On December 15, 2011, President Obama announced that the Department of Labor planned to amend the Fair Labor Standards Act (FLSA) to guarantee minimum wage and overtime protections for 2.5 million home care workers. Since 1974, when Congress amended the FLSA to include domestic workers, home care aides have been subject to the “companionship exemption,” which equated their employment with that of teenage babysitters and denied them the same basic labor protections as other American workers.
Home care workers—90 percent of whom are female, and half of whom are people of color—are the foundation of our system of long-term services and supports. They provide assistance with dressing, bathing, toileting, mobility, and meals for millions of elders and people with disabilities. In some cases, they also provide medical-related assistance, helping to manage medication, taking vital signs, assisting with exercise programs.
Our families rely on home care aides to ensure that our loved ones can remain as independent as possible. That’s why home care is one of our nation’s fastest-growing occupations. With 10,000 baby boomers turning 65 every day, the number of Americans who need assistance is growing rapidly. Within the next decade, the workforce is expected to grow by an additional 800,000 workers.
The outsize demand for home care aides, however, doesn’t guarantee that there will be compassionate, skilled workers to take these jobs in the future. Home care may be one of America’s largest and fastest-growing occupations—but it also among the most poorly paid and supported. Wages average $9.40 per hour, but more than half of workers are part time employees. As a result, annual wages average about $16,600.
These wages reflect the severe undervaluing of the skills and dedication of our home care workforce. These workers play a vital role in our health care system—often reducing overall costs by noticing changes in a client’s appetite, mental clarity, or strength and communicating these changes to a family member or medical professional. With their daily visits to client’s homes, home care workers are the eyes and ears of the health care team.
Yet, for nearly 40 years, as home care has grown into an $84 billion industry, these workers have been denied the most basic labor protections under the FLSA. Home care agencies have used the “companionship exemption,” which was intended to apply to a neighbor who came to sit with grandma for a few hours, to lower labor costs across the board. Confirming this attitude, in a recent article in USA Today, the government relations director for the National Private Duty Association, the industry’s for-profit trade association, said of home care workers, “For them, this isn’t really a job, it’s a lifestyle.”
Tell that to the 2 million women trying to feed their children on poverty-level wages. Though most workers earn above minimum wage, many are not paid for travelling time between clients or for the cost of gas (now nearly $4/gallon). Only fifteen states have wage and hour protections that guarantee time and a half for overtime for home care aides. As a result, at the end of the day, home care workers have so little income that nearly half live in households that rely on public benefits such as Medicaid and food stamps.
The proposed change to the Fair Labor Standards Act, which would narrow the companionship exemption to workers hired by individual households to provide companionship (not personal care), is long overdue. As our nation ages, we need to strengthen and stabilize the home care workforce. Better wages will reduce turnover, which is notoriously high and disruptive to quality care. Moreover, basic labor protections are sign of respect—an acknowledgement that our nation’s 2.5 million home care workers have a true vocation that we value as a society.
The Department of Labor’s proposed rule to provide home care workers minimum wage and overtime protections is open to public comment through March 12. Please add your voice in support of home care workers by visiting www.companionshipexemption.com. Easy instructions and sample comments are available at the website.
– Karen Kahn, director of communication, PHI
– Carol Regan, director of government affairs, PHI
PHI is a national nonprofit dedicated to transforming eldercare and disability services to ensure dignity, respect, and independence for all who receive care and all who provide it.
Tags: companionship exemption, home care workers, long-term care services
Disability rights organizations have significant concerns about eliminating the proposed companionship exemption that applies to attendants for persons with disabilities. Attendants play a critically important role in supporting the independence of people with disabilities, and their access to typical community life. Although these changes may be well-intentioned, they will have a serious negative impact on people with disabilities, and on their ability to participate in the fabric of their community.
We urge the Department of Labor to postpone implementation of these proposed changes in order to work with disability and labor advocates to develop an approach that will appropriately enhance workers’ wages and benefits without concurrently eroding the availability of long term services.
