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I own a Medicaid home care agency in 13 states. We serve low income families and our caregivers, who earn $12-18hr which is higher than minimum wage, absolutely

I own a Medicaid home care agency in 13 states. We serve low income families and our caregivers, who earn $12-18hr which is higher than minimum wage, absolutely struggle. We have created food banks and housing assistance because even working people are a few sick days or one car repair away from homelessness. I would encourage you to go work with average Americans in average towns. The facts on the ground are stark and eroding.

logicchains 3mo ago
>I own a Medicaid home care agency in 13 states. We serve low income families and our caregivers There's an extreme selection bias there. If you run an agency that works with low income families you're not going to see a representative sample of the overall population.
- jancsika 3mo ago
  > There's an extreme selection bias there. Maybe. Unfortunately, what digitaltrees wrote here is ambiguous. It could also be read as this: Our caregivers serve low income families. Those caregivers, who are our employees, earn $12-18/hr which is above minimum wage. Our employees absolutely struggle. Our employees are the ones using food banks and housing assistance because many are one car repair away from homelessness. digitaltrees: which interpretation is correct?
  - dmoy 3mo ago
    I think the latter interpretation is correct. As in digitaltrees runs a business that does not pay its employees a living wage, who then have to rely on food banks and housing assistance.
    - digitaltrees 3mo ago
      We don’t set the Medicaid reimbursement rate so we have no control over wages either. We work to be very disciplined about unit economics and fixed costs so as much money goes to caregivers as possible but if Medicaid pays $22hr you can’t pay $20 because you won’t cover the payroll taxes, workers compensation insurance, or required clinical and other admin expenses.
- mrWiz 3mo ago
  If you read the rest of the comment you’ll find it’s about their employees rather than their clientele.
  - digitaltrees 3mo ago
    It’s both. The clients are more impoverished but the caregivers also struggle. I got into this to build software to lower admin expenses and improve operations for an otherwise under served industry. We are making progress and have supported thousands of people in having stable careers. The horror stories I could tell of other agencies exploiting people due to incompetence or malice are shocking.
- digitaltrees 3mo ago
  We have a private pay arm as well, so the other extreme. I also have a roofing company. And I look at the data.
PaulHoule 3mo ago
Someone could interpret that as a lack of capitalism rather than the opposite. That is, Henry Ford changed the world because he deployed capital to make workers so productive that they could afford to buy the cars they make. A person paid to do child care in an organization with overhead, who has to pay taxes, etc. is not productive enough to put their own children in child care. So child care fails to revolutionize the world the way the car did. See https://en.wikipedia.org/wiki/Baumol_effect https://en.wikipedia.org/wiki/Baumol_effect
- throw0101a 3mo ago
  > Someone could interpret that as a lack of capitalism rather than the opposite. In Capitalism surplus economic value goes to the Capital class, so it seems like it is working as designed.
  - PaulHoule 3mo ago
    Some goes to the capital class, some goes to workers. The Marxist eschatology is that there are pressures that cause the fraction that goes to capital increases over time and breaks the system. Look at the good deal that the UAW has gotten for auto workers in the system, both US car makers and the union are pretty happy right to keep this system in place and shrink in the face of technological change like electrification not to mention abandoning small cars for large cars that are profitable for now. (Funny how I often I see "good old boys" driving Asian compacts because they can afford Asian compacts, and I see office workers driving big-ass trucks)
    - deleted 3mo ago
      [deleted]
  - digitaltrees 3mo ago
    But if that capital accumulation is unchecked it destroys the very market forces such as competition and price setting functions through supply and demand necessary for capitalism to work. So capitalists should want to prevent monopolies and concentration of wealth.
HEmanZ 3mo ago
Median income in the US is much higher than $12-18/hr, it is about $30/hr. 25th percentile make $20/hr. 10th percentile make $15.58. https://www.bls.gov/news.release/wkyeng.htm https://www.bls.gov/news.release/wkyeng.htm So, the people you are mentioning making 12-18/hr, are literally below 1 in 4, to less than 1 in 10. These are not “average middle class Americans” except maybe in that higher end. These are low wage earners and are far below “average”. I mean absolutely nothing normative by this statement, nothing about whether this is good or bad or what we should do policy, socially, whatever. But saying someone making below the 10th percentile is average is like saying someone making $75/hr is average.
- digitaltrees 3mo ago
  They are within 25% of the of the median. So they are the lowest range of 50% of the bell curve.
  - HEmanZ 3mo ago
    Literally not a single one of those numbers is above the 25th percentile. 18 < 20.
taeric 3mo ago
I would fully get behind us paying service providers far more than we do. To wit, it baffles me when people are upset about how much we allocate to pay for services that go to older people, but then we don't do any effort to make sure the services are provided by younger people. Indeed, we seem to go out of our way to make sure the people providing these services are, themselves, low income. It is baffling. But even this feels like it is overstating things. You say folks are one car repair away from being homeless. And there is a lot of polling that shows people would struggle to pay for repairs. But full on homelessness? I can only assume that you are describing towns/cities that offer no transport assistance at all, that lands people into being so dependent on a car. I believe it, but I struggle to think this is literally half the nation.
- digitaltrees 3mo ago
  I had an employee that was homeless last week. We were trying to figure out what to do. We’ve been looking into buying apartments to convert them to condos for a first time home buyer program, but the economics are hard to make work. We have considered buying a camper that can move around The reality is that when 40% of your income goes to rent, how many days of work can you miss before you can’t pay rent? If your car breaks down, how many days will your employer tolerate while you try to get it fixed, assuming you have the money to fix it. You don’t have to believe me, just look up the state on the percentage of Americans living pay check to paycheck.
  - taeric 3mo ago
    The stats on "living paycheck to paycheck" are notoriously rough. With some people that make 300k a year claiming they fit that category. Don't get me wrong, I sympathize with your given scenario. I actually lost my car when I was younger. Was a rough few months while I got used to commuting without one. And I was lucky to have a roommate that kept my cost of living down. And I remain a proponent of increasing pay to service providers. As well as finding ways to provide cheaper living conditions. First time home buyer programs are great, but seem unlikely to be relevant for the workers we are talking about? I see the median age of home care nurses in rural areas drifts up to 51-53. Which, granted, I see the median age of first time home buyer is drifting up. I don't think it is as high as those workers, though. I do think there is a problem here. I just don't think it rises to "half the nation lives in abject poverty."

