This week, the U.S. Court of Appeals for the D.C. Circuit will hear arguments on whether the U.S. Department of Labor (DOL) has the authority to extend minimum wage and overtime protections to workers who provide home care assistance to elders and people with disabilities. This decision will directly impact nearly 2 million home care workers and, given this sector’s growth, millions more in the decades to come.
Whether it’s the care we provide, the care we receive, or the care we coordinate for our parents and loved ones, this federal court case for home care workers affects all of us.
Here are six key facts:
1. The number of people wanting long-term services and supports in their homes has skyrocketed, spurred by the rapid growth of the elder population and a decades-long paradigm shift toward home care delivery.
Various factors over the last decade have sparked this demand for home care: growing numbers of older people and people with disabilities and chronic illnesses; profound legal decisions related to de-institutionalization; new incentives for home care in Medicaid and Medicare; and increased support for interventions that reduce hospital stays and promote cheaper alternatives to institutional care.
2. Many people and their loved ones rely on assistance from home care workers, yet this industry faces significant labor pressures that exacerbate the nationwide "caregiving crisis."
For example, while the demand for home care workers will increase 50 percent by 2022, the primary labor pool from which direct-care workers are drawn—women, ages 25-54—will grow by less than one percent. And while family caregivers are essential to the provision of care in this country, many people lack traditional family supports or are increasingly strained to offer such care, especially in complex health scenarios (such as Alzheimer’s and other forms of dementia). To fill these gaps, millions of older people and people with disabilities will rely on home care workers.
3. Poor job quality and high turnover rates in the home care workforce drive the labor shortage, impoverishing home care workers and effectively diminishing the quality of care.
Among the fastest growing occupations, home care workers are among the lowest-paid; the median hourly wage is less than $10 and the median annual income is $13,000 (when accounting for the unreliable, part-time nature of this industry). Fifty-six percent of home care workers live in a household earning below 200 percent of the Federal Poverty Level and 56 percent receive one or more public benefits. Moreover, bad jobs don’t last. Nearly one in two home care workers leaves her/his job within 12 months. The primary reason for turnover? Low wages.
4. Based on an outdated definition of “companionship” and understanding of home care, the Fair Labor Standards Act (FLSA) has excluded home care workers from essential minimum wage and overtime protections for more than 40 years.
When home care workers were exempted from FLSA protections in the 1970s, home care was largely a form of casual companionship and its broader industry was miniscule. Today’s home care worker provides a vaster, more complicated array of practical and clinical supports that require hard skills and ongoing training. Further, the current home care industry comprises more than 30,000 home health care entities and more than 67,000 agencies providing services to older people and people with disabilities; for-profit franchises are the fastest growing segment of this $100 billion industry.
5. Recognizing this historical transformation in home care, the financial hardship faced by millions of home care workers, and the link between quality jobs and quality care, the Department of Labor exercised its authority to extend minimum wage and overtime protections to home care workers.
The fall 2013 rule from DOL states that home care workers are entitled to the federal minimum wage, overtime pay and reimbursement for travel between cases. In the 18 months following DOL’s announcement, a group of national home care trade associations contested the rule and sued DOL officials; a federal judge vacated the change and DOL expedited an appeal. Most notably, various premier nonprofit organizations and government entities have filed amicus briefs in support of DOL, detailing why strengthening the home care workforce makes practical, economic and historical sense in today’s economy.
6. Advocates across the long-term services and supports (LTSS) field are right to raise questions regarding the implementation of these protections; ultimately, we all need a multi-faceted response that better funds LTSS and acknowledges that improving wages and protections helps create a more equitable and reliable system of care.
Here, questions abound. What can we learn from the 15 states that have extended basic workforce protections to home care workers? How can home care providers, advocates, and federal and state officials work together more closely to address the caregiving crisis, supporting both care recipients and providers? Ultimately, none of these longer-term questions invalidate the merit of home care worker protections. Or as Forbes contributor Howard Gleckman eloquently summarized this debate: "Fighting over a shrinking pie is not going to solve the problem. Neither is putting the burden of the shortfall on the backs of direct-care workers or those they help."