Effort to give home care workers labor protections gains steam on two fronts

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Advocates say the time is ripe to start covering home care workers. They point out that things have changed since the law was last amended in 1974 and that the "companionship exemption" doesn't reflect the reality of today's home care workforce, which would be covered by the law for doing the same kind of work in the nursing home setting.

They also point out that so-called direct care workers are expected to reach 4.3 million people by 2018, more than all law enforcement officials or K-12 teachers. At the same time, America's aging population could be more efficiently cared for in their homes rather than in costly nursing homes or assisted living facilities.

The bill is expected to cost the federal government money because Medicaid covers most home care services. While the bill doesn't require Medicaid to increase its reimbursements to providers, that's still likely to happen as providers face higher costs and seek better reimbursements.

The bill's defenders however counter that paying home care workers higher wages would also save money. It would reduce the industry's high turnover rate. One study estimated a $2.5 billion "hidden tax of turnover" that leads to higher rates of hospitalization and involuntary institutionalization due to interrupted care, while also slashing welfare spending (nearly half of home care workers are eligible for food stamps).

The federal regulations, meanwhile, are expected to resemble regulations President Bill Clinton promulgated at the end of his second term. President George W. Bush retracted them at the start of his administration.

The Department of Labor is expected to overturn the home care worker exemption later this year, but advocates point out that legislation is still needed because the regulation will likely be tied up in the courts for years if home care businesses sue.