Scott Semo and his caretaker Nora Clark pose for a photograph in Semo's home in Roseville. Credit: Jaida Grey Eagle | Sahan Journal

Twenty-one years ago, Scott Semo suffered a massive brain hemorrhage that destroyed his ability to talk, eat on his own, and move around. 

Every weekday now, Nora Clark drives to the 50-year-old Semo’s Roseville home to care for him. As a personal care assistant, Clark cleans for him, cooks, does his laundry. She bathes him, dresses him, brushes his teeth. One of the more challenging parts of the 62-year-old Clark’s job comes when she must physically lift Semo from his wheelchair to his bed, the car or elsewhere.  

“Every transfer is a challenge,” Clark said. “He can’t walk. He can drop at any moment. His ankles are weak.” 

In the last two years, they ran into another challenge: finding enough home health care workers to both care for Semo and relieve Clark. The vast majority of patients like Semo use public insurance to pay for workers like Clark, and a low reimbursement rate from these insurance companies keeps their pay at around $14 to $16 per hour. 

Semo needs constant help, and before the pandemic, he had at least four home caregivers caring for him around the clock. Semo lost three of his providers that year. Since then, a shortage of workers prompted both his 77-year-old mother Delores Flynn and stepfather to do paid caregiving for him. 

“It left this big void,” Flynn said. “He needs 24-hour care.”

Clark works a full workweek but has a hard time taking time off when she needs or wants to because Semo can’t find anyone else. “I’m not allowed to work more than 40 hours per week, even though they could use it,” she said.

Semo is by far the most challenging patient Clark has had in her 17 years of doing this kind of work. But she’s stayed with him for more than five years, partly because of the bond she grew with him and his family, and partly because of how the challenges helped her grow.

“I have family members who say, ‘Why haven’t you quit yet?’” Clark said. “Yet I’m glad I became his caregiver. I learned some things I never knew of before.”

The extent of the current home care workforce shortage isn’t known, but state records currently show 40,000 job vacancies across the healthcare industries. A sizable portion of these vacancies are driven by the lower-earning positions. For example, Hennepin Healthcare Talent Acquisition Director Tony Campisi recently told Sahan Journal that his organization was seeing the worst shortages in nursing and medical assistant positions. 

This is because the pay for high-intensity healthcare jobs like Clark’s must compete with similar pay for less intensive jobs across many industries. 

“These days, even McDonalds pays $14 or $16 an hour,” said Osage Edison, who runs the Brooklyn Park-based home health care provider Anchor House. “If you pay healthcare workers minimum wage, it makes them think they don’t deserve better.”

Home care advocates are pushing the state Legislature to act on wage increases this session. 

Clark loves her work. Every job she’s had required some way of helping people. Before becoming a personal care assistant, Clark worked as a caregiver in group homes. 

“This has been pretty much my life,” she said. 

Clark makes just over $16 per hour. It’s much more than the $9 she started out at in 2005, but still low enough to prompt many of her colleagues to switch to less difficult jobs. That includes two of Clark’s own nieces, one of whom went to work in a group home, where patients can be easier to manage; another who became a bus driver for Metro Transit. 

“It’s not just mopping the floor and taking out the garbage,” says Nora Clark. “We’re actually out here helping human beings stay in their homes.” Credit: Jaida Grey Eagle | Sahan Journal

Across all industries, Minnesota is currently experiencing an average of two job vacancies for every unemployed person actively seeking work—a record high, according to Cameron Macht, the acting assistant director of labor market Information at the state Department of Employment and Economic Development. The majority of industries across Minnesota set job vacancy records last year, prompting employers to add perks like higher wages and better benefits. 

“There’s lots of different options for people who worked in health care before who can get employed in other areas,” Macht said. 

But home health care employers say they can’t just simply raise wages. Their workers’ salaries are based on their patients’ health insurance reimbursement rates, and the vast majority of the time these patients are using public insurance like Medicaid. Minnesota state government decides the reimbursement rate for Medicaid. Any change requires legislative action.

Kathy Messerli, executive director of Minnesota Home Care Association, said that after overhead and licensing costs, the reimbursement rates limit home care companies from paying competitive salaries. 

“The rate of pay is so low that they could go work in an industry that won’t expose them to COVID and make more money than they can as a home health aide,” Messerli said. 

At Anchor House, Edison said that his staff decreased from between 40 and 45 employees before the pandemic to 15 currently. At current Medicaid reimbursement rates, Edison said he can’t afford to pay more than $13 to $14 an hour. 

Personal care assistants did score a big win last year when the state agreed to raise the minimum wage for the occupation from $13.25 an hour to $14.40 an hour. That minimum rate is slated to increase again this summer to $15.25 an hour.

Similarly, the state Legislature approved a bill last year that raised Medicaid reimbursement rates for home health care workers across the board by 7 percent. 

With a $7.7 billion state surplus, advocates are once again aiming for legislators to increase pay for home care workers this legislative session, which began last month and lasts until May. Messerli said her organization is asking the Legislature to allow reimbursement to home health care agencies for tasks like coordinating patients’ appointments with doctors and medical providers. 

“The agencies do that work and sometimes spend many hours coordinating, but they don’t get reimbursed for it,” Messerli said. “They just get reimbursed for going to the house and visiting.” 

And while home care workers appreciate the 7 percent increase in Medicaid reimbursement, Messerli said it’s still not enough. She plans to ask the Legislature for more. 

Clark got a bump in her pay recently, but for her this still isn’t enough to match the dignity of her work. 

“It’s not just mopping the floor and taking out the garbage,” Clark said. “We’re actually out here helping human beings stay in their homes.” 

Personal care assistants, Clark argues, give patients like Semo the ability to live as independently as they can.

Joey Peters is a reporter for Sahan Journal. He has been a journalist for 15 years. Before joining Sahan Journal, he worked for close to a decade in New Mexico, where his reporting prompted the resignation...