The push to extend benefits to in-home aide dates back to the Clinton administration and was revived in 2011, when President Obama announced plans to move forward with new regulations.
A draft proposal subsequently stalled at the White House, sowing frustration among workers in one of the nation’s fastest growing industries.
“We’re just hoping they’re going to do what they promised two years ago,” said Lisa Thomas, an in-home aide from Chicago’s West Side.
Thomas said she had been working in the industry for more than two decades and has watched as colleagues work as many as 24 hours a day for as little as $4.44 an hour.
But industry officials say the in-home care services are largely financed by state Medicaid programs. Pay rates are tied to hourly reimbursement rates that in-home health companies receive through the programs, which are already stretched thin.
Any boost in worker benefits would likely not be accompanied by an increase in Medicaid reimbursements, said William Dombi, vice president of law at the National Association for Home Care and Hospice.
If Medicaid reimbursements were adjusted accordingly, “we’d gladly pay overtime,” Dombi said. “They’re not going to be changing what they’re paying to accommodate the new regulations.”
Despite the opposition, the White House has signaled that the administration is ready to finalize the regulations.
Last month, Vice President Biden said rules excluding benefits for in-home workers were created long before the industry grew. The so-called “companionship exemption” enacted for minimum wage and overtime rules in 1974 did not envision the rise of the domestic care industry, he said.
"As the home care business has changed over the years, the law hasn't changed to keep up," Biden said during a speech on the 75th anniversary of the Fair Labor Standards Act. "Shouldn’t someone working 40 hours a week be able to make a wage that’s above the poverty level,” said Biden.
Earlier this month the item was included in the Obama administration’s spring Unified Agenda, a document that details federal agencies’ rulemaking plans. The agenda predicted the rule would be finalized in July.
But Dombi noted that no one with direct knowledge of the process has said exactly when the rule would be issued. While he acknowledged that it was likely to come soon, he said it was unclear how closely the final regulation would hew to the draft proposal.
Several industry groups called for changes during meetings with the White House.
Dombi said the draft language would likely force employers to limit worker hours, since they wouldn’t be able to afford to pay overtime. The result could thrust the entire industry into upheaval as aides would to take on multiple jobs for fewer hours.
“The main thing would be a large workforce of part-time workers,” he said.
Critics have argued that care would suffer, as the elderly and disabled would see a rotation of aides instead of continuous care from one. Ultimately, they argue, rising costs would be passed along to consumers.
But Poo argued that the only way to ensure quality care for people in the comfort of their own homes would be to create a sustainable workforce. She said as many as 1.8 million people would benefit from the new regulation, though other estimates place the number far lower.
It’s unclear exactly how much the rule would cost the more than $50 billion in-home care industry. The administration has labeled it economically significant, meaning it carries an estimated price tag of $100 million or more.
Workers at Tuesday’s rally said the effort was about more than money.
“I am a professional,” said Margaret Singh, a home care worker from Washington state. “I want my brothers and sisters to be treated with respect.”