They provide for others. Now community attendants want the Legislature to provide a livable wage.

By Madeline de Figueiredo

Reporting Texas

Thomas Greenwell wakes up each morning and gets ready twice — he goes through the motions of brushing teeth twice, doing hair twice and getting dressed twice — once for himself and once for his client, Edgar. 

Greenwell is a community attendant in Pearland, south of Houston, who described his work as a full-time, hands-on effort. “Every single daily task someone would do for themselves, I do for myself and then I also do with Edgar,” Greenwell said. 

But Greenwell doesn’t know how much longer he will be able to afford to take care of Edgar as a community-based care provider under Medicaid. He makes $10.60/hour, a wage set by the Texas Legislature in 2023. 

“The attendant care wages are not sustainable at all,” the 19-year-old Greenwell said. 

He lives with his family but said he has been hoping to move out for some time. “In Pearland, rent alone for a small apartment would take up both my monthly paychecks — forget taking into account gas, food or utilities.”  

The Legislature will revisit attendant wages in this spring’s legislative session as caregivers and advocacy groups push for more competitive and livable wages. 

State Rep. Suleman Lalani, D-Sugar Land, who is also a physician, has introduced a bill that  would set a minimum wage of $15 per hour for personal attendants under Medicaid and other Texas Health and Human Services programs.

“We owe care providers the opportunity to have a good quality of life that allows them to put food on the table,” Lalani said. “When you look at the numbers, people are making more money working at fast-food restaurants and grocery stores than the people who are breaking their backs taking care of fragile communities.” 

Lalani said that the low wages for attendant positions have fueled worker shortages and gaps in care that put preventive care on the back burner and lead to greater expenses down the line in hospitalizations and complications. 

“As a physician legislator, I think we are penny wise and pound foolish in our healthcare policy,” Lalani said. 

The latest Texas Senate Budget bill seeks to raise wages for community attendants to $12 an hour, a number that is still subject to change and a far cry from the $20-an-hour minimum wage that the Personal Attendant Coalition of Texas and its partners are advocating. 

The budget bill allocates $46.5 billion for Texas Health and Human Services, marking a 1.9% increase from the previous state budget. Of that, $756 million is earmarked to boost base wages for community attendants.

“As attendants, we are an extension of the person we assist,” said Cathy Cranston, a community attendant and organizer with PACT. “But we are also struggling.” 

“Some attendants are aging out of this work and many are receiving services through the state, such as food stamps and housing subsidies, because the low wages don’t cover basic expenses in some cities,” Cranston said.

Data from the the Texas Health and Human Services Commission and Paraprofessional Healthcare Institute indicate that the median age for community attendants in Texas is 50 and that 88% of Medicaid home and community-based service workers in Texas are women, 79% are people of color and 35% receive some form of government assistance. 

“Our young people don’t want to come into this field of work under the current circumstances. We need to create incentives,” Cranston said.     

Greenwell recognizes that low wages for community attendants deter both him and other young people from pursuing the profession. 

“I don’t see myself doing this for a long time,” Greenwell said. “Not many young adults are going to be able to do this work given the current wages. The sad part is that without caregivers, people won’t be able to receive the care and support they need.” 

He is not alone in considering leaving the profession. Jeff Miller with Disability Rights Texas said that low wages, lack of benefits and unstable hours make it hard to retain skilled caregivers, compromising care quality.

In the 2023 legislative session, lawmakers raised the base wage for community-based caregivers to $10.60 per hour from $8.11. At the beginning of that session, the Texas House proposed a $15 per hour wage in the general appropriations bill, while the Senate proposed $11 per hour. Many advocates expected a compromise somewhere in between, but instead lawmakers set the minimum wage at $10.60. 

At the same time, they raised the base wage for employees at state hospitals and supported living centers to $17.50 per hour to address urgent staffing shortages at those facilities. Miller said that the wage disparity for similar work has led to an imbalanced competition for job opportunities.

“Provider agencies with the $10.60 wage floor have about a 30% vacancy rate, their employees on average are working between 60 and 70 hours per week because of understaffing, and staff retention is a huge problem,” Miller said. “The low wage has become a real issue for community providers and is directly impacting people with disabilities.” 

Nancy Crowther, an organizer with ADAPT of Texas, a disability rights group, who relies on daily care from a community attendant, has experienced the consequences of the low wages. 

“I have had a very difficult time finding good attendants at the minimum wage pay rate,” Crowther said. “It is very challenging to find someone who will stay in the position at $10.60. When wages are suddenly $16 at Dairy Queen, you will be dropped like a hot rock and left scrambling to find care.” 

Community attendants said they are prepared to continue their advocacy throughout this legislative session.

“We hope this legislative session will bring livable wages to community attendants,” Cranston said. “For many of us that have been attendants for decades, it is in our blood to do this work. We deserve to be compensated fairly.”