Category Archives: Home Health Workers

As elder care grows, so do labor battles

Source: Michael Lawson, American university School of Communication, What Went Wrong blog, January 23, 2012

The pay is low, and injuries are common, but nursing care is a rare bright spot in the gloomy economic landscape, adding jobs at a steady clip. As the field has grown, so, too, have efforts to unionize.

Those unionization campaigns are being fought on a shifting battleground, from massive chains to private homes. With baby boomers moving into retirement and beyond, the tensions aren’t likely to abate any time soon.

Cost of Long Term Care Study

Source: Northwestern Mutual, November 2011

From the summary:
In November 2011, the Long Term Care Group, Inc. conducted customized Cost of Care research on behalf of Northwestern Long Term Care Insurance Company of nearly 2,000 home healthcare providers, assisted living facilities and nursing homes in specific regions of the United States.

This research is important in the understanding of accessibility and affordability of different types of care services by geographic location. The findings help consumers make informed decisions about their long-term care options and costs, which may allow them to stay in their homes or within their local communities in the event of functional limitation or cognitive impairment.

Frontline Caregivers: Still Struggling

Source: Eileen Boris and Jennifer Klein, Dissent, Vol. 59 no. 1, Winter 2012
(subscription required)

These workers are America’s frontline caregivers. They number over 1.7 million nationwide. Home care workers earn just a little but more than the minimum wage and historically have had little or no job security, health benefits, or even workers’ compensation. Government programs began subsidizing home care in the 1930s. Yet in every decade since then, policymakers and welfare administrators have acted on the presumption that the intimate labor of caregiving should be the loving and unpaid duty of wives, mothers, and daughters. So home care aides, defined as elder companions rather than workers, are still excluded from the Fair Labor Standards Act, more than seven decades after it was enacted in 1938. Moreover, because they are often poor women taking care of people receiving public assistance, the suspicion and taint of “welfare fraud” has been used to cut their hours of service or pay in times of fiscal anxiety.

Long-Term Services and Supports Opportunities in the Affordable Care Act

Source: Sarah Barth, Julie Klebonis, and Nancy Archibald, Center for Health Care Strategies, Technical Assistance Brief, December 2011

States now have more tools available to rebalance the provision of long-term services and supports towards more home- and community-based services and away from institutionally based care. In addition to the Money Follows the Person demonstration program, the Affordable Care Act created the Balancing Incentive Payments program, the state plan Community First
Choice Options program, and the modified Home- and Community-Based State Plan option (1915(i)). Selecting the appropriate program(s) to implement is made complicated by the sometimes overlapping and differing requirements of these options.

This technical assistance brief describes the different LTSS program options available to states with particular emphasis on their budget impacts;
application processes; and requirements for participant eligibility, care coordination, and data reporting. It also discusses the ways in which the different options for providing LTSS interact with each other and with existing state LTSS structures.

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