Category Archives: Home Health Workers

Caring in America: A comprehensive analysis of the nation’s fastest-growing jobs: Home health and personal care aides

Source: Dorie Seavey and Abby Marquand, Paraprofessional Healthcare Institute (PHI), December 2011

From the abstract:
This PHI report provides a thorough analysis of the home care and personal care industries in the U.S., as well as of the workers who provide both types of care. The authors detail the many difficulties facing workers in both fields, including uncompetitive wages with little to no benefits offered, inconsistent and often inadequate training requirements, high injury rates, and unpredictable hours. The report lists several recommendations to improve the quality of these jobs.

Notice of Proposed Rulemaking to Amend the Companionship and Live-In Worker Regulations

Source: U.S. Department of Labor, Wage and Hour Division, December 2011

…Although the regulations governing exemptions have been substantially unchanged since they were promulgated in 1975, the in-home care industry has undergone a dramatic transformation. There has been a growing demand for long-term in-home care, and as a result the in-home care services industry has grown substantially. However, the earnings of in-home care employees remain among the lowest in the service industry, impeding efforts to improve both jobs and care. Moreover, the workers that are employed by in-home care staffing agencies are not the workers that Congress envisioned when it enacted the companionship exemption (i.e., neighbors performing elder sitting), but instead are professional caregivers entitled to FLSA protections. In view of these changes, the Department believes it is appropriate to reconsider whether the scope of the regulations are now too broad and not in harmony with Congressional intent.

On December 15, 2011 the Department announced that it will publish a Notice of Proposed Rulemaking (NPRM) to revise the companionship and live-in worker regulations for two important purposes:

– To more clearly define the tasks that may be performed by an exempt companion
– To limit the companionship exemption to companions employed only by the family or household using the services. Third party employers, such as in-home care staffing agencies, could not claim the exemption, even if the employee is jointly employed by the third party and the family or household.

Additional Information on the NPRM:
Notice of Proposed Rulemaking
Frequently Asked Questions
Remarks by the President on Minimum Wage and Overtime Protections for In-Home Care Workers
Press Release
Blog Post
Fact Sheet: Proposed Rule Changes Concerning In-Home Care Industry under the Fair Labor Standards Act
Comparison of Current vs. Proposed Companionship Regulations
Economic Impact Analysis
State Minimum Wage and Overtime Coverage of Non-Publicly Employed Companions

Additional Information on Companionship and Live-In Workers

Applicable FLSA Regulations

States’ Requirements for Home Health Aide Training Lag Far Behind Nurse Aides’

Source: Deane Beebe, PHI, PolicyWorks Blog, 08 December 2011

A new PHI analysis found that only 15 states require home health aides to have more training hours than are federally mandated, yet 30 states and the District of Columbia require certified nurse aides (CNAs) to have more training hours than the federal requirements.
See also:
Press Release

Maintaining and Improving Social Security for Direct Care Workers

Source: Shawn Fremstad, Center for Economic and Policy Research, November 2011

From the summary:
America’s more than three million direct care workers (DCWs)–a category that includes nursing assistants, home health aides, and personal and home care aides–play a crucial role in maintaining the health and economic security of elderly retirees and people with disabilities. Yet, they are among the most poorly compensated and economically insecure workers in the United States.

Only about one in every four direct care workers have employer-provided retirement benefits. When these workers themselves retire or become disabled, many of them will rely almost exclusively on modest Social Security benefits to keep a roof over their heads and meet other basic living expenses.

Some recent proposals to cut Social Security would put the retirement security of direct care workers–and millions of other workers in poorly compensated jobs–at risk. Instead of cutting Social Security benefits, the federal government should strengthen Social Security in ways that increase retirement security, particularly for retirees who have worked in poorly compensated jobs and typically have little or no retirement savings outside of Social Security.

This brief provides direct care workers and their allies with information they can use to become engaged in efforts to maintain and strengthen Social Security. After providing background on how Social Security works and why today’s direct care workers can count on it being there for them when they retire, it details some troubling recent proposals that would cut Social Security benefits. The final section way to improve Social Security and increase the retirement security of direct care workers.

2011 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and Home Care Costs

Source: MetLife Mature Market Institute, October 2011

From the summary:
The national average daily rate for a private room in a nursing home rose 4.4% from $229 in 2010 to $239 in 2011.

The national average monthly base rate in an assisted living community rose 5.6% from $3,293 in 2010 to $3,477 in 2011.

The national average daily rate for adult day services rose 4.5% from $67 in 2010 to $70 in 2011.

The national average hourly rates for home health aides ($21) and homemakers ($19) were unchanged from 2010.

Raising Expectations: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers

Source: Susan C. Reinhard, Enid Kassner, Ari Houser, Robert Mollica, AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation, September 2011

From the summary:
This report by AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation shows some states significantly out-perform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities.

The study finds, however, that even the best performing states have a long way to go to create a high-performing system of long-term services and supports. It shows that all states need to vastly improve in areas including home care, assisted living, nursing home care, and supports for family caregivers, and more efficiently spend the substantial funds they currently allocate to LTSS.
See also:
Scorecard Website

PHI State Data Center

Source: PHI, September 2011

The PHI State Data Center, the first web-based tool to provide comprehensive, state-by-state profiles of the direct-care workforce, is now live at the PHI PolicyWorks website.

The PHI State Data Center profiles nursing home aides, home health aides, and personal care assistants (including direct support professionals) in every state. It provides easy-to-read charts with up-to-date, key direct-care workforce statistics, which can be easily downloaded and reproduced, featuring information on:

* workforce size and projected employment growth
* trends in wages for each direct-care occupation, and
* information on health insurance coverage rates and reliance on public assistance.

The state data on wages, benefits, and occupational growth are compared to all occupations in that state.

Predictors of Low-Care Prevalence in Florida Nursing Homes: The Role of Medicaid Waiver Programs

Source: Elizabeth A. Hahn, Kali S. Thomas, Kathryn Hyer, Ross Andel, Hongdao Meng, Gerontologist, Volume 51 Issue 4, August 2011
(subscription required)

From the abstract:
This study examined the relationship between county-level Medicaid home- and community-based service (HCBS) waiver expenditures and the prevalence of low-care residents in Florida nursing homes (NHs)….The findings suggest that Medicaid HCBS waiver programs may reduce the prevalence of low-care residents in NHs. Future studies should evaluate whether Medicaid HCBS waiver programs are effective in promoting community-living among low-care residents and mitigating the growth in long-term care expenditures.

Fair Pay for Home Care Workers: Reforming the U.S. Department of Labor’s Companionship Regulations Under the Fair Labor Standards Act

Source: Paul K. Sonn, Catherine K. Ruckelshaus and Sarah Leberstein, National Employment Law Project, August 2011

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.

Summary of the California 2011-12 Enacted Budget: Impact on Older Adults and People with Disabilities

Source: SCAN Foundation, Fact Sheet, no. 21, July 2011

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.