Aging boomers seen as adding urgency to caregiving reforms

Boston Statehouse

BOSTON (SHNS) – Increasing pay for home care workers, destigmatizing family caretaker burdens in the workplace, and increasing predictability of hours were among the pitches senators heard Wednesday as they examine long-term strategies to reform care systems in Massachusetts.

Industry leaders and advocates have warned for years about gaps in care services across multiple generations, including early education for young children and in-home services for older adults.

Those concerns have become even more dire during the COVID-19 pandemic, those groups said Wednesday, with widespread closures forcing many parents to balance remote work and child care and exacerbating staffing shortages at home care agencies.

Mary Ann Mulligan, a legislative consultant to the Home Care Aide Council, told a Senate panel exploring ways to address long-standing structural challenges in the wake of the pandemic that many home care agencies in the state are in the midst of “the most severe recruitment and retention challenge they have ever faced in their time in this industry.”

She urged lawmakers to use funding available through the American Rescue Plan stimulus package — Massachusetts could receive up to $400 million under the home and community services waiver, Mulligan said — to support workers through child care and transportation waivers or one-time bonuses.

“Agencies need to be able to offer competitive benefits, incentivize the staff to pay, and to demonstrate the loyalty, respect and investment that they deserve,” Mulligan said.

Many labor leaders and workers have warned that the existing model pays too little to retain workers, leading to shortages and frequent turnover.

survey of the home care aide workforce that the Home Care Aide Council conducted in 2016 and 2017 found that 40 percent of employees in the field lived in households with an annual income less than $20,000.

Paul Spooner, executive director of the MetroWest Center for Independent Living, told senators that reforms must correct historic undervaluing of caregivers.

“We need to value them,” he said. “We need to provide them with a living wage, with a comprehensive benefit package, which should include issues around health care, family medical leave, and the opportunity to invest in retirement.”

The effects of a burdensome caretaking system extend out beyond the industry itself, too.

Cigna New England President Mark Butler urged business leaders to recognize that caretaking responsibilities are widespread and often stigmatized, leaving workers hesitant to request time off or changed hours.

That can increase absenteeism and decrease productivity, he said, causing ripple effects across the economy.

“It begins to create a tremendously stressful work environment,” Butler said. “The call we’re really making is to employers to understand that this exists, begin to bring tools and solutions that you as an employer have.”

Demographic trends are poised to make caretaking challenges even more potent as the Baby Boomer generation ages out of work and into greater needs. Butler said by 2025, 27 percent of the labor force will be members of Generation Z — those born between 1997 and 2012 — and 30 percent of those individuals will be in some kind of caregiving situation.

He called impending changes “a tsunami coming over the labor force.”

“If you multiply that out, it lends it all to: the way we work will have to change. We know that’s going to happen,” Butler said. “The pandemic has amplified and I think opened the issue of caregiving that was already there.”

Senate President Karen Spilka wants to achieve a “moonshot” transformation of intergenerational care, and Mulligan said that industry statistics prove the challenges they face cut across age groups.

More than 25 percent of workers in the field have their own personal caregiving responsibilities for family and friends, and 36 percent of home care aides are parents of children under 18, according to survey results Mulligan described.

“You can see the challenges they face to meet all of those needs — for their jobs, for their families, for their own children,” Mulligan said.

The most pressing short-term action lawmakers can take, Mulligan said, is to fund a reimbursement rate add-on that would boost wages for the home care workforce. The Legislature did so in its fiscal year 2020 and fiscal year 2021 budgets, and without similar action this spending cycle, Mulligan warned that rates will drop almost $3 per hour for home care and home health.

“It’s significant. When we say cliff, it’s a cliff,” Mulligan said.

The House included a $28 million rate add-on in its FY22 budget bill approved in April, and Mulligan urged the Senate to follow suit when it debates its version of the spending plan this month.

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