Home Care, Too 

The Fair Labor Standards Act needs a broader scope.

The first Monday of September, Americans celebrate the workers who make our country strong. On Labor Day, we are proud of the traditions that brought us the eight-hour work day, paid vacation and sick days, and minimum-wage and overtime protections. These basic labor standards helped to make our country the wealthiest in the world by creating a vast middle class able to buy the goods and services that kept our economy growing.

Unfortunately, 129 years after the first Labor Day celebrations, more and more American workers find themselves without some of these basic labor protections. Amazingly, the fastest-growing occupations in the country — personal care and home health aides — are explicitly excluded from the Fair Labor Standards Act minimum-wage and overtime protections.

As a result, the 1.7 million workers who provide loving care and assistance to our frail and disabled family members are among the most poorly paid workers in our nation.

In 1974, the Fair Labor Standards Act was updated to include most domestic workers, such as cooks, maids, and yard workers. However, companions for the elderly were exempted. At the time, long-term services and supports for elders and people with disabilities were primarily provided in skilled nursing facilities. Home-care workers were considered the equivalent to babysitters, providing company to elders who were lonely or needed "someone in the house" to assure safety while family members were out working.

Today, the home-care industry is one of the fastest-growing sectors of our economy. Federal and state policies explicitly promote care at home over facility-based care — and by 2018, home and community-based aides are expected to outnumber facility-based aides by 2 to 1. Home-care aides provide the same skilled services to their clients as certified nursing assistants provide to nursing-home residents.

These services include not only personal care such as bathing, dressing, and toileting but assistance with mobility, oral and injected medications, nutrition, and monitoring of vital signs such as blood pressure. Clearly, these are not "companionship" services.

The Department of Labor recently held two listening sessions to solicit input on revising the companionship exemption to ensure that workers who provide skilled home-care services receive the fair wages they deserve. Industry advocates argued that narrowing the exemption would make care unaffordable for seniors and people with disabilities and would undermine quality.

This argument does not honor our tradition of providing workers with fair wages — wages that allow them to support their families and live with dignity. Moreover, it is not supported by the evidence.

First, 22 states already provide minimum-wage and/or overtime protections to home-care aides. These states have thriving home-care sectors that have been growing apace with the expansion of demand from a rapidly growing elder population. Second, the biggest challenge facing the industry is attracting and retaining workers. Providing basic labor protections would show that as a society we value the essential services that home-care workers provide — and that we respect their right to fair wages.

Better wages, along with better training and supports, would attract more workers to the field and decrease turnover, thereby reducing industry costs and increasing the quality of care provided to clients.

Finally, leading the lobbying effort to maintain the companionship exemption are for-profit home-care franchises experiencing astounding growth, even during these difficult economic times. While it costs on average $19 per hour to hire an aide through these agencies, starting pay for aides is less than $9 per hour.

Obviously, agencies have other business expenses besides worker wages, but profit margins for many are high. This suggests that the additional costs of paying a fair wage would not necessarily need to be passed on to customers.

America's families are the consumers of home-care services. We want our loved ones to have compassionate, quality care provided by someone we trust and respect. Often these caregivers become like "family members." But they have families of their own to support.

We cannot ask the caregivers — usually poor, often immigrant women — to sacrifice their meager wages to make the system of care affordable. Rather, we must find solutions that work for everyone. We must begin with the assumption that our nation's labor laws apply to all workers, including those who provide the intimate caregiving services that allow our loved ones to live independently and with dignity at the end of their lives.

Steven C. Edelstein is the national policy director at PHI PolicyWorks, a nonprofit dedicated to improving the quality of jobs for direct-care workers and the quality of care for elders and people with disabilities.

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