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'The worst compensated job in Texas' | Texas is facing a worsening home caregiver shortage

Advocates say the issue has reached a crisis point, leaving home caregivers overworked and underpaid for back-breaking work.

AUSTIN, Texas — For more than two decades, Gene Rodgers has depended on a community-based caregiver to come into his home to help give him life-sustaining care that includes helping him in and out of bed, getting dressed and assisting him with meal preparation.

It keeps the 67-year-old as independent as possible after, as a teen 50 years ago, he broke his neck when he fell from a cliff on a hiking trip in his native Ohio. 

Rodgers, who has continued a life of travel and adventure, moved to Texas in the late 1990s because of a strong advocacy community for people with disabilities. 

But, in recent years, finding the care he needs has become increasingly difficult. He blames an unprecedented shortage in community-based caregivers, fueled largely by poverty wages set by Texas lawmakers that have failed to keep pace with the earnings of other – sometimes less demanding – jobs.

Advocates say the issue has reached a crisis point, leaving home caregivers overworked and underpaid for back-breaking work such as helping clients with daily needs that also include giving medications and bathing. And the situation places Rodgers in danger of possibly not getting the necessary care that helps keep him healthy and independent.

Lawmakers have failed to meaningfully raise the current $8.11 reimbursement rate to home caregivers for a decade, at a time when fast food jobs offer several dollars more an hour, luring the workforce away.

Rodgers is among tens of thousands of Texans with intellectual and developmental disabilities who depend on the services, through a Medicaid waiver, to receive care in their homes or small group homes rather than living in a nursing home or State-run institution.

“The Legislature, in my opinion, considers us expendable,” Rodgers said.

Rodgers' daily ritual 

Rodgers' daily routine begins around 9:30 a.m., when his 76-year-old home caregiver, Shirley, arrives at his Central Austin apartment. 

“The first thing is to get him checked – for his temperature – and then prepare for him to get dressed,” Shirley said. 

Once she gets him dressed for the day, she helps him move from his bed to his wheelchair. 

“Living in an institution is not an option for me,” Rodgers said. “I would hate to say what it would come down to if I were left with that.”

He said Shirley earns $10.50 an hour – roughly the state average for a caretaker – because the agency she works for supplements the state’s base wage.

Although Shirley has worked with Rodgers for about five years, he has struggled to find caretakers for evening and weekend shifts – to the point that he has had to call firefighters or paramedics to come help him out of bed or his wheelchair.

Thousands of open positions 

With Texas now estimating about 5,200 open caregiving positions statewide, advocates say the low pay has now resulted in a massive workforce shortage. 

“It is the worst compensated job in Texas,” said Dennis Borel, director of the Coalition of Texans with Disabilities. “When you ask people with disabilities who are your most important health care providers, very few will say their doctor or their therapist or their nurse. They will tell you it is the lowest paid person on the totem pole, the community attendant.”

According to the U.S. Bureau of Labor Statistics, the average pay for home care and personal attendants nationally was $14.50 an hour – four dollars more an hour than in Texas.

The State has known for years about the issue, flagging it most recently in a November 2020 report saying, quote, “Community attendants across Texas often face financial insecurity from low wages, lack of benefits such as health insurance … Addressing these and other challenges related to the community attendant workforce demands a coordinated, statewide approach.”

Seven days a week

In a house outside Georgetown, Serena Acfalle takes care of four women with disabilities around the clock.

“I work seven days a week,” she said. 

She keeps those hours because of the difficulty her employer has finding other caretakers to cover shifts.

“We’re very short staffed, so the ones who are left have to pick up all the shifts,” she said.

Acfalle earns $11.50 an hour because the agency squeezes money from other operating costs.

Legislative action? 

Raising the base wage for caretakers to $17 an hour by 2025 – as advocates are asking – could cost Texas more than $3 billion. 

But the advocates point out that it will save Texas money, ultimately, by having people in their own homes instead of more expensive nursing homes.

State Rep. James Frank chairs the House Health and Human Services Committee

“As a state, I would like to see more money put into that,” he said. “At the end of the day, I think in almost every business – whether it is government-run or privately-owned – there is less money that goes to the people that actually do the work than should.”

With Texas now about three months away from its biennial legislative session, advocates say they will again press lawmakers to give a boost in pay to caretakers.

Meanwhile, Rodgers puts his faith in the home caregiver who has stayed by his side, hoping the State will add more to her wallet. 

“She’s a real caring person, very compassionate,” he said. 

And that a raise to home caregivers will bolster his feeling of security that he will still get the in-home help he needs to live. 

“The State thinks, 'Well, there are dedicated people out there. Regardless of what we pay them, they will be there,'" Rodgers said. “I don’t know how long they can hold onto that notion.”

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