When 62-year-old Debora Larson suffered a traumatic brain injury in a major car accident, she quickly learned what it meant to rely on someone for care.
“My kids took care of me for about four years. I became a burden to my family, and I knew that, but there was nothing I could do,” Larson said.
Larson worked in corporate management, but the accident forced her to change careers. Now, her days are spent gaining her clients’ trust, completing small chores, and walking their dogs.
“I get just as much out of caregiving as the clients do,” Larson said. “You’re always on the lookout for trips and falls. I watch their behavior, their body language, their speech, ask questions. I stay with my clients until they pass, so I really do get to know them.”
Three years ago, she began working for a local home care company and earned $17 per hour, but she had to pay for her own gas to get from client to client.
“I was gone all day until 11 o'clock at night, but only got paid for maybe six to eight of them. I’m driving around all over the place. I was still living with my kids. It was very tight,” Larson said.
At one point, she even considered retiring and taking Social Security early.
History shows care workers not making livable wages
Nevada’s average hourly wage for home care workers and personal aides is $15.62, according to the U.S. Bureau of Labor Statistics. That’s nine dollars less than the living wage — enough for a full-time worker to pay for basic necessities without public or private assistance — for an adult without children in Reno, according to the Massachusetts Institute of Technology’s Living Wage Calculator.
Katrina Kazda, the vice president of Home Care Innovations at the national nonprofit ICA Group, which advocates for employee-owned businesses, said care work has been historically undervalued.
“Workers don’t have reliable access to health care, paid time off, sick leave. We think of it as unskilled and domestic work. It’s really this holdover of who does this work and ingrained systems around racism, sexism, slavery. This work was, at one point, completely unpaid,” Kazda said.
In 2023, nearly 80% of these workers quit within their first 100 days due to low pay, lack of support, and unsustainable schedules, according to the Home Care Association of America.
Kazda said one solution is home care cooperatives. She supports care-worker-owned business models in 11 states, including California, New Mexico, and Texas, which have helped reduce turnover.
“Caregivers in our cooperatives often just talk about how they’re respected, they’re valued, they’re not treated like a commodity that’s coming in and out, and thought of as business owners and professionals. It really just changes the power dynamics,” Kazda said.
Policy requires politics to get personal
The Service Employees International Union (SEIU) Local 1107 in Las Vegas, which represents care workers, has also fought to increase pay.
In the 2023 legislative session, the union helped raise the minimum wage for home care workers under Medicaid from $11 to $16. Political director Natalia Jordan said the union is seeking to increase that to $20 during the 2027 state legislative session.
“I don’t think $16 is enough anywhere with the way that prices are. Retention is something that we are still fighting for. Many of them have second jobs,” Jordan said.
Jordan said many, if not all, of the SEIU Local 1107 care workers qualify for Medicaid themselves. She said the union is also striving for greater negotiating power and to allow doctors to prescribe more hours of home care for patients, so care workers can clock more time with their clients.
Efforts to increase the minimum wage for home care workers to $20 per hour failed in 2025. Jordan said it requires politicians to understand the issue first-hand.
“Many of these legislators know someone or have someone in their life that is going to start the process of getting a home care worker,” Jordan said. “When it’s your mom, when it’s your dad, your grandparents, it starts to affect people a lot more.”
For Democratic State Sen. Rochelle Nguyen, who helped pass the pay increase, the issue is personal and stems from her childhood.
“My grandfather lived with us after he had a stroke. We were able to keep him in our home for over 10 years because we were able to have home health care workers in our home. It's a cost-savings, quality-of-life issue. We tend to pay those people the least amount, which is just shocking to me,” Nguyen said.
In March, care worker Larson began working for a new home care company that pays more. Making $23 an hour has been life-changing.
“I’ve had to spend my retirement twice due to life emergencies, so I’m trying to put something back together. Not having to worry about a full tank of gas, not having to worry about insurance,” Larson said. “I’ve always bought generic groceries, and lately I’ve gotten the brand name or the little extra. It’s also helped me feel better as a mom and a grandma because I can provide certain things for them.”
She said this pay increase allows her to continue doing the job she loves without worrying about providing for herself or her family.
It’s a job Larson cherishes. One of her fondest memories is the music she and her clients share.
“I took her to an appointment, and we stopped at La Cucina to get her dinner, and it was really hot outside. I said, ‘I'm gonna leave you in the car.’ I turn the air on real high and the radio. I come out, this woman has Frank Sinatra blaring. I just fell in love with that moment,” Larson said.
This story was published with the assistance of the Journalism & Women Symposium Health Journalism Fellowship, supported by The Commonwealth Fund.
