LaToya Francis hasn’t paid rent since December of last year.

She usually struggles to afford the $1,250 in rent for her apartment in Northeast D.C., where she and her two kids live, but an unexpected need for a new radiator during the already expensive holiday season put her even further behind than usual. Her domestic violence survivor subsidy is expected to end soon, and she does not know how she’ll afford the $325 increase in rent payments. Just last week, her bank account had a negative balance because her phone bill’s automatic payment kicked in and she incurred overdraft fees.

“The amount that I get paid is just not enough,” Francis tells DCist/WAMU. “I’m trying to find a way to take a little bit from this bill and put [it] towards another bill — kind of rob Peter to pay Paul.”

Francis works as a certified nursing assistant at BridgePoint Hospital in Bellevue. She says she does the “the dirty jobs that nobody else wants to do.” She bathes, dresses, feeds, and toilets people who can’t do so by themselves.

Francis says BridgePoint pays her a minimum of $18 an hour for this work. To make ends meet, she also moonlights as a home health aide, another job that’s physically and emotionally taxing. She travels 40 miles west to Manassas, Va., for her second job, picking up as many aide shifts as she can manage outside the three 12-hour overnight shifts that make up her full time work at the long term acute care hospital. Between caring for her patients and her kids, Francis is exhausted.

“Thank God I have a supportive partner and a supportive family behind me because if not I’d really be drowning in my struggle right now,” she says.

Francis is part of a coalition of 20 groups — including local labor union 1199 SEIU, adult public charter school Academy of Hope, and various senior villages — calling on D.C. lawmakers to increase the starting wage for direct care workers to $22 per hour. Direct care workers include certified nursing assistants, home health aides, and direct support professionals who care for people who are elderly or disabled, either at their home or in long term care facilities like nursing homes. These workers earn just under $30,000 per year on average, according to the District’s state plan to the U.S. Department of Labor — the lowest median annual wage of any sector.

Direct care workers and their advocates say the increase will benefit people who are barely surviving financially, while also alleviating the sector’s labor shortage. Wage increases would also address racial disparities, since 87% of regional direct care workers are people of color, as well as economic disparities in a city where nearly 1 in 5 workers live in poverty, according to testimony to the D.C. Council by 1199SEIU.

Francis says a base wage of $22 an hour would be life-changing.

“It would mean I can afford to take a day off and actually use the vacation time that I’ve earned because my body just needs to rest,” she says.

Like many direct care workers, Francis has considered leaving the profession. The low wages and dangerous working conditions meant people quit in droves during the pandemic.

According to a study from the University of California, San Francisco, 168,370 direct care workers nationwide were displaced from their jobs during the first three months of the pandemic and none of them returned to the industry in early 2021. That’s a significantly lower rate of re-entry than other sectors (39% of food preparation and service workers, for example, returned to their industry).

In a 2020 survey, over half of 22 long term care providers in D.C. said they didn’t have enough home health aides to staff every shift.

Marla Lahat, the executive director of Home Care Partners, told the D.C. Council during a recent hearing that they’ve never had this much trouble hiring home health aides in their more than 60-year history. Lahat says two of three new hires just left. One woman told Lahat the $17 an hour she made was not worth taking the bus in the snow or catching COVID-19.

“It’s easy to understand when you consider that Amazon, banks, and even many retail stores are now paying more than we pay,” said Lahat.

Consequently, Home Care Partners has a waiting list of more than 100 seniors and people with disabilities seeking care, she said.

The direct care sector’s staffing shortage isn’t new, the pandemic just exacerbated it. “One person described it as going from a crisis to a collapse,” says Robert Espinoza, vice president of policy at PHI, who says historically low wages are to blame. (PHI is a nonprofit that focuses on improving elderly care and disability services.)

The origin of direct care’s low pay goes back to the 1930s, when Congress excluded domestic workers (along with agricultural workers) from wage and overtime protections in New Deal programs. This move was an attempt to preserve the racist Jim Crow order of the South by excluding the majority Black and female domestic workforce from basic protections such as Social Security, minimum wage, and overtime laws.

“Those series of decisions devalued the direct care job and impoverished workers for decades,” Espinoza tells DCist/WAMU. “It’s still wrongly understood as low skilled or unskilled.”

As more and more people leave the profession, the demand for their work is only increasing. According to long term care advocates, roughly 36,000 D.C. residents have trouble caring for themselves or living independently — a figure that’s projected to increase by 10% every 5 years.

The D.C. Workforce Investment Council says the home health aide occupation is projected to have the fastest job growth of any sector.

Direct care workers and their advocates say lawmakers need to immediately address the labor shortage, otherwise families will shoulder these responsibilities without compensation — if patients have family able to support them at all.

Medicaid, a public insurance program, is the largest payer for long-term care, which means Mayor Muriel Bowser and the Council have some control over workers’ wages. Advocates say lawmakers first need to increase funding for Medicaid in the mayor’s budget. They then need to increase Medicaid’s reimbursement rates to long-term care providers, and pass legislation to ensure this expansion goes directly to workers’ wages and benefits.

The new starting rate of $22 dollars per hour would adjust annually for inflation, so these jobs stay competitive.

In a Jan. 25 letter, advocates urged Bowser to take advantage of the extra $88 million that the American Rescue Plan Act provided to the District for Medicaid home and community-based services. So far, advocates say Bowser allocated $30 million to recruitment and bonuses in the sector, which they argue doesn’t address the underlying problem.

New Jersey, for example, took advantage of the COVID-19 federal package and proposed increasing wages for direct care workers to $23 an hour.

In response to a request for comment, the D.C. Department of Health Care Finance wrote in an email, “We are aware of the request for higher wage increase. Budget deliberations continue on this issue.”

Founder and chief executive officer of BridgePoint Healthcare, Marc Ferrell, says it’s more difficult for health care facilities to raise wages compared to other private sector employers.

“Certainly if we receive necessary reimbursement to pass onto the workers, we would have no problem doing that,” he tells DCist/WAMU.

He says lawmakers need to define which direct care workers get wage increases, including occupation type and place of residency (countless D.C. workers do not live in the city).

“The private sector has responded to the workforce shortage by offering higher wages. D.C. Medicaid has not yet done that,” says Claudia Schlosberg of the D.C. Coalition For Long Term Care.

“Providers, the people who are part of our coalition, they are losing workers daily because they’re able to find jobs that pay much higher and are much less stressful and have a lot less responsibility,” she adds.

Schlosberg says she just heard from one local provider who lost a certified nurse assistant to Bank of America, which pays tellers $21 an hour.

Francis, along with direct care advocates, says there’s a particular mismatch given how vital their work is.

“We’re the eyes and ears of the facilities. We’re the ones that help the doctors and the nurses know what’s going on because we’re the most in contact with these people,” says Francis. “We sure enough don’t feel like the superheroes and wonder women that people want to praise us to be because the last time I checked Superman or Wonder Woman wasn’t wondering whether their car was going to be repossessed because they haven’t been able to pay the bill on time.”