Legislature balks on significant pay bump for home health aides

Texas lawmakers aren’t expected to approve any substantial wage increases for attendants who care for aging Medicaid recipients with disabilities, despite state agency requests for a raise and widespread evidence of a workforce shortage.

The Texas Health and Human Services Commission has asked the Legislature this session to raise the $8 hourly base wage for attendants by 50 cents, saying that they “can earn higher wages in the fast food and other industries that hire low-wage workers.” Advocacy groups are pushing for $15 an hour.

The Texas House, however, has proposed raising the base wage by just 10 cents, and the Texas Senate envisions no raise.

With less than half of the legislative session left and most of the budget spoken for by larger priorities such as boosting school spending and providing homeowners with property tax relief, the likelihood of a pay raise is slipping, even though Medicaid recipients have for years pushed for higher wages for their attendants. Raising the hourly wage of attendants by 50 cents would cost the state about $150 million over the next two-year budget.

“It’s a matter of life and death for me,” said 63-year-old East Austin resident Gene Rodgers, who is paralyzed from the head down after he fell from a cliff at age 17. “With inflation, the buying power of (attendants’) wages has gone down. They could be flipping burgers for 15 bucks an hour or working at Amazon.”

Attendants’ duties, which vary depending on the need of a client, can include cooking, feeding, bathing, house cleaning and operating medical equipment. They allow disabled people to live healthier and more independently in their own homes rather than in nursing homes or assisted living facilities that are costlier to the state.

“We have a tendency to duck away from funding cost-effective preventative programs like reliable attendant care and then complain when people are paying these high bills because we didn’t keep them healthy,” said Dennis Borel with the Coalition of Texans with Disabilities.

He said lawmakers’ lack of interest in boosting attendant wages is a slap in the face.

A state health agency spokeswoman could not say how many Medicaid recipients need attendant services or how many attendants would be affected by an increase in the base wage. According to the U.S. Bureau of Labor Statistics, there are about 276,000 attendants (personal care aides and home health aides) in Texas, and as the population ages, the demand for attendants is expected to grow.

The Legislature has increased attendant wages by 50 cents since 2014. Agency officials noted in their recent pay raise request to the Legislature that without a change, “providers will continue to experience high turnover among community attendants.”

Advocates say reliable attendants are becoming harder to find and keep. State officials have acknowledged that Austin is particularly affected by a workforce shortage because of the high cost of living. But rural areas that have fewer attendants to begin with are also seeing workforce shortages.

High turnover

For a period of time, Rodgers had a new attendant every two weeks. Rodgers’ longest-serving attendant, Shirley Eason, has been with him for five years.

“The whole mental outlook, attitude is changed when they send in new people and I have to train them from the very beginning everything to do,” Rodgers said.

Attendants typically don’t receive health or retirement benefits or paid vacation, sick or personal days.

Eason said she wouldn’t be able to survive off her $10 an hour attendant wage — she is paid a little more than the base wage because Rodgers has higher needs — if she did not draw Social Security benefits. Eason, 73, doesn’t think she can do the job for longer than two more years even though she’s grown to enjoy Rodgers’ company.

“Attendants should be paid according to what they have to do,” Eason said, adding that her job requires her to be physical, such as when she’s dressing Rodgers.

Sandy White, 56, who makes about $1,000 a month as an attendant for Susie Angel, 48, and Juan Muñoz, 47, who live together and both have cerebral palsy, said she has only $10 left every month after she has paid for rent, utilities, food for her and her dogs, and anxiety and blood pressure medication.

“You can probably make more working at Buc-ee’s, and this job has more responsibilities,” she said.
Angel said low pay has led to poor quality attendants. Once, an attendant was startled by one of her spasms and walked off the job in the middle of showering her, she said.

“Minimum $14 to $15 an hour,” Muñoz said when asked what rate he believes White should be paid. “Enough that they can survive. We’re not asking for them to be sitting pretty. If they can’t survive, we’re not going to survive.”

Budget cuts

Attendants who serve Medicaid recipients with higher needs, such as those with intellectual and developmental disabilities, also have struggled with low pay even though their wages are set at a slightly higher rate. The Statesman reported in December that an Austin woman, Sue Schnars, had trouble finding and keeping attendants at $11 an hour and was forced to place her 43-year-old daughter, who has cerebral palsy, in a nursing home. Her daughter had lived at home all of her life.

Private agencies that employ attendants also told the Statesman they were having to redirect money from other programs and cut their administrative costs to keep attendant wages competitive. Losing money, some private agencies had stopped serving individuals in certain Medicaid programs such as Texas Home Living.

The state health agency has whittled away at the higher wages paid to smaller Medicaid programs that serve individuals with intellectual and developmental disabilities. In 2017, the agency cut rates in Texas Home Living and Home and Community-based Services by 21 percent to $17.73 an hour to align the rates with other Medicaid programs. The decision affected caregivers for about 8,000 people in both programs.

“We want to raise those lower wage programs,” Borel said. “Texas has consistently missed the boat on developing a sustainable Medicaid program, one they can handle increasing demands and needs as our population grows and our population ages.”

The Legislature does not appear to be incentivizing the state agency to increase Medicaid services either. Over the past several budget cycles, the Legislature has directed the state health agency to cut Medicaid costs. This budget cycle, the Legislature told the agency to cut $350 million. The Legislature is poised to ask the agency to do the same again over the next cycle. This would result in a reduction of $550 million in federal matching dollars.

“The Legislature has been intently focused on constraining the cost of Medicaid recipients for the last 20 years, so the only way attendant rates go up is if the Legislature specifically identifies that’s something they want to do,” said Anne Dunkelberg with the left-leaning Center for Public Policy Priorities. “And they have done increases; they’re just still woefully inadequate.”

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Legislature balks on significant pay bump for home health aides