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Brian Lehrer: It's the Brian Lehrer Show on WNYC. Good morning again, everyone. Let's focus now on one of the major priorities in president Biden's jobs plan or reconciliation bill known these days by so many names, as we talked about last hour, the American Jobs Plan, Build Back Better, Reconciliation Bill, Human Infrastructure Bill, they're all the same thing. We're going to talk about the provisions to expand the availability of home health care to our country's aging population and to offer better wages and working conditions to the people who do the intense work of caring for the physical and personal needs of people as they lose the ability to care for themselves.

Across the country, according to stats I've seen 820,000 seniors who need help. Also younger disabled people sit on waiting lists for Medicaid's home care program with an average wait time of over three years. For the tens of thousands of people who work as at-home caregivers, they earn wages so low as to be unlivable in many cases. This was a problem President Biden took aim at earlier this year when he announced his American Jobs Plan, which contained $400 billion to make home health care cheaper for Americans who need it and raise care workers wages at the same time.

So far, in negotiations, Democrats have agreed to less than $190 billion, that's less than a Biden's original proposal by far. With me now to talk about what more funding could mean for the home health industry and to talk about the individuals on both sides of these very intimate relationships is Ai-jen Poo executive director for the National Domestic Workers Alliance. Ai-jen, welcome back to WNYC. Thanks for coming on today.

Ai-jen Poo: Thanks so much for having me, Brian,

Brian Lehrer: Let's start with the Biden plan, how did he originally come to a $400 billion proposal? That sounds like it's one of those big mind numbing numbers that the general public doesn't even know what it means or what it can buy, but I think it was something that your group had pushed for, right?

Ai-jen Poo: Yes. The numbers in some ways are really, it's more important to think about the goals of the funding. The funding is meant to do two things that are really long overdue. The first is expanding access to home and community-based care for the growing aging population and people with disabilities who need those services desperately in their homes and in their communities. It's about expanding access to services, one.

The second goal is about raising wages for the home care workforce. This is a workforce that is more than 90% women and majority women of color, 30% black women and it's a workforce that has always been undervalued and invisible. The average annual income for a home care worker in this country is $18,100 per year.

Think about the fact that the people that we are relying upon to take care of the people that we love, who are aging and maybe need more support can't even take care of themselves and their own families doing this work as a profession that also leads to high rates of turnover and the most dedicated care workers actually having to leave this profession because they simply can't make ends meet. The $400 billion is really about transforming these jobs into good jobs and making sure that the people who need the services can get them.

Brian Lehrer: It is incredible to think about home health aides, making something like $18,000 a year. In many cases, when the work they're doing is such intimate work, personal work. When as you say, we're trusting them with the care of the people who we love the most, and yet the market will pay people on Wall Street, people in tech jobs, you could go down the list so much money to do things where there is less immediate human survival and human quality of life at stake.

We talked about the same thing with respect to people who work with young children and childcare. It's up to the government, I guess, is your position to make sure that there's a decent wage because the market isn't going to do it on its own.

Ai-jen Poo: That's right and 70% of the home care workforce actually works through the Medicaid program, which is a government run program. In fact, this investment, well, it seems like the numbers are big. It's actually saving taxpayers money because every day that we keep people out of nursing homes is a day that we save taxpayers money.

What I mean by that is that the average cost of a person in a nursing home per year through the Medicaid program is about $90,000 per year. The average cost to keep somebody in the home and in the community, which they prefer for the most part, 88% of Americans want to age at home and in the community, it costs $26,000 per year. It's about a quarter of the cost. In every way actually this is an incredibly cost-effective way to take care of the people that we love and this investment will allow for us to also take care of the care workers as well.

Brian Lehrer: Listeners, do we happen to have any current or former home health care workers listening right now? 646-435-7280 if you want to call in and talk about what your experience has been working through the pandemic or at any other time, do you have to work another job in addition to your home care work just to make ends meet? Do you get time off or over time? What's your experience working in the home care industry? 646-435-7280.

We can also hear from some people, if you are on the waiting list to receive home health aides care through Medicaid. How long you've been waiting or anything else or anyone who has been taken care of, or is currently being taken care of by a home health aid and wants to talk about what you think should be in this Reconciliation Bill. 646-435-7280, 646-435-7280 for Ai-jen Poo, executive director of the National Domestic Workers Alliance.

