Fair Pay in Best Interests of Home Care Consumers

California home care workers and consumers won a major victory when an agreement was reached to limit proposed cuts to service hours in the In-Home Supportive Services program for fiscal year 2014. Yet home care workers in California – and across the nation – still await another critical decision that will affect their paychecks and their dignity: whether a federal labor law will continue to exclude home care workers from minimum wage and overtime protections.

In December 2011, the Obama administration announced a proposal to revise a decades-old rule that denies basic wage and hour protections to our nation’s fastest-growing workforce: home care aides. Among the nation’s most poorly paid workers, home care aides are a lifeline for millions of Americans who need assistance to remain living in their homes and communities. Yet, for decades, these workers have lived in the shadows, their crucial role in supporting America’s families—and maintaining the health and well-being of elders and people with disabilities—denied.

The proposed rule, which is now under final review, would extend federal minimum wage and overtime protections to nearly a half million California home care workers—and nearly 2 million workers across the country.

California’s In-Home Supportive Services (IHSS) program is the nation’s largest publicly funded home care program. It serves more than 400,000 elders and people with disabilities (called “consumers”). Some state officials and IHSS consumers have not been supportive of the change in federal law because, they believe, California’s Medicaid program cannot absorb the additional cost of paying time and a half for overtime. Consequently, they argue, the new regulation will cause a reduction in services and force people with disabilities into institutional care.

In a recent analysis of IHSS authorized service hours, however, PHI found there is no evidence to support these claims. In fact, we believe that the proposed change supports consumers’ needs by making home care a more “legitimate” and respected occupation, one that can attract sufficient workers to meet the growing needs of aging and disabled Californians.

Our findings show that 90 percent of IHSS workers use less than 160 hours of support services per month. That means, for the vast majority of IHSS consumers, overtime hours are not required.

Individuals with very high-hour support needs (280-283 hours per month) comprise only 2.5 percent of all IHSS consumers. For these individuals—if they rely on only one home care aide —the annual cost of services, including time and a half for overtime, would be $50,022 annually. Nursing home care for the same individual would cost $63,875, nearly 25 percent more.

So even under the most extreme assumption—that one worker is providing nearly 70 hours of service per week—it would still be less expensive to serve this individual at home. Moreover, under the Supreme Court’s Olmstead decision, the state has an obligation to serve individuals with disabilities in the most integrated setting of their choice.

In reality, IHSS is likely to adapt by asking consumers who have high-hour needs to schedule multiple workers. Consumers, along with family members who work as IHSS paid assistants, might find such a solution disruptive at first. But it can lead to real benefits. Consumers would have the added insurance of a trusted backup attendant when their primary attendant is unable to work. In addition, the many IHSS workers who work part time but would prefer more hours could receive additional work through sharing high-hour cases.

Notably, 15 states already provide, under state law, minimum wage and overtime protections for home care aides. On average, these states have the exact same rates of institutionalization for people with functional limitations as states that do not offer such protections. Nevada, a state that offers these labor protections, has the nation’s lowest rate of institutionalization.

California’s home care workers earn a median hourly wage is $10.33. One third have no health coverage, and half rely on public benefits to support their families. Is it fair to continue to ask these workers—predominantly women of color— to sacrifice their wages to keep costs down for consumers? Home care workers provide valuable services—and the need is growing dramatically. Without basic labor protections, it will be increasingly difficult to attract workers to this vital occupation.

Providing all home care workers with minimum wage and overtime protections under the Fair Labor Standards Act (FLSA) would help make home care a respected occupation–-and ensure the stable, skilled home care workforce necessary to support growing numbers of Californians who, despite functional limitations, wish to live in their own homes and communities.

Dorie Seavey, Ph.D., is Policy Research Director for PHI, a national nonprofit committed to improving the quality of long-term services and supports by improving the quality of jobs for direct-care workers.

Eileen Boris, Ph.D., is Hull Professor and Chair of the Department of Feminist Studies, University of California Santa Barbara. She is the author, with Jennifer Klein, of Caring for America: Home Health Workers in the Shadow of the Welfare State (Oxford University Press, 2012).

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