A citrus smell permeates the air as local homecare worker Irma Luz Lopez — Malu Lopez for short — makes the weekly supply of homemade orange juice for her client, Diane Wohlman.
“Diane, should I make all of them today?,” Lopez asks. Her client replies, “Pretty much, maybe leave a couple.”
Wohlman, 61, lives in a cozy condo complex in southeast Las Vegas. The living room décor is fancier than your average home. A large silver flower vase sits on the coffee table, a vine of silk leaves snakes around a silver-framed mirror, and a white fur blanket lays on the sofa.
Wohlman’s cats, Baby and Coco, were too scared to come out — for which my allergies made me grateful. But besides them, Wohlman lives alone. Dressed in a green and purple, flower-patterned sundress, she waits patiently in her wheelchair for her orange juice.
From trips to the nail salon, to going out for ice cream, to squeezing fresh orange juice, Lopez does things for Wohlman that far exceed caregiving. She makes life easier … and even provides emotional support. Wohlman finds Lopez’s services invaluable. But homecare workers might describe themselves as under valued … not by their clients, but by the state.
WOHLMAN HAS BEEN Lopez’s client for more than six months and sees her 12 hours a week. Lopez was hired following a stroke that affected the left side of Wohlman’s body. She says it has affected her ability to do everyday things.
“Well, I use a walker,” she says. “I can walk, but I’m just doing it right now just to be safe, because a couple of weeks ago, I fell. It affected my left side of my body, my left hand, my left shoulder, and my left leg. So, it’s like I’m just learning how to peel potatoes again, and chop vegetables and that. So, I needed help, with meal prep and stuff.”
Wohlman used to work in the convention industry. But since the stroke, she is considered disabled and can’t work. The hospital that admitted her got her to apply for Medicaid, and through a review process, it was suggested she receive a homecare worker to assist her.
“The big thing was me taking a shower,” she says. “Everybody was scared that, they didn’t want me doing that alone without somebody here. So, that’s very helpful. (Lopez) does help with my hair, putting lotion on me. It’s whatever I need. I just mentally make a list of what do I want to get done today? And so, I just know, okay, don’t worry about it, Malu is coming today. So, she’ll take care of it.”
Lopez is 58, and she says she’s been a home healthcare giver with local agency Absolute Home Health Care for more than five years. In black scrubs, contrasting her straight blond hair, she smiles and says home care is something that came naturally: “I came from Mexico 28 years ago. I decided to become a home healthcare giver because I’ve been doing this my whole life. I can’t even remember when I started taking care of others. But once I was blessed with my residence and Social Security, I decided to do it fully.”
Lopez has a bubbly way of talking and a warm smile that she flashes every opportunity she gets. It’s hard for others not to feel happy when they’re around her. But why does caregiving make her happy?
She explains, “This is not a real job.
This is … this is heaven. For me, going and visit people is a blessing. You know, I’m doing what like it most … When I discovered that it’s in my nature to serve, I was happy. So, it’s not something that I’m suffering to do. I love it!”
Wohlman chimes in, “I think she just comes to see my cats.”
But, as much as Lopez enjoys her job, there’ve been some challenges — pay and working hours being the biggest. The State of Nevada approved a raise for homecare workers that took effect in January, and Lopez now earns $16 an hour. It’s a significant increase from the $12 she used to get paid, but she says it’s still not enough.
“At the beginning, I had only two hours here, three hours there, and it was constantly fighting to not always be behind the bills or behind the rent,” she says. “I had to do a lot of things to … survive. But now I feel blessed, because at least with $16, it’s a better living. But still, I always try to have another job in this industry, because at $16, if I were working only the eight hours a day … you do the math. At the end, who can pay a decent rent with that?”
According to the think tank Economic Policy Institute, a Nevada resident who lives alone and has no children would need to make more than $21 an hour just to live comfortably.
The industry also needs more homecare workers. In an ideal routine, a worker can focus on only two clients at a time, but Malu sees three. This can lead to reduced times with each client.
“I would love to spend more time because I can see the results even for myself,” Lopez says. “But unfortunately, we don’t have enough hours. Because even with the commute, it’s almost one hour to come and one hour to go home, because I live far away. But I would love to have my client have more hours in her recovery.”
