For Elders and Caregivers, the Arithmetic is Simple


At the Federal level, the Department of Labor wants to eliminate the current home care workers’ exemption from overtime provisions.  In California,  AB 241 has been introduced as the “Domestic Worker Bill of Rights”.  Unfortunately, it – and the Federal proposal – are wrong.  They will not only hurt elders, the disabled and others who need home care, but they will seriously impact the wages of Home Care Aides.  As communicated to the Congress and the California legislature in letters, faxes, emails and in hearings, the arithmetic is really very simple.  For legislators – and voters – interested in substance, rather than rhetoric, that arithmetic is laid out below.

Assistance with medication is critical for some seniors

There is a myth that caregivers are not protected by wage and hour laws and regulations in California.  Currently, with the personal attendant exemption from overtime provisions, at the federal and state levels, we have employees who are being paid $192 or more for every 24-hour shift they are working.  We have many clients who require 24-hour care, seven days per week.  Our employees are paid for each and every one of those 24 hours, as required by Wage Order 15 in California.  We currently have many employees working four day shifts, making $768 or more per week, with three days off each week.  That person’s teammate works three days and makes $576 per week.  Our clients have only two Home Care Aides each week, and that means continuity of care and a minimum of disruption, which is very important to seniors and others needing home care.

If the provisions of AB241 become law, home care agency employers will be forced to do two things.  The first is that we would have to implement a wage schedule that would allow us to constrain costs.  Our recipients of care cannot afford a significant increase in costs.  Medicare, Blue Cross, Kaiser, …, none of these forms of medical insurance pay for the home care our clients need.  So, no employee could work more than eight hours per day or 40 hours per week, in order to avoid overtime.  Our clients cannot afford any other approach.  Thus, for a client requiring 24 hour care, seven (7) days per week, we would have to have 21 shifts during the week.  That means a minimum of six employees covering the shifts.  Cutting wages (normally we pay $11-$12 for eight hour shifts) to $8 per hour is inevitable, to maintain the current cost level for 24-hour shifts.  Thus, each Home Care Aide would make no more than $320 per week (three of them would make much less).  To sustain themselves, they would have to find other jobs, but their schedules would interfere with their ability to do so.

Wages and Costs

The hardship does not apply only to 24-hour shift workers.  We have clients and employees engaged in 10-hour or 12-hour shifts.  Those will all have to be cut back to 8-hour shifts, with additional Home Care Aides filling in short gaps.

At the national level, Congress amended the Fair Labor Standards Act in 1974 to include coverage for domestic workers. However, at the same time, it included an exemption for employees providing companionship services for individuals who are unable to care for themselves. Legislative history indicates that Congress included the exemption because it was concerned about the potential costs of companion care to individuals who may be least likely to afford it. Shortly after passing the amendments, the Labor Department promulgated implementing regulations.  Nothing has changed to suggest that eliminating that exemption, at the federal or state level, is appropriate.  The many change in our society is that many more people need home care than when the exemption was first enacted.

Private pay non-medical home care allows the client to avoid institutionalization, something that is very important to our seniors and individuals with disabilities.  In-home non-clinical care is considerably more cost-effective to society as a whole than institutional care that is usually paid for through Medicaid or some other government program.

Affordability is a primary consideration of the individuals and families that home care agencies that employ Home Care Aides serve.  Striking the wrong balance means individuals who cannot afford private pay home care may turn to institutional options, such as eliminating assets to qualify for Medicaid,  which, while less expensive for them, are more costly for society.

If you are reading this thinking this is all about a greedy business owner, please look at the arithmetic again.  There is no discussion above about impact on business.  We will have to hold the cost line, because our recipients of care cannot afford any increase.  That means we will have to cut the wages of our employees to provide the same hours of care.  It is not a business issue.  It is an issue of the quality of care and the quality of life of our clients and our employees.

If you would like more information on this matter or have questions please contact:  Home Care Association of America, 941 East 86th Street, Suite 270, Indianapolis, IN 46240; Phone:  (317) 663-3637  Fax: (317) 663-3640
Email: info@homecareaoa.org

I would love to “hear” your thoughts.  Best wishes.  Bert

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