Home care and nursing home workers need wage protections, advocates say

Each year, thousands of Marylanders who are aging or have disabilities receive health care through a family member’s help, in nursing homes, or from at-home patient visits. But a coalition of health organizations believe that those types of health care workers are often not paid adequately for their service.

Caring Across Maryland, the coalition which includes health care worker union 1199 SEIU, has announced its support for bills in the 2024 legislative session aimed to support home care, nursing home workers and family caregivers.

“Home care workers are leaving the field for jobs with higher pay and better benefits. At the same time, Maryland’s population is aging; the number of individuals over the age of 85 in the state will increase by 40% by the year 2030,” according to a Wednesday news release from the coalition. “Caring Across Maryland aims to address the staffing crisis in the state’s nursing homes, improve job quality and financial transparency in the long-term care industry, and prevent private equity firms from degrading quality of care.”

Two of the bills supported by Caring Across Maryland received their first hearing in the House Health And Government Operations committee meeting Wednesday. Each of those bills are related to how people who provide home health care are paid.

“These are the people who take care of your Granny or your Auntie in the nursing home. These are the people who take care of your cousin who has disabilities and needs assistance at home,” Del. Robbyn Lewis (D-Baltimore City) told the House committee. She has sponsored House Bill 39, called the Homecare Workers Employment Act of 2024. Sen. Arthur Ellis (D-Charles) sponsors the Senate version, SB 197.

The bill would prohibit state-funded Medicaid reimbursements from going to residential service agencies (RSAs) that employ home care workers as independent contractors. The House of Delegates previously approved the legislation during the 2023 session, but it did not receive a hearing in the Senate.

Vivian Boone, a home care worker of 35 years, said she has been “misclassified” as an independent contractor, missing out on certain employee benefits and paying taxes at a higher rate than if she were considered a typical employee.

“Home care workers deserve higher wages, insurance, sick leave, unemployment benefits, and more,” Boone told the committee. “We pay our taxes as though we are independent contractors, meaning that we are taxed at higher rates. That hurts us, as we are already underpaid, and the RSAs are plunging us deeper into poverty.”

However, some residential service agencies say that their workers prefer being classified as independent contractors, and the legislation would restrict that option withholding by Medicaid reimbursement.

Morgan Mills, representing the Circle of Friends residential service agency in Ashton, said that their workers like the flexibility that comes with being an independent contractor, which she refers to as a 1099 employee as opposed to a W-2 employee.

“The legislation requires any RSA that participates in state-funded home care programs to classify all providers as employees of that RSA,” she said. “Of course, that bill does not outright say that you have to classify providers as W-2 or you have to stop business. But, it is essentially doing that in a de facto way by not allowing RSA’s with 1099 employees to receive reimbursement.”

“In our clients’ experience, employees prefer the flexibility that comes with being a 1099 employee. They like to choose their client, like to choose where they work, when they work. A lot of them are part time who work W-2 jobs outside of this,” Mills said.

The other home care related bill discussed during the Health and Government Operations hearing was HB 189, also sponsored by Lewis, to gather state data on the wages that home care workers earn in Maryland. Sen. Clarence K. Lam (D-Howard and Anne Arundel) sponsors the Senate version, SB 371.

The bill would prompt “provider agencies” to annually report wage rates for personal care aides to the Maryland Department of Labor, so that lawmakers can know “where these workers are, how many of them and what their wages are,” Lewis said.

The two bills discussed Wednesday will be referred to a subcommittee for further deliberation, according to HGO Chair Joseline Peña-Melnyk (D-Prince George’s and Anne Arundel).

Caring Across Maryland supports additional bills aimed to widely address financial struggles among certain health care workers.

One bill is the Nursing Home Staffing Crisis Funding Act of 2024, which aims to direct additional state funds towards improving wages among direct care workers and tackle the nursing home labor shortage. Sen. Jim Rosapepe (D-Prince George’s and Anne Arundel) and Del. Ashanti Martinez (D-Prince George’s) are the chief sponsors.

As for family members who take care of the day-to-day needs of loved one with disabilities or mobility limitations, SB 202 and HB 32 would create a tax credit for family caregivers. Sen. Joanne C. Benson (D-Prince George’s) and Del. Andrea Fletcher Harrison (D-Prince George’s) are the primary sponsors.

Family caregivers could receive a new tax credit up to $5,000 if the legislation becomes law. The tax credit would apply to purchases and expenses that directly relate to the care and living needs of the qualified family members. Those expenses include transportation needs, assistive care technology, and household accessibility improvements, among other necessities.

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