When you picture a home health aide, what do you see?
Do you see someone sitting in a comfortable chair, chatting with a perfectly healthy companion while they both chortle at Dancing with the Stars? Or do you see a trained professional working with a patient -- helping with essential daily activities such as dressing, bathing, medication reminders, walking, and transferring the patient from bed to wheelchair?
Most Americans recognize that home health aides fall into the second category. Unfortunately, federal law does not. Home health aides are excluded from the minimum wage and overtime protections of the federal Fair Labor Standards Act because of something called the "companionship exemption." Designed in the 1970s, this exemption was slipped into the law to ensure neighborhood babysitters and sporadic workers would not be given federal employment protections. Unfortunately, the exemption has also excluded the professionalized home health aide workforce as well -- many of whom work full-time.
Thankfully, President Obama has signaled that the federal government may soon recognize home health aides as the competent, highly-trained professionals that they are. Last week, President Obama proposed new regulations that would eliminate the companionship exemption -- a long-overdue move that would finally guarantee minimum wage and overtime protection to this group of workers. Notably, as Secretary of State Hilda Solis wrote on the Department of Labor's blog, 92 percent of the 2 million home health aides in this country are women, and nearly half are people of color.
Home health aides are trained professionals who do demanding work that is in increasingly skilled. To work for home health agencies, home health aides must receive many hours of classroom training (which is regulated by state law) either through a home care agency or a private school. Their work encompasses everything from feeding, bathing, and toileting patients to assisting with medication and guiding patients through range-of-motion exercises. And yet, under the Fair Labor Standards Act, home health aides are not guaranteed wage and hour protections. Tellingly, as Steven Greenhouse noted in his New York Times article discussing President Obama's proposal, nearly 40 percent of home health aides are forced to rely on public benefits such as food stamps and Medicaid.
Moreover, the lack of minimum wage and overtime protections for home health aides hurts more people than just the workers themselves. Consumers inevitably suffer as well. Because home health agencies are not required to pay home health aides overtime, home health aides work extremely long hours -- even though many home health care agencies are for-profit corporations that charge customers considerably more than they pay their workers. This leads to a stressed-out, overtired workforce that is more likely to make mistakes. Unsurprisingly, the long hours and low pay also lead to heavy turnover among home health aides, which results in less continuity of care for patients.
Before President Obama's announcement, the national landscape for home health aides was a mixed bag, although workers' advocates around the country have mobilized around this issue for many years. In some cities, such as New York, home health aides are unionized and covered by living wage laws And state governments have made progress as well; many states already
On the federal level, before President Obama's announcement, the outlook for home health aides was bleak. A few years ago, the Supreme Court rejected efforts to dismantle the companionship exemption. The Labor Department has repeatedly signaled its willingness to write new regulations that would extend the Fair Labor Standards Act's protection to home health aides, but it has repeatedly failed to do so.
Last week, President Obama observed, "homecare is one of the fastest-growing industries in America, partly because we're getting older as a society." The president also emphasized the sad truth that "[a]s the homecare business has changed over the years, the law hasn't changed to keep up." Earlier this year, legislation that would end the companionship exemption was introduced in the U.S. House and Senate. Hopefully President Obama's backing will be the game-changer that home health aides have been waiting for.