The Underpaid and Overlooked Workforce that Cares for Virginia

Sep 4, 2018


When Barbara Williams (right) had shoulder surgery, she relied on home health aide Barbara Napier (left) to make breakfast, clean, take her blood pressure, and help her get ready each morning.
Credit Kate Thompson

Thanks to a rotating crew of homecare companions, Barbara Williams’ husband was able to live at home at the end of his life

“I met many many good people during that time, that were really good caregivers and very caring,” recalls Williams.


They’re the people who take care of the physically disabled, mentally disabled, our elderly parents. They bathe, feed, comfort and care. They’re home healthcare workers. And as our population ages they’ll be more in demand than ever before.

When Williams had shoulder surgery, she knew to call Companion Extraordinaire. The home health agency sent an aide to her house every morning.

“It meant I knew I had somebody that was going to be here to help me and that meant a whole lot,” says Williams.


Related: Read the Rest of the Series on Home Healthcare

Their days developed a routine. Her aide, Barbara Napier, made coffee, made breakfast, and took her blood pressure. She bathed Williams, dressed her, even fixed her hair.

Aides like Napier are a quickly growing workforce. By making it possible for people to stay at home instead of going to a nursing facility they save taxpayers hundreds of millions of dollars annually.

And yet they face serious challenges. They’re poorly paid, struggle to find consistent work, and their role in healthcare is often overlooked and misunderstood.

In RADIOIQ’s series CARING, we’ll be exploring who makes up this workforce, the challenges they face, and why it should matter to taxpayers.

"I Sacrificed a Lot"



Joyce Barnes is sixty and has worked in healthcare for decades. She loves working one-on-one with people. Her chihuahua was a gift from one of her patients.
Credit Kate Thompson

Joyce Barnes lives in a small one-bedroom apartment outside Richmond. Knock on her door and the first sound you hear is her chihuahua, TJ. The dog has been with her eight years, after a former patient gave him to her.

She took the day off for an interview, but when prompted she admits she still has to work in the evening.

Barnes regularly works 11 hour days. She’ll spend all day looking after an elderly couple, before driving across town to take care of another woman until 10 p.m.

She loves her job. But she struggles to make ends meet.

The median income for this workforce is less than $14,000. Nationwide, more than half rely on some form of federal assistance.

It hasn’t always been this financially tough for Barnes. She used to work as a certified nurse assistant, or CNA, at the Virginia Commonwealth University hospital system. In that role she made just over $16 an hour, but when she switched to working as a home health aide she took a pay cut by half.

“I sacrificed a lot for (my patients),” Barnes explains. “Just so I’ll be there to take care of them...and some that don’t have family. All they have is you.”

She still regularly visits former patients, like one woman who has moved on to a nursing facility.

“Like this weekend is her birthday, so I’m going to make sure I go out there and take her a birthday gift and let her know ‘I didn’t forget you.’,” says Barnes.

Reporting for this series is based off more than a dozen in-depth interviews with home healthcare workers. Most expressed the same motivation as Barnes -- to provide personal care in a one-on-one setting. Many were reluctant to complain about low pay.


But Barnes recalls her grandson bringing home a paycheck from his job as a janitor.

“To know that I have grandkids now that’s working summer jobs and stuff, and they’re coming out with already $10-something,” Barnes says. “I’m the hardest worker. I work so hard till my knees and stuff, is hurting..I ache. And I can’t get ahead for nothing.”



I think there are important questions we could be asking ourselves. Primarily, why aren't we paying a living wage to the women who are doing this work?

"We Know Very Little About It"

Homecare ranks among the top ten fastest growing occupations in the country. And yet according to an industry survey, turnover in the industry is more than 60-percent. Home healthcare workers cite low pay and inconsistent hours as major struggles. Experts predict huge shortages in the near future.

The fact that there aren’t people to fill the jobs could spell trouble for our quickly aging population. By 2030, 1-in-5 Americans will be 65 or older.

Jenny Inker is a gerontologist and researcher at VCU. She’s studied the effect of the home health industry on Virginia’s economy.

“What’s really interesting to me about homecare is that despite the fact that it’s such a big influence on our economy we know very little about it,” says Inker.

Joyce Barnes loves what she does, but makes about $9 an hour and doesn't get benefits like health insurance or paid sick leave.
Credit Kate Thompson

At a state level there’s not much data, and even less analysis. We don’t know much about who is doing this work, what kind of training they receive, or how well the job is being done. Inker says that lack of information reflects our priorities.

“From just a justice and an equity standpoint I think there are important questions we could be asking ourselves,” Inker says. “Primarily: why aren’t we paying a living wage to the women who are doing this work?”

Inker cites women specifically because almost 90-percent of the workforce in Virginia is female. The workforce is also overwhelmingly people of color, and increasingly immigrants. That mirrors nationwide statistics.

"I Can Give More of Me"

For weeks, Joyce Barnes went off the map. She would only answer texts sparingly. One day, she finally picked up the phone.

She had contracted a bacterial infection from one of her patients and spent eleven days in the hospital. Like most in her field, she doesn’t have benefits. No sick days. No health insurance.

She found herself thinking back on that decision she had made years ago, to leave her job at VCU and become a home health aide.

My heart is not at the hospital, my heart is dealing with people one-on-one.

“But my heart is not at the hospital,” she sits on the couch in her apartment, thinking out loud. “My heart is dealing with people one-on-one. Because I can give more of me, to that person than running around the hospital.”

Maybe that was a mistake, she admits.

“But I can’t worry about that now,” she adds.

As Barnes waits for the hospital bill, she’s trying not to stress. Instead, she’s been back at the hospital. The patient she caught the infection from has taken a turn for the worst. And along with the patient’s family, Barnes has been by her bedside.