Medicaid, to be clear for our listeners who don't know is the federal government health insurance program for poor people. People under a certain income, they get Medicaid. Medicare is for anybody over 65. Since this is so age-related in general who needs home health aides, why doesn't Medicare cover it more and how much does it cover?

Ai-jen Poo: Medicare actually does not cover long-term care. That's a really common misconception in this country. I just want to be clear that right now, if you need long-term care, your two options are to figure out how you become, or whether you are eligible for Medicaid or to purchase very expensive long-term care insurance, that oftentimes doesn't cover what you need when you need it. It's a private market product.

Medicare, there is currently no other government program that supports long-term care. The reason why president Biden's investment is supporting an investment in Medicaid is because it is what is available to Americans right now when it comes to meeting the need for these services. Longer term, I do believe that with a growing aging population, 10,000 people turning 65 every single day as the baby boomers age into retirement and people living longer than ever, it would be really important for us to think about whether Medicare should cover long-term care or any other number of solutions to make sure that long-term care in the setting of choice is more universally accessible and available to everyone.

President Biden's investment goes a long way to getting us there, especially because it's about securing a workforce who can provide these services and do so sustainably, actually earn a decent living where this profession can be one where you can continue and know that you can take care of your family as you do it.

Brian Lehrer: Would the bill establish a national minimum wage for home healthcare workers or some kinds of limits on their hours or provide sick time or-- What's in it in these respects?

Ai-jen Poo: Well, the two overarching goals, as I mentioned are to expand service and to eliminate the waitlist that you mentioned, 820,000 people waiting for these services, making sure that those people have access to them and to raise the wages and put these jobs on pathways to having the kinds of benefits that allow people to sustain in their jobs.

The way it will work is that because Medicaid is a state-run program, the money will go to states, to essentially set up a process where they can just set new rates for wages and conditions, according to the context in that state. It will go from, it will be federal dollars that will be made available for states to really build out a kind of infrastructure and workforce that will meet the particular needs of each state.

Brian Lehrer: Let's take a phone call. Anna in Brooklyn, who says she's a home care worker. Anna, thank you for calling in, you're on WNYC. [silence] Do we have Anna? Am I saying your name-

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Anna: Yes, I'm here.

Brian Lehrer: Hi there?

Ai-jen Poo: Good morning.

Brian Lehrer: Good morning. You're on the air.

Anna: Thank you. Thank you for inviting me and to get into the line. It was really important for me to speak out. I'm a home care worker for 18 years. My agency are Sunnyside Home Care and Personal Touch. Through the pandemic, it was really hard. It took me like six months for me to start, go back to work because of the pandemic. Most of the clients didn't want no one to come into the homes. Also, it was really hard because economically, I was struggling to pay my bills and everything.

Brian Lehrer: You didn't know about the risk to yourself either, right? Going into people's homes where you didn't know if they were infected with COVID.

Anna: Thank God, no, because as soon as the vaccine came out and we were eligible to get the vaccine, I went, I consulted with my doctor and he told me to get the vaccine because it will protect you, your family, and the person who you will be caring for, and that's what I did. I took my first vaccine in January 15th and then the second on February 9th, so I've been vaccinated for more than six months.

Brian Lehrer: That's how important this was to you. It sounds like you remember the exact dates.

Anna: Yes. It's really important and I encourage all my co-workers, my fellow co-workers, and home care workers to come out and do the vaccine because it's really important because it will save you, your family, and the person who you're caring for.

Brian Lehrer: Anna, thank you so much for your call, and continued good luck to you. We're going to go next to Gemma in Queens, you're on WNYC. Hello, Gemma?

Gemma: Hello? Can you hear me?

Brian Lehrer: I can hear you just fine.

Gemma: Okay. Hi. How are you? I'm not sure I said Queens, I'm calling from Kingston, New York.

Brian Lehrer: Sorry about that.

Gemma: That's okay. No, that's okay. I was listening and I just got on, and I guess my concern is first thing is, when is this money going to come through? That's something I'm just really not sure with. I thought it was set in place already that this money was going to be going towards the home and community-based services.

Brian Lehrer: Do you want to talk about your own experience a little bit, either financially or-

Gemma: Sure. Of course.