The proposed policy changes negatively impact people with disabilities, and most seriously impact people who have the most significant disabilities and rely on Medicaid home and community based services to be independent and have access to their community. According to DOL’s own analysis, the proposed rules have the potential to increase institutionalization of people with disabilities, which conflicts with the spirit of the ADA, the Olmstead decision, and continuing efforts in HHS and the Department of Justice to secure the civil right of people with disabilities to live in their own homes and communities.
This policy change, as proposed, will promote unnecessary and unwanted institutionalization in the following ways:
1. Increasing the cost of home and community based services by requiring overtime pay, without concurrently increasing the Medicaid rates or raising the Medicaid caps for available funding, will result in a reduction in hours of personal assistance, forcing some people into unwanted institutionalization. State cuts in personal assistance funding in recent years has already left many people in a precarious position as far as having the essential services they need to remain independent. The proposed change, as currently planned, will no doubt push many over the brink into more costly institutions, where they will be segregated from family, friends and community.
2. Requiring minimum wage payments for overnight assistance will also raise the cost of serving individuals above established Medicaid caps, resulting in people with significant disabilities either going without needed assistance, compromising their health and safety, or being forced into unwanted institutionalization.
3. The proposed changes limit the availability of family and friends as paid attendants in consumer directed personal assistance programs. This will certainly reduce the available workforce, especially in rural, frontier and tribal communities across the country, where this issue is critical. Lack of workers, especially trusted ones who are in geographic proximity, will again force more people with disabilities into unwanted institutional placement.
We are also concerned about:
1. DOL’s offensive characterization of consumer directed service, and the failure of the DOL analysis to assess the impact that the proposed changes will have on that method of providing services and supports to people with disabilities.
2. The minimum wage requirement, with no concurrent funding increase, will no doubt also make the cost of travel with an attendant prohibitive. This will have a number of negative consequences, e.g. where people must travel long distances for medical and rehabilitative services (as in rural, frontier and tribal communities), often needing to stay overnight; or simply want to visit an infirm or dying relative, or be part of a family reunion. This change will additionally severely restrict the ability of people with disabilities to participate in state and federal committees, commissions and task forces; to testify in person at their state legislatures, etc.; and to otherwise be personally present when decisions and policy about their lives are being made.
And finally, but just as critical, we believe that because of the current intense pressure on state Medicaid budgets and the demonstrated determination of policy makers to curtail spending on long term services and supports, attendants will not, in the end, benefit from the proposed rule. In fact, the changes as proposed are likely to negatively impact them as well.
For attendants who work in Medicaid-funded programs, these changes will result in reductions in the hours that attendants may work, downward pressure on their wages, and the obligation to work for more agencies to sustain a living. These real-world negative implications for workers reinforce our argument that the proposed changes be postponed.
The disability community is most acutely aware of the importance and essential nature of assistance from our attendants. In order to attract and maintain quality people, people who attend to our most intimate needs, we are committed to our invaluable attendants receiving a livable and fair wage. And so it is absolutely necessary to balance efforts to enhance workers’ wages and benefits with the health, safety and needs of people with disabilities. Both communities deserve improvements and none of the improvements should sacrifice one community for the other. The symbiotic nature of the employer-attendant relationship must be taken into account and attended to in a collaborative fashion.
Over the past few years, some Guiding Principles were developed between SEIU and disability advocates. According to those Guiding Principles, formally signed on November 16, 2011:
“As a general principle, enhancements to workers’ wages and benefits shall be paid for through increased funding.”
The Department of Labor proposal does not do this, and it is clear that DOL staff did not adequately engage the disability community or consider these issues when it developed this policy direction.
Home care workers do better care of you but they actually need your support because initially they are not aware with your likes and dislikes so its your responsibility to tell them all the required things which he must know to give you proper care.