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Fair Pay for 2.5 Million Home Care Aides Facing Industry Opposition

Posted: Feb 16, 2012

Photo: President Barack Obama proposed new fair-employment protections for home care workers in December. Shown behind Obama in the pink turtleneck is Filipina immigrant Thelma Reza, who called the speech “historic.” Public input on the rule change ends Feb. 27. (White House Photo by Pete Souza)

NEW YORK--Every day, Thelma Reza goes to the home of an elderly couple in Los Angeles to care for them. As a home care worker, Thelma provides her clients with critical assistance for daily activities many of us take for granted, such as bathing, dressing, using the toilet and getting around their home.

Thelma, an immigrant from the Philippines, often works long hours, sometimes staying with her clients around the clock.

For her difficult, stressful, and often dangerous labor, Thelma earns just $35 a day. Because Thelma is a home care worker, she is excluded from the federal law that guarantees most other workers the right to earn a minimum wage and receive time-and-a-half pay for overtime.

Obama Proposes Changes

Recently, however, President Obama and the U.S. Department of Labor (DOL) took a step that may finally ensure a fair wage for Reza and the 2.5 million home care and personal assistance workers who support elders and people with disabilities.

At a White House press conference in December, Obama announced a plan to amend the federal labor law that currently excludes home care workers from minimum-wage and overtime protections.

DOL is soliciting public comments on the proposed plan through February 27, and the home health industry has wasted no time in filing arguments that the change would burden home care companies.

The industry recommends instead that Congress alter the rules and also increase provider payment levels from Medicaid or other third-party payers. Otherwise, they say, provides will be compelled to “reduce the availability of care to the elderly and infirm.”

But the DOL projects that the cost of compliance with the proposed rule change would be a negligible fraction of the industry’s $84 billion revenue – just one-tenth of 1 percent of the cost.

DOL will issue the final revised regulation after the comment period closes and full consideration of public input is considered. We believe that home care workers should wait no longer for fair and safe working conditions.

If implemented, the president’s proposed regulation would have a huge effect on the field of home care--one of the fastest-growing service industries in the country. Total revenue was estimated to be more than $84 billion in 2009, up from roughly $40 billion in 2001, according to data from the U.S. Census Bureau.

That home care has continued to grow at such a robust pace, even during the economic downturn, is proof that demand for home help is greater than ever before. As the boomer generation enters retirement age--about 10,000 boomers will turn 65 every day for most of the next two decades--and as their elderly parents continue living longer--the demand for home care is not likely to slow any time soon.

Overwhelmingly, the workers supplying that care are women. Almost 90 percent of the home care workforce is female, according to an analysis of national occupational data by the Paraprofessional Healthcare Institute (PHI), a nonprofit organization advocating for long-term care reform.

Home care workers are also disproportionately nonwhite. Roughly half are people of color--and approximately a quarter of these workers are foreign-born.

Poverty Wages for Crucial Care

These workers are paid poverty-level wages for providing crucial care to elders and people with disabilities. The average home care worker earned just $9.40 an hour in 2010, and about half worked less than 40 hours per week.

With annual wages averaging below 200 percent of the federal poverty level, more than 40 percent of home care workers are forced to rely on public benefits, such as food stamps and Medicaid.

In addition, few occupations carry greater risk of on-the-job injury and illness than home care work. In 2010, one-third of injured home care workers missed a month or more of work (and wages) because of their injuries.

The low wages, inadequate hours, and high injury risk associated with home care work combine to contribute to massive turnover in the field--between 44 to 65 percent each year, according to various estimates.

This turnover has a negative effect on elders and people with disabilities, who find it difficult to cope with a revolving door of unfamiliar faces entering their homes.

Numerous studies over the years have shown a correlation between high workforce instability and low quality of care. If home care jobs don’t improve soon, millions of aging boomers and their very elderly parents will be unable to find the high quality care necessary to remain in their own communities during their retirement years.

That is why it is long past time for the largely female and immigrant home care workforce to be guaranteed at least the most basic wage protections available to workers under federal law.

Current Rule a Vestige of the Past

The federal Fair Labor Standards Act (FLSA) was first enacted in 1938 and assured a minimum wage, extra pay for overtime and other basic protections for the vast majority of workers in the United States. But since 1974, when Congress amended FLSA, the “companionship exemption” has excluded “companions to the elderly and infirm” from these basic rights.

The 1974 rule is a vestige of an earlier era when a neighbor or family friend would sit with Grandma or Grandpa, so home care workers should not be subject to the same labor standards as those in other fields.

But the companionship exemption provided a potentially exploitable loophole for home care employers to legally pay their workers less than minimum wage and less than time-and-a-half for overtime.

The current rule is simply not fair. America’s home care workers provide the skills needed to ensure our parents, grandparents, aunts, uncles, neighbors and friends get proper meals when they can no longer cook for themselves, don’t fall in the shower and break a hip, take their medications at the right times, and remain as healthy and active as possible—at home, not in a nursing institution.

Providing basic labor protections for home care workers is a sign of respect that what they do is real work. Thelma Reza, who was at the White House when Obama announced the proposal, called the president’s announcement “historic.” She declared, “Our work is finally being recognized.”

Now is the crucial time for public comment. The public can learn more about this vital issue for home care workers--and home care recipients—and how to add their voices to the debate by visiting PHI’s Campaign for Fair Pay.

Jodi Sturgeon is the vice president of the nonprofit advocacy group the Paraprofessional Healthcare Institute. And Ai-Jen Poo is the director of the National Domestic Workers Alliance, an alliance of domestic workers in 19 cities and 11 states.

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