Brian Lehrer: -quality of the nature of your work?

Gemma: Yes. Yes. I'm in the Hudson Valley organizer for Hand in Hand and the New York Caring Majority. I work to increase the wages for home care workers. It's called fair pay for home care, for everybody to know, and it's for New York state because the average income for home care workers in New York state is $12.50, which is inhumane for the amount of work that they do. I'm sure the other individuals who make just a little bit more, it's inhumane as well to think that you can be able to live and have a livable wage to provide for your family.

That's what I do and my experience besides doing that, which is incredible work. I am a consumer and I've been for about a year give or take a little more. It's very, very difficult to find home care workers with-- I'm a consumer with an agency, and because people are not able to work for $12.50 an hour, and now--

Brian Lehrer: Let me ask you one follow-up question about that. When you say $12.50 an hour in New York, isn't New York's minimum wage, $15 an hour? Is there an exception in some way for home health aides?

Gemma: Yes. You're exactly correct. Yes, that's the problem. It went up for fast food workers, which again, no problem, everyone deserves more money, but they left out home care workers. Just to add on to my fair pay for home care, just to let you know, the purpose of fair pay for home care would be to increase the minimum wage is by 150% to make it so that 2,200.50 cents would be the lowest that home care worker would make.

They definitely skipped over home care workers when it came to the new minimum wage, so that's the problem. No one seems to be looking out or paying attention to that. That's a big issue and that's why we're losing home care workers, and that's why it's so difficult to find home care workers like myself, as I'm supposed to have every single day in the morning and the evening. I'm left several times without home care workers.

Brian Lehrer: Gemma, thank you so much for your call. Ai-jen Poo from the National Domestic Workers Alliance, do you want to comment on either of those first two calls, including-

Ai-jen Poo: Yes.

Brian Lehrer: -Gemma's assertion that home health aides were left out of the minimum wage increase in New York state?

Ai-jen Poo: Absolutely. First, I want to thank both Anna and Gemma for their work. Anna's tireless work as a home care worker, the essential lifeline to so many people who were most vulnerable to the COVID virus itself relied on the courage and sacrifices of workers like Anna. I just want to say, thank you for that. Gemma, thank you for your leadership and your advocacy on behalf of this potential workforce.

I know from the consumer side, this is a struggle that so many people have trouble getting access to services that they need because there isn't a workforce in place. The thing that a lot of people may not realize that, Brian, you and I have talked about in the past is that this workforce of workers who provide caregiving services in the home has faced a really long history of exclusion from basic labor rights, and dating all the way back to the new deal when our labor laws were being put into place, Southern Dixiecrats refused to support the new deal, labor protections, if they included farmworkers and domestic workers who were largely black at the time.

In that act of racial exclusion, it set a tone for how this workforce would consistently be treated as less than real professionals and protect it as less than, or actually not protected. That is why this investment that President Biden is proposing is so profound because here we are in this new, new deal moment, and he is saying that this workforce that has been excluded for generations because of racism should be at the forefront of who we are investing in, in the jobs of the future and as we rebuild from the COVID pandemic, I think it's really, really important.

Brian Lehrer: Dana, in Massapequa, you're on WNYC. Hello, Dana?

Dana: Hi, good morning. Thank you for the opportunity to have this conversation. Well, first I'm a registered nurse and owner of a home care company that services Long Island and the boroughs of New York. We have been strong supporters for fair pay for home care workers. My company is Reliance Home Senior Services, and we are 1199 union agency. I was just listening to the last caller, talking about the professionalism of home care workers and how they've been neglected or really dismissed.

Even through COVID, my workers were working every day. My office staff was working every day. We would watch governor Cuomo on the TV talk about essential workers and how all the heroes that are out there, which they are. I don't want to take that away from them, but not once was mentioned home care and all the home care workers that were putting their lives on the line by using public transportation and other means to get to see their patients and help maintain those individuals at home safely, and they were disregard the entire time.

Not once did anybody mention a home care worker as an essential worker as well as a hero, and I think that speaks to the way people feel about home care workers and that really has to change.

