Almost a year ago, I published two great articles from one of our most experienced and thoughtful employees. She has been through hospice with her father and provided home care services for many years — including to her mother, under the auspices of Support For Home.
She just wrote to me, concerning the topic that has been showing up a lot, in my blog and in the news: the removal of the wage and hour overtime exemption for professional caregivers. I am very pleased to share her thoughts with you. As someone who might be directly impacted, in terms of employment and as a consumer of home care services, she is very much worth hearing.
I’ve been thinking over the subject that keeps coming up in the newsletter [and news]; the issue of possible legislation [and federal rules] requiring overtime pay for home care aides. I agree that clearly it serves no one; not families, not clients, not home care agencies — for all the reasons you list. Well-intentioned but not well though out.
But — I think the real problem is that this is only a small piece of the TOTAL problem, which is that home care for an elderly or disabled person is a medical expense that is not covered in any way except the expensive and therefore rarely used long term care insurance option or veteran’s benefits coverage. The cost of most home care falls to the individuals or their families — out of pocket. As you mention, the risks of hiring outside a reputable agency are many, and the issues of payroll, insurance, etc. are serious obstacles. But an agency is more expensive and out of the reach for many… For families who do not have the resources and fall above the absolute poverty limit which qualifies them for In-Home Supportive Services [through Medicaid], there are only these few funding options. [After exhausting family, friends, etc.] many seniors and disabled adults [are] trying to get by each day at great risk and diminished quality of life. It is really a heartbreaking situation.
So the real problem is not whether caregivers should be paid overtime, or even more — it is that most families can’t afford the age-related (and therefore medically related) expense of their senior members at all. Or do so at great financial sacrifice. There isn’t a Medicare provision for home care aides, even though it is as necessary to the physical well-being of at-risk seniors as “medical” care administered by a doctor. Meeting ADL [Activities of Daily Living support] needs has a direct impact on health and welfare, no question. But without some sort of funding for this kind of medically related care it will remain or become a serious problem for most families at some point.
And without some sort of supportive funding, families and agencies will never be able to raise the pay for their home care aides beyond the marginal. The position involves tremendous responsibility and judgment and is a vital link of communication between the client, their families and doctors and agency personnel. Yet it is (even though above minimum wage) not a well-paid profession, and won’t be as long as the basis for funding both private and agency workers are family resources.
This is a problem that is just going to get worse as we get older as a population and continue to be stressed economically. without some sort of outside funding, most families will continue to struggle to meet the needs of their senior loved ones, and all the good services of a well-run agency will not change that. Home care costs a great deal for most people. Obviously a Medicare provision for home care is not in the works and is not likely to ever be, but the truly desperate and timely need for SOME sort of family financial assistance is the elephant in the room that the legislators who well-meaningly propose overtime payment do not see.
We could not agree more about the need for medical insurance and Medicare to recognize that non-medical home care is vital to the health and well-being of the seniors and disabled who receive it and should, therefore, be covered under those forms of insurance.
In the meantime, we need to make sure legislators and regulators, well meaning or not, do not make the situation even worse than it is now.
Best wishes. Bert