Unintended consequences for direct care workers in Iowa

A recent illness and stay in a local hospital’s Critical Care Unit (CCU) served as a stark reminder of how my vulnerability was linked to the excellent health care workers and various professionals at a local hospital.

Direct Care Workers (DCWs) often experience not only economic insecurity and vulnerability, but also poor physical, mental, and emotional health due to the demands of their jobs and burnout. The Iowans they serve can become vulnerable when access is hindered by workforce shortages and lack of resources.

The Public Assistance Program Integrity Bill SF 494, which is on its way to Gov. Kim Reynolds’ desk, will create new restrictions on food assistance and Medicaid eligibility It is also a workforce bill that will have unintended consequences on the existing direct care worker shortage, turnover, and Iowans’ access to care. Access is already seriously compromised, increasing the vulnerability of both the workforce and the Iowans who rely on them.

We at Iowa CareGivers don’t pretend to have a vast understanding of Medicaid and its various formulas, but we do have more than 30 years’ experience working with and supporting DCWs. Our role is to put a face on many of those who receive SNAP benefits, Medicaid, and other supports that enable them to work.

DCWs have more than 30 titles such as Home Care Aides (HCAs), Personal Care Assistants (PCAs), Direct Support Professionals (DSPs), and Hospice Aides.

DCWs provide 70-90 percent of the direct hands-on essential care and support to Iowans of all ages and abilities.

DCWs work in the homes of individuals served, assisted living and residential care facilities, nursing homes, hospitals, group homes, hospices, hospitals, non-medical senior services, and other settings.

As of February 2023, Iowa Workforce Development (IWD) reported 1,645 job vacancies for DCWs in Iowa, second only to licensed nurses.

In 2019 Iowa CareGivers partnered with IWD on a statewide Direct Care Worker Wage and Benefit survey. It was a departure from its usual surveys for only employers, and instead surveyed DCWs. The DCW survey provided a unique and complementary perspective to the employer survey.

Findings relevant to proposed legislation:

17 percent of direct care workers were receiving SNAP benefits.

28 percent were working two jobs.

23 percent received health care coverage through Medicaid.

54 had children on HAWK-I health insurance.

2019 Median hourly wage for Home Health Aides was $15.63; Certified Nurse Aides earned $13.80 and Personal Care Aides $13.34.

IWD 2021 Labor Market Information (LMI) reported a median hourly wage for Certified Nurse Aides, $14.42, and Home Health Aides/Personal Care Aides, $13.89.

DCWs’ wages haven’t budged much since 2019 which is difficult to understand given the high demand.

Factor in an 8.7 percent Cost of Living Adjustment (COLA) for 2023. We believe even more DCWs are now relying on SNAP and other assistance enabling them to work.

This is not the profile of individuals who are trying to rip off the system, but rather the picture of hardworking individuals, already economically, emotionally, physically, and mentally vulnerable. Deemed “heroes” during the pandemic, the last thing these vital workers need is the burden and fear of losing the very supports that make it possible for them to work.

Further analysis needs to be done by IWD on the most recent LMI data to ensure signing SF 494 won’t make what is already a dire workforce situation even worse.

Finally, HF 264/SF 7 is legislation that would exempt a subset of DCWs, those who provide support to people with disabilities, from paying state income tax. While we support doing all we can to lift the direct care workforce up and increasing their wages, we have the following concerns.

Selecting one subset of the direct care workforce to receive this benefit is not equitable and sends the wrong message to the thousands of other DCWs who perform equally important work but are employed in other settings serving various other populations.

Health, long-term care, and home and community-based employers are competing for the same workforce and this bill would give a competitive edge to one provider type. All direct care/support workers and child care workers should be exempted from paying state income tax regardless of the setting within which they work, or the population served.

Iowa CareGivers supports and advocates for those who provide direct care, so the care needs of Iowans are met; employers have access to a highly qualified workforce; family caregivers have the supports they need when caring for loved ones; and to ensure Iowa’s rural and urban economies thrive. www.iowacaregivers.org

Di Findley is executive director of Iowa CareGivers.