logicchains 3mo ago

>I own a Medicaid home care agency in 13 states. We serve low income families and our caregivers There's an extreme selection bias there. If you run an agency that works with low income families you're not going to see a representative sample of the overall population.

jancsika 3mo ago
> There's an extreme selection bias there. Maybe. Unfortunately, what digitaltrees wrote here is ambiguous. It could also be read as this: Our caregivers serve low income families. Those caregivers, who are our employees, earn $12-18/hr which is above minimum wage. Our employees absolutely struggle. Our employees are the ones using food banks and housing assistance because many are one car repair away from homelessness. digitaltrees: which interpretation is correct?
- dmoy 3mo ago
  I think the latter interpretation is correct. As in digitaltrees runs a business that does not pay its employees a living wage, who then have to rely on food banks and housing assistance.
  - digitaltrees 3mo ago
    We don’t set the Medicaid reimbursement rate so we have no control over wages either. We work to be very disciplined about unit economics and fixed costs so as much money goes to caregivers as possible but if Medicaid pays $22hr you can’t pay $20 because you won’t cover the payroll taxes, workers compensation insurance, or required clinical and other admin expenses.
mrWiz 3mo ago
If you read the rest of the comment you’ll find it’s about their employees rather than their clientele.
- digitaltrees 3mo ago
  It’s both. The clients are more impoverished but the caregivers also struggle. I got into this to build software to lower admin expenses and improve operations for an otherwise under served industry. We are making progress and have supported thousands of people in having stable careers. The horror stories I could tell of other agencies exploiting people due to incompetence or malice are shocking.
digitaltrees 3mo ago
We have a private pay arm as well, so the other extreme. I also have a roofing company. And I look at the data.

