Report paints stark picture of direct-care industry

The need for direct-care givers in New Hampshire is being outstripped by the supply — and the situation will only become worse as the population of the state ages.

That’s the conclusion of yet another study of the state’s direct-care landscape, this one by the Carsey Institute at the University of New Hampshire.

The Carsey report, “Home Care Workers: Keeping Granite Staters in Their Homes as They Age,” was written by Kristin Smith, a family demographer at the institute. Released Sept. 14, it was conducted in partnership with a survey by the New Hampshire Coalition for the Direct Care Workforce. The coalition, in conjunction with the New Hampshire Institute for Health Policy and Practice and the Institute on Disability at UNH, made policy recommendations in a white paper.

According to the report, “direct care givers” are those who provide hands-on care for older adults and those with disabilities.

The report’s results “call us all to the table to reduce existing barriers to support and expand this field,” said Nick Toumpas, commissioner of the New Hampshire Department of Health and Human Services, which has staff members serving on the coalition.

Statistics in the report from the coalition survey paint a stark picture:

• The median hourly wage for home-care workers in New Hampshire was $10 in 2008, compared to the median hourly wage for all New Hampshire workers of $16.48 in 2007 and $17.25 in 2008.

“There is some variation depending on position,” Smith told NHBR. “For example, licensed nursing assistants make about $11.77 per hour, whereas homemakers make less than $9 per hour.”

• Some 29 percent of home-care workers in New Hampshire typically work full-time hours for their home-care agency. By cobbling together part-time jobs, 46 percent attain full-time hours, but they lack benefits and face a wage disadvantage compared to those who have full-time hours at their home-care agency.

“There are number of other reasons where part-time positions are more prevalent,” said Smith. “Some workers may only want to work part-time. Others are taking care of a family member or a friend, and are getting paid by an agency, but do not want to care for strangers. Some clients only need 20 hours of care per week.”

• Very few home-care workers receive paid time off; in fact, 67 percent have no paid leave of any kind. Full-time workers are twice as likely to have paid leave as part-time workers.

• One-third of home-care workers in New Hampshire lack health insurance, primarily because it is too expensive for the employees to obtain.

There are about 2,790 employees in the “Home Health Aides” category, according to the May 2008 report by the state Economic and Labor Market Information Bureau. By 2016, the category is expected to increase by 1,300 positions — a growth of 59 percent.

Improving wages

While a direct needs comparison of the over-65 population cannot be made — not all seniors will require home-health care and some of those that are much younger may need such care — the state’s population of those aged 65 and older may grow from about 165,000 currently to as many as 437,000 in 2030, according to statistics from the state Office of Energy and Planning.

Based on the survey, increasing wages was the top issue in improving job satisfaction among direct care givers. While raising the minimum wage is one possible solution, taking a closer look at “the state’s Medicaid reimbursement structure to ensure that home care workers receive a livable wage and have access to benefits, such as health insurance and paid leave” could be another option, according to the report.

Another way to improve job satisfaction is to offer more full-time employment. Those who are working part-time but want more hours often work several part-time jobs to earn a higher income.

“Their part-time status often makes them ineligible for health insurance coverage and cuts in half their likelihood of having paid leave. Increasing work hours to full-time for those who want more hours could improve job quality, increase take-home pay, and improve access to benefits,” said the report.

Smith said she hopes the report “spurs debate to get people thinking about strategies. Use the data in policy discussion. There is no one quick fix.”

To view a copy of “Home Care Workers: Keeping Granite Staters in Their Homes as They Age,” visit

Cindy Kibbe can be reached at