My sister died just the way she wanted to. At home, with her bed near the window so that she could look out and watch her cats playing.
This was possible only because she had 24/7 home health care, provided by a quiet, caring, capable aide.
Most people who receive home care aren’t in the last stages of a fatal disease. Some are like my guest blogger Laura and her brother, whose disabilities would make it unsafe for them to be home alone.
Most, however, are elderly people who need some variable mix of services to continue living independently. My mother-in-law, for example, is able to contentedly “age in place” because a home health aide comes in to help with housekeeping, grocery shopping and the like.
Will enough qualified care workers be available to serve the many millions who’ll be best off at home? Doubtful unless some major policy changes are made.
Here’s the first — and to me a shocker. Home care workers* are, at this point, exempt from federal minimum wage and overtime requirements.
Twenty-one states and the District of Columbia provide some coverage under their own wage laws. Here in the District, as in five of these states, only the minimum wage is required — not the overtime rate.
As the National Employment Law Project explains, the federal exemptions reflect an over-broad interpretation of a carve-out Congress made when it extended coverage under the Fair Labor Standards Act to domestic workers.
NELP recommends two related regulatory fixes. No Congressional action required — thank heavens! There is, however, a bill pending in Congress that would force the Labor Department to act.
In 2009, the average home care worker wage was $9.34 an hour. The average annual wage would thus have been $20,283, assuming full-time, year-round work and no overtime. Barely enough to lift a family of three above the federal poverty line.
But PHI, which advocates for long-term care workers, tells us that a large percentage work only part-time or for part of the year. Average annual earnings were thus $16,800.
As a result, 46% are poor enough to qualify for benefits like food stamps and Medicaid. Sadly ironic when so many of them indirectly get their wages from Medicaid.
Needless to say, morale is low and turnover high — an estimated 50%-80% a year.
Clients who need stability have to continually adjust to new caregivers — and new caregivers to them.
Employers incur ongoing recruitment and training costs. A vicious cycle here since the more they spend due to turnover, the less they’re ready to invest in turnover-reducing wages.
And, of course, some of the best potential candidates look elsewhere from the get-go.
Still, that average hourly wage is more than the minimum the FLSA requires. And the fixes NELP recommends wouldn’t compel states with higher minimums to cover home care workers.
So what would a more appropriate federal rule achieve? Some important things, I think.
First and foremost, it would entitle all home care workers to the same base-level hourly rates as the vast majority of other workers in the country. This would mean, among other things, that they’d be paid for time spent traveling from one client to the next — and, of course, time-and-a-half for extra long hours.
It would also formally recognize home care work as a genuine paraprofessional occupation — one that entails far more than providing some “companionship” to elderly and disabled people.
These two changes would help ensure a sufficient supply of well-trained, experienced home care workers — the sort we’d want for ourselves and our family members.
Emphasis here on “help” because the FLSA rule change is, as logicians say, necessary but not sufficient. It would, however, rectify what seems a clear case of economic injustice.
There are currently about 1.7 million home care workers in the country. The Bureau of Labor Statistics projects 2.5 million by 2018. That’s an awful lot of hard-working people to leave at risk of poverty.
If you agree, you’ve got a chance to weigh in right now.
The Department of Labor is holding two call-in “listening sessions” on the home care exemption. They’re scheduled for Monday, July 25 and Wednesday, July 27, both 4:00-5:00 EST. Call-in number and passcode here.
* Home care workers belong to one of two occupational categories in the Bureau of Labor Statistics’ classification system — home health aides and personal care aides. This issue brief from PHI details duties and distinctions.