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More and more Americans need home health care, and finding a caregiver is hard. The pay is low. Turnover is high, which is why Nevada has been raising caregiver wages. NPR's Andrea Hsu reports.
ANDREA HSU, BYLINE: Thomas Draa is a high school science teacher. Almost 20 years ago, he was in a car crash.
THOMAS DRAA: In 2005, my buddy ran a red light.
HSU: He suffered a spinal injury that left him unable to use his legs. Since then, he's needed help getting out of bed, getting cleaned, getting dressed and getting in his van to go to school. That help hasn't always been reliable.
DRAA: We would have people coming and going or not showing up to get me up, and I wouldn't go to school that day.
HSU: Then came Irma Nunez. For the past 12 years, she's been at his house 20-some hours a week.
DRAA: What is it, 23?
IRMA NUNEZ: Like, 23, 24 1/2, around there.
HSU: That's how much Medicaid covers every week.
NUNEZ: I come a.m. and I come p.m., every single day.
HSU: In the mornings, she's there at 4:30 so that Draa can make it to school by 6 a.m. - an hour before the kids get there.
DRAA: I wouldn't be able to go to school or work if it wasn't for Irma.
HSU: After school, she returns to help Draa get back into his house and back into bed. The work is taxing. And a year ago, she was earning the going rate - around $11 an hour.
DRAA: I always thought it was just crazy they made such a little amount of money.
HSU: To make ends meet, Nunez used to pick up as much work as she could, taking on multiple clients, driving from house to house - a couple hours here, a couple hours there - seven days a week.
NUNEZ: You see a lot of people needing you, so you help them. You know, you're helping, and that makes you feel good.
HSU: Still, she was frustrated - not just with her low pay, but her lack of health insurance and other benefits.
NUNEZ: No PTO, no vacations, no nothing. I don't work, I don't get paid.
HSU: So she jumped at the chance to do something about it. In 2023, she and other caregivers took their fight to the Nevada legislature, with backing from the union SEIU. They asked the state to send more Medicaid dollars to the agencies that employ them, so the agencies in turn could pay them more. The caregivers shined a light on how hard their days are - bathing and feeding patients, helping them go to the bathroom. Turned out they had a receptive audience.
NUNEZ: People told us personal stories about their dads, moms, grandparents, so they knew what we were talking about.
HSU: And in the 2023 budget bill, Nevada lawmakers granted their wishes. They even set a new $16 minimum wage for home care workers - far higher than the state minimum wage. It took effect in January last year.
NUNEZ: First paycheck, I'm all like, oh, wow. Like, way different.
HSU: Now, a year later, the wage boost is proving to be game-changing for the industry, too. It used to be that half of home care workers in Nevada didn't even last a year. In the four months after the new minimum wage took effect, turnover fell to almost nothing. Home health agencies have been growing their ranks at a faster clip, and so has the union. Since 2023, a thousand caregivers have voted to unionize - to have a bigger voice. And when the Nevada legislature convenes again next month, Irma Nunez will be part of a larger contingent of caregivers demanding another raise.
NUNEZ: Maybe from $16 to $20 - or, if possible, higher, because we need it.
HSU: She says her rent keeps going up. Her car needs new tires. She still has no health insurance. And, at 58, she herself is dealing with all kinds of health problems.
NUNEZ: I'm older. I'm older, and I'm not the Irma that I used to be.
HSU: A $20 wage, she says, would help her save a little money for her own retirement.
Andrea Hsu, NPR News, Henderson, Nevada.
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