‘You sacrifice your life': Home health care workers are demanding better pay. Cuts to Medicaid could stand in their way.

Boston Globe

29-04-2025

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'You sacrifice your life so someone else can have one,' said Moshier. 'I've done that for the last three years without a full day off, no matter how I've felt, no matter how sick I was, or how much physical pain I've been in due to my own physical ailments.'
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Moshier makes $21 an hour for a 40-hour week, or less than $44,000 annually
— a rate that cannot contend with
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It's a system that is not sustainable and deeply broken, advocates say. Now Moshier and thousands of other home health care workers who care for some of the state's frailest residents are fighting for change.
In March, Moshier and nearly 2,000 fellow home health care workers in Rhode Island overwhelmingly voted to unionize, marking the largest election of state workers since the 1980s. They'll join the SEIU 1199NE union.
'This is the lowest wage health care job in the state of Rhode Island,' said Jesse Martin, SEIU 1199's executive vice president. 'They are working in apocalyptic conditions.'
These Rhode Island workers are part of a broader effort by home health care workers and the unions trying to organize them nationally to demand better wages and benefits. But they may face an uphill battle, due to
Proposed changes in federal funding and policy 'are likely to have wide-ranging impacts on health and human services programs and resource availability moving forward,' said Kerri White, a spokeswoman for the Executive Office of Health and Human Services, the state agency that runs the home care programs.
White said any federal changes 'may require us to make difficult decisions to preserve the progress we have made' while also reallocating investments elsewhere.
US House Republicans have proposed
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Home health care workers, who call themselves the 'invisible workforce,' help seniors and people with disabilities who live at home with daily needs including bathing, feeding, dressing, toileting, getting to doctors appointments, grocery shopping, picking up prescriptions and medication reminders.
Cuts to Medicaid would have profound effects on the
Across the country, a "
In 2023, legislation made thousands more home care workers in Massachusetts eligible to organize and join a union. At the time,
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Workers in Rhode Island are expected to request higher wages, benefits, time off, and training in their negotiations with the state. They will also seek
a functional registry to connect consumers with workers, create more stability and flexibility in the system, and give workers the ability to take time off.
Destiny Moshier has been caring of her best friend, Holly Allen, for the last three years.
Jonathan Wiggs/Globe Staff
'If there was a registry, I could take a full day off to go to the doctor's while someone else cares for Holly,' said Moshier, who currently must complete daily errands for herself and Allen within two hours, the amount of time Allen can be left on her own.
Overwhelmingly, home health workers are typically family member caregivers or close friends of their patients.
That includes Emanuel Rodriguez, 25, who cares for his brother Jorge, 26, who was born developmentally delayed.
His brother, Rodriguez said, can't be left alone for long. 'He'll start cooking, and he'll forget he's cooking and move onto something else and there's a fire. That's happened on one or two occasions already,' he said.
His brother was also a victim of a recent
Rodriguez went to school for one year to study mechanical engineering, but left to care for his brother. Doing so has earned him just $15 an hour for the last five years. It forced him to take a second job as a paraprofessional for children with special needs in the Coventry Public School District.
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Home health care workers
'care for the most vulnerable... We make sure they are not just left to their own devices,' he said.
States, including Rhode Island, could raise taxes to cover federal cuts to Medicaid. Meyers said it's more likely
that states will cut back on services.
'In Rhode Island, it's a really constrained environment that's only going to be pushed further to the brink,' said Meyers.
Moshier, who made a promise to her friend's elderly mother years ago to care for her daughter, gets frustrated when home care workers are characterized as 'glorified babysitters.' She sees no difference between what she does and those who work in a facility, such as a group home for adults.
'We're caring for people who have nowhere else to go. And people don't realize how many caregivers are struggling just to make ends meet and don't have a safety net,' said Moshier.
'Being in the position I'm in, you have to make it work. You have no choice,' said Moshier. 'You do it out of love for another human being. But comes at a cost.'
Alexa Gagosz can be reached at