Care work in America: Expected but not respected

Home care workers allow millions of elders and people with disabilities to stay in their homes, helping with activities of daily living like bathing, toileting, and eating. They monitor vital signs, clean catheters and tracheostomy tubes, and administer medications (in some states). They help prevent costly hospitalizations and even save lives, intervening before a decline turns deadly. 
 

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For this important work, they average less than $10 an hour. Many are not paid for travel time between clients or for providing care during an overnight shift. Few get paid sick time or vacation. Nearly 40 percent have no health insurance, and about half must supplement their incomes with food stamps, Medicaid, or other public benefits. These facts are key contributors to the industry’s high turnover rate, estimated to be between 44 and 65 percent a year.

We owe it to these workers, and to the people who rely on them, not to fall for the myths the big franchises are circulating in their effort to block the proposed rule. 
 
Myth #1: Home care will become unaffordable, forcing people to do without care or to go into nursing homes.

According to a recent MetLife survey, agencies charge an average of $21 an hour for home health care services, which is more than twice the average wage for home care workers. As a result, gross profits of 30 to 40 percent are not unusual for large home care franchises, which should be able to absorb whatever relatively minor costs this rule may impose.

Besides, home care employers have managed to stay in business in the 21 states that mandate minimum wage and/or overtime pay, with no reported decline in the amount or quality of care provided. 

Myth #2: Paying overtime will hinder care quality by forcing elders and people with disabilities to employ more workers.

Care recipients are better off with a small team of caregivers who can share the hours and fill in for one another as needed than with one worker who logs large amounts of overtime and can’t afford to take time off for illness or a family emergency. Turnover is the biggest threat to continuity and quality of care in home care, and low wages and poor benefits are the leading cause of the industry’s high turnover rates.

The best way to make sure we can find and keep qualified caregivers is to give home care workers the respect, wages, and benefits they deserve. Let’s start by granting them the same basic FLSA protections as most other American workers.

Myth #3: Paying overtime will hurt workers, since employers will cut hours rather than pay time-and-a-half. Workers will have to make do with less or take a second job.

Poor pay already forces many home care workers to hold down multiple jobs, but only about 1 in 10 work more than 40 hours a week for any one employer. Of that 10 percent or so, many already get overtime pay, since 21 states and the District of Columbia mandate minimum wage and/or overtime pay for their home care workers. So relatively few workers would lose income if employers stopped assigning overtime—and many more would gain.

Frequent changes in clientele and two- or four-hour shifts make it difficult for many home care workers to piece together as much work as they need. If agencies redistribute workloads to cut back on overtime, at least some of the extra work would go to the 40 percent of home care workers who want more hours. Meanwhile, workers who put in overtime will be compensated properly for it.
 
Thanks to the aging baby boomers and our strong preference for home care over institutional care, home care work is one of the few job categories that’s sure to grow over the next few years. We can do nothing to improve those jobs and swell the ranks of the working poor, forcing hundreds of thousands more people to turn to public assistance despite working 40 hours or more a week. Or we can strengthen our middle class by ensuring that home care jobs provide fair wages and basic labor protections.

The Department of Labor just extended its public comment period on the rule to March 12. (It was originally set to end this month.) The franchises and their allies advocated for the delay and will use the extra time to marshal even more comments, so we must do the same. You can help by typing your comment into the online submission page.

Our economy is at a crossroads, and the proposed rule is an important step in the right direction.

Ward is director of policy and planning at the Direct Care Alliance. Owens is executive director at the National Employment Law Project.