PaulHoule 3mo ago

Someone could interpret that as a lack of capitalism rather than the opposite. That is, Henry Ford changed the world because he deployed capital to make workers so productive that they could afford to buy the cars they make. A person paid to do child care in an organization with overhead, who has to pay taxes, etc. is not productive enough to put their own children in child care. So child care fails to revolutionize the world the way the car did. See https://en.wikipedia.org/wiki/Baumol_effect https://en.wikipedia.org/wiki/Baumol_effect

throw0101a 3mo ago
> Someone could interpret that as a lack of capitalism rather than the opposite. In Capitalism surplus economic value goes to the Capital class, so it seems like it is working as designed.
- PaulHoule 3mo ago
  Some goes to the capital class, some goes to workers. The Marxist eschatology is that there are pressures that cause the fraction that goes to capital increases over time and breaks the system. Look at the good deal that the UAW has gotten for auto workers in the system, both US car makers and the union are pretty happy right to keep this system in place and shrink in the face of technological change like electrification not to mention abandoning small cars for large cars that are profitable for now. (Funny how I often I see "good old boys" driving Asian compacts because they can afford Asian compacts, and I see office workers driving big-ass trucks)
  - deleted 3mo ago
    [deleted]
- digitaltrees 3mo ago
  But if that capital accumulation is unchecked it destroys the very market forces such as competition and price setting functions through supply and demand necessary for capitalism to work. So capitalists should want to prevent monopolies and concentration of wealth.

HEmanZ 3mo ago

Median income in the US is much higher than $12-18/hr, it is about $30/hr. 25th percentile make $20/hr. 10th percentile make $15.58. https://www.bls.gov/news.release/wkyeng.htm https://www.bls.gov/news.release/wkyeng.htm So, the people you are mentioning making 12-18/hr, are literally below 1 in 4, to less than 1 in 10. These are not “average middle class Americans” except maybe in that higher end. These are low wage earners and are far below “average”. I mean absolutely nothing normative by this statement, nothing about whether this is good or bad or what we should do policy, socially, whatever. But saying someone making below the 10th percentile is average is like saying someone making $75/hr is average.

digitaltrees 3mo ago
They are within 25% of the of the median. So they are the lowest range of 50% of the bell curve.
- HEmanZ 3mo ago
  Literally not a single one of those numbers is above the 25th percentile. 18 < 20.

taeric 3mo ago

I would fully get behind us paying service providers far more than we do. To wit, it baffles me when people are upset about how much we allocate to pay for services that go to older people, but then we don't do any effort to make sure the services are provided by younger people. Indeed, we seem to go out of our way to make sure the people providing these services are, themselves, low income. It is baffling. But even this feels like it is overstating things. You say folks are one car repair away from being homeless. And there is a lot of polling that shows people would struggle to pay for repairs. But full on homelessness? I can only assume that you are describing towns/cities that offer no transport assistance at all, that lands people into being so dependent on a car. I believe it, but I struggle to think this is literally half the nation.

digitaltrees 3mo ago
I had an employee that was homeless last week. We were trying to figure out what to do. We’ve been looking into buying apartments to convert them to condos for a first time home buyer program, but the economics are hard to make work. We have considered buying a camper that can move around The reality is that when 40% of your income goes to rent, how many days of work can you miss before you can’t pay rent? If your car breaks down, how many days will your employer tolerate while you try to get it fixed, assuming you have the money to fix it. You don’t have to believe me, just look up the state on the percentage of Americans living pay check to paycheck.
- taeric 3mo ago
  The stats on "living paycheck to paycheck" are notoriously rough. With some people that make 300k a year claiming they fit that category. Don't get me wrong, I sympathize with your given scenario. I actually lost my car when I was younger. Was a rough few months while I got used to commuting without one. And I was lucky to have a roommate that kept my cost of living down. And I remain a proponent of increasing pay to service providers. As well as finding ways to provide cheaper living conditions. First time home buyer programs are great, but seem unlikely to be relevant for the workers we are talking about? I see the median age of home care nurses in rural areas drifts up to 51-53. Which, granted, I see the median age of first time home buyer is drifting up. I don't think it is as high as those workers, though. I do think there is a problem here. I just don't think it rises to "half the nation lives in abject poverty."