This policy brief urges the Department of Labor to exercise its broad discretion to restore the companionship exemption to its properly narrow scope, thereby extending wage-and-hour protections to most of our nation’s home care workers. The brief begins by reviewing the history of the companionship exemption. It then explains the impact the current exemption is having on home care jobs, and recommends simple principles that should guide revised regulations. Next it explains why extending minimum wage and overtime coverage to most home care workers is necessary to vindicate FLSA’s policy goals. It concludes with a discussion of the potential cost impact of transitioning to a narrowed companionship exemption.
On June 30, 2011, California Governor Jerry Brown signed the 2011-12 budget. The enacted budget includes significant cuts and prepares the framework for additional cuts in the following 2012-13 budget year that negatively impact health and human services programs serving older adults and people with disabilities.
The following items of importance to older adults and persons with disabilities reflect items that the governor signed into law as part of the final budget actions.
Each time an employee leaves a job, expenses are created for the employer. The time required and out-of-pocket costs paid to replace employees can be quite significant in occupations with high turnover rates. Historically, direct care professionals have filled positions paying low wages, lacking benefits including health insurance, and receiving employer-specific training again and again as they change jobs. These conditions contribute to the higher-than-average frequency of workers leaving their jobs and the profession. The cost of turnover in the direct care workforce was examined in 2011 by the Iowa Department of Public Health Direct Care Worker Advisory Council to better understand the current and future impacts of turnover.
The Estimated Cost of Turnover in Iowa’s Direct Care workforce:
It is estimated that turnover of one direct care professional in Iowa creates $3,749 in direct expense for the employer. Using this Iowa cost per individual of $3,749, the direct cost of turnover in the direct care workforce for 2010 is estimated at $117,000,000, rising to $126,000,000 in 2011. The following table illustrates the estimated cost of turnover through 2014.
Source: Anita Bercovitz, Abigail Moss, Manisha Sengupta, Eunice Y. Park-Lee, Adrienne Jones, Lauren D. Harris-Kojetin, Marie R. Squillace, National Center for Health Statistics, National Health Statistics Reports, Number 34, May 19, 2011
The picture that emerges from this analysis is of a financially vulnerable workforce, but one in which the majority of aides are satisfied with their jobs. The findings may be useful in informing initiatives to train, recruit, and retain these direct care workers.
Occupational hazards and safety in home care were the focus of “Home Health Care Health and Safety: Emerging Occupational and Patient Safety Issues in Home Care for Patients,” a conference sponsored by the National Institute for Occupational Safety and Health (NIOSH) and the Columbia University Mailman School of Public Health (MSPH).
At the May 19 conference, three researchers presented their findings on the many serious health risks that home care aides and nurses face while on the job:
– Hazards in the Home, by Jane Lipscomb, PH.D., R.N., F.A.A.N., of the University of Maryland Baltimore Schools of Nursing and Medicine
– Summary of findings on sharps injuries and blood exposures, by Margaret Quinn, Sc.D., of the University of Massachusetts Lowell
– Home Health Care Patient/Worker Health and Safety Issues, by Robyn RM Gershon, MHS, DrPH, Mailman School of Public Health Columbia University
This policy brief begins by reviewing the history of the companionship exemption. It then explains the impact the current exemption is having on home care jobs, and recommends simple principles that should guide revised regulations. Next it explains why extending minimum wage and overtime coverage to most home care workers is necessary to vindicate FLSA’s policy goals. It concludes with a discussion of the potential cost impact of transitioning to a narrowed companionship exemption.
This policy brief details the key coverage-related provisions of health reform, and discusses steps that direct care workers, direct care associations, and others can take to ensure that the coverage provisions of health reform are implemented in ways that work for direct care workers and employers. Direct care workers have a vital role to play in the implementation process, and may want to advocate for the following:
– a state advisory committee on health reform implementation that includes direct care workers;
– that states take full advantage of new options in the law to streamline eligibility for Medicaid and subsidies for purchasing health care coverage in the exchange;
– the implementation of the Basic Health Plan option for residents with incomes below 200 percent of the poverty line;
– the establishment of a publicly administered health plan to compete in the exchange; and
– the use of federal grants to fund and strengthen independent and effective Consumer Assistance Programs to help consumers navigate the new system.
These recommendations are explained in more detail later in this policy brief. Health reform also includes important provisions related to health care workforce development, long-term care insurance, public health, prevention and many other health-related issues. Although not discussed in this brief, many of these provisions are relevant to direct care workers.
From the summary:
A new PHI analysis on health care coverage for direct-care workers found that occupation, industry/setting of employment, and geographic region were key indicators of whether these frontline caregivers had coverage.
The new analysis found that in 2009, of all the nation’s direct-care workers — nursing assistants, home health aides, and personal care aides:
* nearly 1 million (28 percent) were uninsured;
* nearly 20 percent received health coverage through Medicaid or other public insurance at some point during the year; and
* only 47 percent had employer-sponsored coverage — compared to 68 percent of U.S. workers generally.
Source: AI-Jen Poo, New Labor Forum, Vol. 20 no. 1, Winter 2011
What does the triumph of Domestic Workers United mean for the future of the labor movement?
From the press release:
Direct Care Alliance announced the launch of the Direct Care Alliance Personal Care and Support Professional Credential, a competency-based test that will help improve the quality of long-term care for the elderly and people living with disabilities who depend on personal assistance workers to maintain their autonomy and quality of life.
The credential for personal assistance workers will help professionalize the direct care workforce by: 1) providing elders, people with disabilities and their families with a reliable way to assess the knowledge of those they hire; 2) giving agency employers a customer-centered assessment tool; 3) establishing a national standard for state policy makers; and 4) allowing workers in this field to demonstrate their professionalism and skill.