Personal Care Aides as Household Employees and Independent Contractors: Estimating the Size and Job Characteristics of the Workforce

Background and Objectives

Although studies pointed out that the number of personal care aides (PCAs) at risk of being in informal employment arrangements is sizeable, little is known about its size and worker characteristics. This study aimed to estimate the share of PCAs working as household employees or independent contractors. It also aimed to compare their basic job characteristics against the job characteristics of those working as agency and government employees.

Research Design and Methods

Using data from the 2014–2018 American Community Surveys, a sample of 43,287 PCAs working for pay in the home- and community-based service (HCBS) industry was identified, and their job characteristics—full-time weekly work (i.e., working at least 35 hours per week), year-round work (i.e., working at least 50 weeks a year), and annual gross earning—were analyzed by their employment arrangement.

Results

Analyses found that (a) close to a quarter of aides in the HCBS industry work as household employees or independent contractors while their share in the workforce varies by state and that (b) the work hours and earnings of full-time year-round working household employees or independent contractors are greater than those of their agency counterparts. The results shed light on why some aides may work as household employees or independent contractors.

Discussion and Implications

The presence of household employees and independent contractors has important implications for PCAs’ job characteristics and labor shortage in the U.S. home care industry. Considering the potentially negative consequences for both the aides’ economic security and the quality of care that consumers can receive, attention should be paid to ways to bring the aides into a more formal employment arrangement.

LTC 2.0: The 2017 reform of home- and community-based long-term care in Taiwan

Taiwan planned to establish a social insurance-based long-term care system in 2016. However, due to the change in political parties that year, it was decided that Taiwan's long-term care policy would remain a tax-based financing scheme. The new policy focuses on providing home- and community-based service (HCBS); a three-layer HCBS service network within towns and districts was set to provide the 17 types of services in the HCBS spectrum, including preventive care. The reform was criticized as being too restrictive and lacking flexibility. However, the HCBS service spectrum has been widened, the target group has been enlarged, and thus HCBS utilization has increased. A rolling amendment has continued into 2018: the HCBS system requirement has been eased, and a new capitalized fee-for-service payment system has been launched. This paper discusses the analysis of the policy reform.

Availability of Medicaid home- and community-based services for older Americans and people with physical disabilities

This article provides an overview of Medicaid home- and community-based services (HCBS) for older adults and individuals with physical disabilities by describing eligibility criteria, availability, and types of services. All 50 state Medicaid programs provide supplementary HCBS in addition to mandatory services. The amount, type, and eligibility for HCBS varied widely between states. Variation in service provision and eligibility rules has led to a patchwork of services from state to state, with the same person eligible for services in one state but not another.