In other words, advocates say, this year’s raises were a good start. But they’d like to see more worker concerns like Lopez’s addressed. Nevada lawmakers and union activists are hoping to do just that.
ON MAY 30, dozens of unionized homecare workers gathered at Springs Preserve in Las Vegas to hear about potential legislative and union-backed plans in the pipeline for them. Several Nevada dignitaries were also invited to speak at the event organized by the Service Employees International Union Local 1107, the largest healthcare union in the state. It has more than 20,000 members, and Malu is one of them.
Dawn Ralenkotter is another. She’s in union leadership, and a homecare worker herself. She says she wants to fight for her peers: “I’m here to help fight for all, all the homecare workers, not just myself. But I do my footwork and ... I help go to the legislature and speak to legislators. We do phone banking, postcard mailers, and just whatever we can do.”
Union lobbying played a big part in getting the Nevada Legislature to approve the state’s first homecare employment standards board as well as the January raises. But activists say their work isn’t finished.
Among those at the Springs Preserve event were Nevada state senators Dina Neal and Rochelle Nguyen. With union support, Neal and Nguyen are looking to raise the minimum wage for homecare workers another $4 to $20 per hour. They also want to increase the number of hours workers can spend with clients, improve training, and make the homecare employment standards board permanent.
And, they say, increasing the Medicaid reimbursement rate from $25 to $30 an hour is key to paying homecare workers more, because Medicaid is a major source of the funding private agencies need to pay their workers.
Neal says balancing profit and paying workers a living wage can be challenging for businesses, but necessary. “We need to have a conversation about what is the balance between work and business, because at the end of the day, the worker that you have coming in every day to work for you — you need them to be able to perform. How is it that they can give you their best selves, their best mental space in the job when they’re worried about whether or not there’s going to be an eviction notice when they come home? And I think that argument is prevalent just because businesses do want to take care of their workers,” she says.
Neal and Nguyen, who are up for reelection this November, hope to introduce these measures in the 2025 state legislative session. They stress the urgency of taking care of Nevada’s homecare worker crisis as soon as possible. It’s more than just campaign rhetoric. In a 2023 report, the American Association of Retired Persons ranked Nevada as the sixth-worst in the nation for homecare worker access, quality, and support.
All these factors add up to an environment that doesn’t exactly motivate people to join the homecare industry. On the contrary, it’s motivated some to leave the profession altogether. In 2020, the Guinn Center for Policy Priorities reported that one in two homecare workers leave the job within a year of taking it.
Senator Nguyen says fixing retention is a top priority for her, adding, “It’s not easy work. It’s emotionally difficult. It can be physically difficult. And so, trying to retain them, I think having better training, having more increased wages — all those kinds of supportive services can lead to, to make sure that we have a robust workforce in this area.”
Complicating matters, Nevada’s senior population is growing faster than in the rest of the U.S. A 2023 report from the state’s Aging and Disability Services Division shows that, from 2011 to 2019, Nevada’s 65-and-older population grew by 46 percent compared to that of the U.S. overall, at 30 percent. And that rate of growth is expected to keep increasing through 2030.
With the population aging rapidly, will Nevada have enough homecare workers to meet demand in the future? The 2020 Guinn Center report found that Nevada’s homecare workforce is growing at a slower rate than the national average.
The state currently has more than 13,000 homecare workers for a population of 3.2 million and would need to hire more than 5,000 additional workers by 2026 to keep up with demand.
SO, WHAT WOULD happen if homecare workers such as Lopez didn’t start making a living wage, or spend as much time as needed with their clients? What happens if the state’s homecare crisis in general doesn’t get solved? Wohlman doesn’t want to find out.
“With all of this with my stroke, I count my blessings every day. I realize how much the good Lord has done for me, and he sent me Malu. So, I’m so grateful. I mean, I don’t want to get emotional,” she says, choking up, “but … it is hard. Because you need people. So, this is a very important service, you know, that someone’s coming in checking on me, making sure I’m okay. And, you know that I’m surviving, that I’m thriving. So, it’s very important.”
Perhaps thinking about those who don’t qualify for the service, she adds, “Check on your elderly neighbors. They may not be doing okay. They may need some help.”
