying for the waiver was for us to get a break, for us to have someone directly for my dad,' Reyes said. 'Unfortunately, we never got the chance.'
Her father died while still on a waiting list for a worker. As of last July, nearly 20,000 people were on a waiting list to receive a waiver, according to the state's Medicaid agency.
As the state's population ages, the number of people looking for at-home care is expected to grow. In the next decade, the state is projected to need nearly 11,000 more home health care workers than it already has, which is more than any other health care job, according to the state Department of Employment and Workforce.
How many people can get services depends on whether the state has the money to reimburse providers for their care. The House's initial spending plan includes $5 million to increase the number of slots available for Home and Community-Based Services waivers, which pay for home health care workers to take care of people.
Getting more people the help they need is great, Reyes said. But increasing the number of people eligible for a home health care worker without taking steps to improve pay and conditions for the workers will likely only make the problem worse, she said.
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Government inaction exacerbated the suffering. How can America repeat that failure?
