Will Proposed Pay Regulations Help Home Care Aides?
By Beth Panitz
May 16, 2012
Employers may soon be required to pay home care aides minimum wage and to compensate them with time-and-a-half pay for overtime work. The Department of Labor (DOL) proposal comes at a time when America's aging population is increasingly demanding more care at home. Supporters say the change could raise the status of home care aides and boost their wages -- helping to attract individuals to these jobs. Meanwhile, critics contend that it would make care costly and prohibitive, and cause a deterioration in services.
Aging at Home
The U.S. Bureau of Labor Statistics (BLS) projects that home health aides and personal care aides will be the two fastest growing occupations this decade, with employment in both projected to jump about 70 percent. In total, BLS projects the two fields to increase by nearly 1.3 million jobs between 2010 and 2020. This growth is fueled by an aging population increasingly seeking care in the comfort of their own homes.
Both types of aides provide elderly and disabled individuals with social support and help with everyday living tasks, such as eating and going to the doctor, as well as self care, like bathing and getting dressed. Home health aides also perform paramedical duties, such as wound care. "These workers provide hands-on, direct care, performing tasks that are integral to the patient's well-being," says Dorie Seavey, director of policy research for PHI (Paraprofessional Healthcare Institute), a national organization representing direct-care workers.
"We used to think that when people got older and sickly it was best to place them in nursing homes," says Seavey. "But today, individuals have a strong preference to receive long-term aging care services in their home." Increased state and federal funding for home-based care has helped make this a more financially feasible option. "This funding reflects the Olmsted Act and the Americans with Disabilities Act, which both give individuals the right to receive care in the least restrictive setting," explains Seavey.
The Companionship Exemption
The new rules proposed by DOL in December would provide minimum wage and overtime protections for the nation's 1.8 million home care workers. After a comment period this winter, DOL is reviewing public input and is expected to make an announcement this summer.
Currently, workers classified as "companions" are exempt from the minimum wage and overtime pay requirements of the Fair Labor Standards Act. In her DOL blog, Secretary of Labor Hilda L. Solis notes that the exemption was established in 1974 "to cover casual babysitters and companions for the elderly and infirm, not the many workers today employed as professional caregivers." The issue gained national attention in 2007, when the Supreme Court ruled that Evelyn Coke, a home care worker who worked as much as 70 hours a week, was not entitled to overtime pay under existing regulations.
The change would apply to home care workers employed by third parties, like staffing agencies. It would not pertain to aides employed directly by the family, provided that their main function is to serve as a "companion" offering "fellowship and protection"--such as playing cards or watching television together.
A Difference of Opinion
"This revision would be an essential first step to stabilizing the home care workforce and positioning it to meet the demand we see coming," says Seavey. "We can raise the floor of these jobs in a way that's win-win. We can attract more workers to these jobs so that we meet demand, and in so doing, it will improve the livelihood of workers." Nearly 40 percent of home care workers rely on public benefits such as Medicaid and food stamps.
In a House Committee hearing on the issue in March, Catherine K. Ruckelshaus, legal co-director of the National Employment Law Project, testified that "the current shortage of home care workers is expected to become acute in the years to come. Denying workers a fair wage makes it harder to attract and keep the workers we need." Annual turnover rates vary from 40 to 60 percent, depending on the region, according to the National Direct Service Workforce Resource Center.
Some for-profit staffing companies argue that the change will harm their businesses. "The issue isn't the minimum wage. It's the overtime requirement," says Kathy Janz, who heads Matched CareGivers in California. The company pays its home care aides, $11.50-$15 per hour, well above the federal minimum wage of $7.25 per hour, but doesn't pay time-and-a-half for overtime.
Most home care companions receive at least minimum wage, with average earnings of $10.49 per hour for home health aides and $9.88 for personal care aides, according to the BLS. Janz predicts that some companies will simply reduce these base wages, so that the overtime regulation won't be so prohibitive. In California, she expects that many home care agencies will convert to domestic referral agencies, which refer aides rather than employ them. "This is going to throw more people into the underground economy, where there's no workers' compensation."
Overtime Care
PHI recommends that the industry adopt staffing strategies that spread work among aides, creating balanced workloads. "The notion that you get the best care when you have one aide working more than 40 hours a week is very questionable," says Seavey. "We need a more modern approach to what continuity of care means."
In her House Committee testimony, Ruckelshaus declared that "long hours can also result in worse care for patients, as caregivers working 60-hour or 70-hour weeks face fatigue and stress in performing what is a demanding job under any circumstances."
Janz says that long shifts are needed because some patients require 24-hour care. Splitting that into eight-hour shifts would be detrimental to the aides as well as the patients, she contends. "It's hard putting in aides at midnight. There are areas that are dangerous to walk in at that time," she says. "Also, the patient is usually asleep then. They don't want to wake up to a different face."
Also testifying at the Congressional hearing was Wynn Esterline, owner of an in-home non-medical companionship care business in Adrian, Michigan, where the state already requires aides be paid minimum wage and overtime. The state legislation "drastically changed my business, negatively affecting my caregivers and the seniors we serve," Esterline testified.
"Our seniors who need the most care are usually those with Alzheimer's or dementia, and they are least likely to be able to comprehend or handle a parade of different people into their homes over a week," said Esterline, referring to a patient of his who moved to a nursing home, because she couldn't cope with the "strain the additional caregivers brought."
Ricardo Lopez, executive associate of the Cooperative Home Care Associates (CHCA) in New York City, says he favors the DOL proposal. "It's a good recommendation because it brings accountability to the companies." CHCA already minimizes overtime by tasking coordinators with spreading hours evenly among aides. When patients require round-the-clock care, the company divides the week between two aides, with the aides sleeping at nighttime when the patient sleeps.
An Invaluable Service
No matter what side of the issue they are on, all agree that home care aides provide crucial services for the elderly and infirmed.
Aide Shenel Barker cares for a cancer patient in Olney, Md. "I do whatever I can to make sure she's comfortable," says Barker, including repositioning the patient in bed and helping her transfer to a wheelchair. Barker also prepares the patient's food and does incidental housekeeping. "I like to think, 'If my grandmother was in this position, how would she want to be taken care of?'"Barker received her training through a 120-hour program at the Cambridge Nursing Assistant Academy in Hyattsville, Md., which included 40 hours of clinical experience. The program focused on basic nursing skills such as taking vital signs, patient safety and caring for patients with Alzheimer's and related disorders. She hopes to continue her education and become a registered nurse.
Home health aides working for Medicare or Medicaid-certified agencies are required by federal law to complete at least 75 hours of training. The Institute of Medicine (IOM) recommends that minimum be raised to 120 hours and include a demonstration of competence in the care of older adults. Currently 16 states exceed the federal minimum for training hours, but only six of those meet the 120 hours suggested by the IOM. The federal government has no training requirements for personal care aides."I love my job," says Lila Sarante, a CHCA aide. "I just like helping people." She patiently listens to her patients' troubles and holds their hands when a nurse gives them shots. "When I get older, I hope someone will take care of me this way."
Correction: May 16, 2012
This article has been revised to reflect the following correction:
The upper end of the range of annual turnover rates for home care workers was corrected to state 60%, depending on the region. The turnover rates source was also updated.
For more information about related careers visit BrainTrack's Home Health Aides page.
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