More than two and a half million home care workers take care of the nation’s frailest citizens in their homes every day. They help those individuals bathe, dress, and get their meals. Sometimes they provide assistance with medication and medical devices; in other cases, they assist with wheelchairs and walkers, shopping, and social activities. The work is important, difficult, and even dangerous. Home care workers have among the highest rates of injury of any occupation in the U.S.
Yet these workers who are so vital to the health and well-being of millions of Americans are not guaranteed the federal minimum wage or time and a half for overtime. Often, they are not even paid for the time they spend traveling between clients.
Home care workers earn an average wage of less than $10 per hour, barely above the poverty level for women supporting their own children (90 percent of the workforce is female). One in three lack health insurance, and nearly half must rely on public assistance to support their families.
It’s scant consolation to these workers that they belong to the nation’s fastest-growing occupation: according to the Bureau of Labor Statistics, the growth of America’s elderly population will require nearly four million home care workers by 2020.
On December 15, 2011, the Obama administration proposed regulations that would insure that home care workers are covered under the Fair Labor Standards Act, the minimum guarantee of basic labor protections for most of the country’s workforce.  In the three months following the announcement, the U.S. Department of Labor (DOL) received over 25,000 comments from the public, more than 75 percent of them in favor of the revised rule. The final regulations are now under OMB review, where they are being heavily lobbied by representatives of the extremely profitable home care industry. Even by Washington standards, fourteen months should be enough time to put such a straightforward policy into effect.
The Department of Labor has estimated that the additional costs associated with this change would be less than one-tenth of one percent of the home care industry’s $84 billion in revenues. This is a small price to pay to help some of our nation’s lowest-paid workers get a step up. But this investment has an added benefit as well — it is crucial to building the stable, committed workforce we need for the future.
The annual turnover rate for home care workers is a staggering 50 percent, which undermines quality care. To build an experienced home care workforce that provides excellent care, we need to make sure that home care workers have basic wage guarantees that will help to keep them on the job.
Adoption of the Final Regulation to extend the Fair Labor Standards Act to home care workers would not only promote the president’s goal of strengthening the middle class; it would also address the growing need for home care services among aging Baby Boomers and millions of families caring for individuals with disabilities. We owe it to ourselves to insure that there’s an adequate supply of fairly-paid, well-trained, committed workers to take care of us when we need it.
Vladeck directed the Medicare and Medicaid Programs during the Clinton administration, and has been involved in long-term care policy for more than 30 years.