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Are Family Caregivers Worth Less?

Editor’s Note: According to the Star Tribune, (thank you PHI National for posting this) a county judge has ruled that the 20% cuts for family caregivers can be enacted.  “Lindman found that the Legislature offered the necessary “rational basis” for the pay cut when it decided that family members have “moral obligations … toward helping family members [and] will continue to provide care even if affected by a pay cut.”

If you are a relative Personal Care Assistant being paid to provide those services by the Minnesota health Care Programs, you will be paid at 80% of the allowable rate if you are related to the care recipient as a parent, sibling, adult child, grandparent or grandchild. This change in payment rates was enacted as a result of budget deliberations in the 2011 Minnesota Legislative Session, 1st Special Session (Chapter 9, Article 7, Section 10) and these changes go into effect October 1, 2011. Personal Care Assistants provide direct care assistance with bathing, grooming, eating, transfers as well as light housekeeping, laundry and meal preparation among other services.

Why should this be? The exact rationale beyond budgetary challenges is hard to determine since budget negotiations were closed to the public. But having a long view on the caregiving advocacy battles may lead one to believe we are back to dismissing supporting caregiving families with comments such as “They are doing the work anyway” or “Caregivers do it for free”. The missed point here is the difference between “free” and “cost”. The economic cost to a caregiver for providing extended care is over $300,000 when factoring in lost wages, benefits and retirement contributions. What appears “free” to some policy makers comes at a significant “cost” to families.

Another way of looking at this issue is changing incentives and shifting costs for caregiving families whether it is by lowering their rate of reimbursement or shredding the community-based service network to the point where placement is the only economically viable option for families. For those adult children caregivers who are working – the majority of primary caregivers now – the choice between caring for your family member at home and the economic stability of your family now and in the future becomes an untenable choice. What incentives do we choose to offer to families struggling with this issue? And do these incentives drive families to use the options that cost the public sector the most: placement in a nursing home or other facility?

Of course, there is the equity issue at the heart of this discussion. If two Personal Care Assistants are doing the same level of work, is it equitable to pay one less – as in this case, 20% less – because they are related to the care recipient? Would we tolerate this in any other areas of employment? Perhaps this issue will be played out in the courts in Minnesota regarding employment discrimination in differential pay scales for similar work.

We are making this change in public policy more public in order to alert families and those who care about this issues and to sound a warning: if this can happen in what is acknowledged to be the best state in the country for long term supports and services*,will other states follow?

*As ranked in “Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers”, AARP Public Policy Institute, SCAN Foundation, Commonwealth Fund, September 2011.

Public Comments and background on the new regulations regarding the new payment scheme:

You can also email, send a letter or make a phone call to Governor Mark Dayton.

Mailing Address:
Office of the Governor
130 State Capitol
75 Rev. Dr. Martin Luther King Jr. Blvd.
St. Paul, MN 55155

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Telephone: 651-201-3400
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