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Commentary Health Care

Opinion: Maryland Has a Home Care Workforce Crisis. Two Bills in the Legislature Can Fix That 

Home Care photo by guvo59.

By Lisa Brown and David Rodwin

Brown is an executive vice president at 1199SEIU, which represents direct care workers in various settings across the region. Rodwin is an attorney at the Public Justice Center focused on job quality in home care.

Put yourself in the shoes of William Fields. You use a wheelchair. You rely on home care workers to assist you into and out of your wheelchair and to help you bathe, dress and cook. These workers allow you to live in your home; their work gives you the freedom to stay in your community, near your neighbors and places you know.

But when the worker scheduled to provide you with care this week gets sick and calls out, and the home care agency can’t find a replacement, what can you do? You wait, hoping the agency will find someone. A few hours go by, and you are still in your wheelchair. A full day goes by, then a night. Then another day, and another night. For 48 hours, you have no choice but to remain in your wheelchair, unable to use your own bathroom, until finally the agency finds a home care worker to send to you.

That’s exactly what happened to Mr. Fields, a 65-year-old man with a neurological disorder, when his aide called out. Why did it take so long? Because there’s a home care workforce shortage.

Mr. Fields’ story is just one of many such incidents to happen recently in Maryland, and these stories are becoming more common.

This past year saw a series of investigations into the home care workforce shortage, including by Maryland Matters. Demand for home care is increasing as Maryland becomes an older state and more people with disabilities receive care in their homes. A 2018 study found that Maryland will need nearly 40% more care workers over the next 10 years, and the pandemic has only magnified this trend.

But the supply of home care workers is not increasing. Home care jobs pay an average of $13.50 in Maryland, and even lower when the work is funded by Maryland Medicaid. Home care agencies report very high turnover; workers are leaving for higher paying, less stressful jobs at places like Chipotle, Walmart or Royal Farms.

Maryland’s older adults and people with disabilities already have extreme difficulty finding and keeping home care workers. If more comprehensive action is not taken soon, the shortage – and its consequences for the tens of thousands of Marylanders who rely on home care – will only worsen.

In this year’s session of the Maryland General Assembly, legislators are considering two bills that would help solve this crisis.

The first, Senate Bill 600/House Bill 544, sponsored by Sen. Delores Kelley and Del. Lily Qi, would empower policymakers with the information they need to ensure that home care jobs are decent jobs that workers want to do.

Even though Medicaid funds nearly 60% of Maryland’s home care, the state has no information about the most basic aspects of these jobs: pay and benefits. Policymakers set Maryland’s Medicaid reimbursement rates and determine what conditions the state puts on businesses that receive this reimbursement. But without basic workforce data, it is impossible to make informed policy decisions. This bill would provide that data without putting any administrative burden on home care agencies.

The second bill, Senate Bill 863/House Bill 981, sponsored by Sen. Cory McCray and Del. Shaneka Henson, would give a raise to both home care agencies and home care workers.

Dozens of states from across the political spectrum have instituted policies increasing the money paid to a home care agency for an hour of care – while also requiring that some minimum amount of that money goes to the workers.

Maine’s recent legislation provides that Medicaid-funded direct care workers must be paid at least 25% more than the state’s minimum wage of $12.75 – about $16 an hour. Maryland’s bill would do the same, increasing the hourly reimbursement rates that Medicaid-funded home care agencies receive from about $20.50 to about $23.50, while requiring that the workers who actually do the work be paid at least $16 an hour.

It’s a common-sense solution that will help push home care wages to something closer to a living wage. Even if Maryland did not have a historic budget surplus, the workforce crisis would require Maryland to invest in care. The surplus makes this solution an even easier call.

Improving home care jobs helps everyone. It helps older adults and people with disabilities who rely on home care to remain in their homes and communities. It helps the workers – about 90% of whom are women and about 70% of whom are Black – who for too long have been paid poverty wages with state money. And it helps the health of the state overall, making Maryland a better place to age and live with dignity.

This session let’s give home care the attention it demands and help solve the home care workforce crisis.


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Opinion: Maryland Has a Home Care Workforce Crisis. Two Bills in the Legislature Can Fix That