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Low Pay for Care Workers Leads to Understaffing

Renee Lopez and her care attendant Maria Medina pose for a portrait at Lopez’s home on Tuesday, April 18, 2023 in Hutto, Texas. Lopez, 61, wears leg braces, and uses a motorized wheelchair, which requires help from Medina. Texas is currently facing a shortage of care attendants mainly due to the low wages provided to the workers.
Sergio Flores

Renee Lopez wears leg braces, uses a motorized wheelchair and needs assistance in the morning to get out of bed, take a shower and get dressed. The 61-year-old Austin resident has had limited mobility since birth and depends on a personal attendant.

She gets reliable aid from a live-in attendant who gets paid by a state-funded agency. But should she ever need someone else to fill in, Lopez might be out of luck.

“I called the agency this week, and they don’t have anybody. They have one ‘floater’ for emergencies,” says Lopez, a former state employee who advocates for people with disabilities.

Texas faces a shortage of what are known as community attendants who help individuals with disabilities, including Lopez, with basic day-to-day tasks.

Advocates say the shortage is largely due to low wages. The base wage rate for personal care attendants is $8.11 per hour—about half of what some major retailers and fast-food chains pay.

An estimated 300,000 Texans depend on personal care attendants, but many don’t get the full hours of service they’re supposed to receive because agencies are understaffed, says Dennis Borel, executive director of the Coalition of Texans with Disabilities, a nonprofit advocacy group.

It’s a problem that doesn’t just affect those with disabilities, says Andrea Earl, AARP Texas advocacy and outreach director.

“A lot of older Texans have spent their savings and are needing to use this service,” Earl says.

Attendants provide personal care, such as bathing and dressing. They help with meals, laundry and other household tasks. If people with disabilities and chronic conditions can’t get the help they need, their health suffers, Borel says.

“This is a tragic situation,” he says. “You can’t sugarcoat it.”

Pressing for higher wages

Some advocates want the state to raise the base pay for community attendants to $15. The last rate increase was in 2019 when the Legislature raised it from $8 to $8.11 per hour, Borel notes.

In a presentation to state lawmakers this year, the Texas Health and Human Services Commission acknowledged the need for a wage increase but did not recommend a dollar figure.

The commission noted in a November 2020 report that community attendants play an important role in avoiding more costly admissions to institutional care settings, such as nursing homes, and in reducing potentially preventable hospitalizations and emergency room visits.

“Community attendants in Texas and across the nation often face financial insecurity from low wages, lack of benefits such as health insurance, and high levels of part-time employment,” the commission wrote.

Low pay has led to high employee turnover—estimated at 150 percent annually, according to a report by the nonprofit Texas Health Institute, a public health policy advocacy group. That means a company staffing 100 attendants would need to recruit 150 new workers every year to keep positions filled. The average attendant tenure is only eight months, the report shows.

AARP Texas is among the groups urging lawmakers to increase attendants’ pay during the current legislative session.

State Rep. Mary González (D-El Paso County) introduced legislation that would set a $15 hourly base wage. An increase to $15 an hour would cost the state an additional estimated $2.24 billion in fiscal 2024 and 2025 combined, state data shows.

The issue is also expected to be considered during the ongoing state budget process.

Without higher pay, attendants will continue to migrate into better-paying jobs, González says.

Thomas Korosec is a writer living in Dallas. 

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