Reliance, we stand with the fair pay for home care. We need an increase for the workers, not only to more legitimize their position, but also to have people come into the profession and have them see it as something that they could feel good about and that they want to continue working in the home care field because if they keep leaving the industry, there's not going to be people to care for us when it's our time to be--

We all want to stay home. We want to maintain our safety and loved ones at home, and without these home care workers, it's going to be impossible. We actually at Reliance I created a not-for-profit. It's called All Things Home Care, where we focus on education and support, and we're very strongly supporting transportation initiatives in order to help home care workers on Long Island get to and from their jobs and so that they can maintain safety against COVID as well as getting them to places on Long Island that is deemed unstaffable because we can't get workers to them.

Another thing that we're doing at Reliance and All Things Home Care, is we're looking to talk to nursing students while they're in school to become a home care in order to help with the staffing crisis, which is becoming worse every day with this mandate, with the vaccinations, which we're fully supportive of, but it's taking away a lot of the workforce for the home care. The staffing crisis is getting worse.

Brian Lehrer: Dana, in the long run, at least from the statistics that I've seen, home healthcare workers are the fastest-growing section of the healthcare industry because of the aging of the population and people living longer than in the past, and so there's a supply and demand issue that one would think would push wages up just by its very nature. For you running an agency, what are you seeing?

Dana: We get calls we have to turn away from patients looking for services. For the Managed Cares here on Long Island are looking for us to staff their cases. We turn away 10 to 15 cases a day, which it's the patients because we don't have enough workers. We do everything we can to increase the recruitment aspect, we spend every day trying to recruit, and right now I feel, this is just my opinion, that home care workers they know their worth, and they're not going to return to work without given what they deserve, which is fair wages.

On Long Island it's $15. It's less than $15. Total package comes out to be $16 something with benefits, but still in their pocket they're getting paid $14.41. I don't know about you, but you can't survive on Long Island or New York getting paid a minimum wage for the job that they do. It's ridiculous, actually, and I, myself as well as people on my board, we testified up at the Senate a couple months ago, talking about fair wages and the issues that are coming up in home care. I just feel like they listen, but nothing is ever done about it.

It's like that perfect storm is happening right now, where you have people that can't get services, that can't get care, and the workers are just not returning the way we were hoping. Unemployment was a whole different issue, and once that stopped, we thought, "Okay, maybe they're going to return to work," and it has not returned to the point what we expected, number one, but number two is what we need. There's people, human beings that are going without services every single day because we can't get workers to their homes, and it's a problem that has to be rectified sooner than later.

Brian Lehrer: Dana, can't you or your staff charge more for the services and therefore people will come back and do those jobs without government intervention?

Dana: Well, the majority of licensed agencies on Long Island we are reimbursed through Medicaid. We don't have the ability to pay.

Brian Lehrer: There it is.

Dana: Yes, most of our work is Medicaid work, and it's through the managed long-term care, which is the reimbursement for the agencies is minimal as it is. On the private side, yes, but the most licensed agencies that I deal with we're all Medicaid reimbursed.

Brian Lehrer: Medicaid, and Dana thank you very much for your work and your call and your clarity, and as we run out of time, Ai-jen, there it is. Right?

Ai-jen Poo: That's right.

Brian Lehrer: It's a burden on the poor people who are the home health aides and doing this hard intimate work for such low wages, and it's a burden on the poor people who are the patients, the recipients of the care because Medicaid is the program for them, and so that's where the shortage is, and that's what Biden's bill is trying to address. All correct?

Ai-jen Poo: All correct, and the bill also supports the 48 million working family caregivers in this country who are struggling, especially women to manage the care that their loved ones need in the home while working full-time jobs. We saw over 2 million women get pushed out of the workforce because of caregiving challenges in the COVID pandemic. This is also about them. Care jobs are job enabling jobs, and so when we invest in them, by the way, these jobs can't be outsourced, they're not going to be automated. These are jobs we know are here to stay.

When we invest in making them good jobs for the 21st century, it is a win, win, win for those workers and their families, for the family caregivers that they enable to go to work, and for the people whose quality of life relies upon their services.

Brian Lehrer: Ai-jen Poo, executive director for the National Domestic Workers Alliance. Thank you so much for joining us today and having what I think was a very important conversation that lets people know in more detail about one of the central portions of this bill that's now stuck in Congress. Thank you so much.

Ai-jen Poo: Thanks for having me.

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