The Obama Administration just announced that, starting in 2015, health aides and certified nurse assistants, whether they work in skilled nursing facilities, group homes or individual homes, will be covered by the Fair Labor Standards Act’s minimum wage and overtime guarantees. For many beneficiaries of Social Security Disability Insurance and Supplemental Security Income, these workers are a crucial support for an independent life.
Yet since 1974, trained healthcare workers who provide in-home assistance have been legally classified as “companionship workers” like baby sitters. Therefore, they haven’t been eligible for the FLSA’s legal guarantees of a minimum wage, time-and-a-half for overtime, meal and rest breaks, and other fair labor rules. As a result, an estimated 40 percent of these healthcare professionals themselves depend on Medicaid and food stamps to survive.
This change in the law has been under consideration since 2011, and it has not been without its critics — including among disability care advocates.
“We’re very concerned that this will mess with the continuity of care,” said the head of the National Council on Independent Living, for example. “Medicaid isn’t going to pay for overtime. That’s going to mean people will have to bring a stranger into their house.”
Another worry concerns people on with disabilities, whose main source of income is SSDI, SSI often pay home health aides directly. In many cases, people use Medicaid funds to pay family-member caregivers. How will the new rule affect them?
While we won’t truly know until the rule goes into effect, you should know that 15 states already offer these protections to home care workers, and the sky hasn’t fallen. Also, the U.S. Department of Labor has made adjustments to the original proposal in response to some 26,000 stakeholder comments.
Those adjustments included a more flexible definition of those caregivers who will be covered. When caregivers provide mixed services, they can spend up to 20 percent of their time providing health care without triggering the minimum wage and overtime rules. The rules on family-member caregivers will also be more flexible.
Perhaps the most fundamental change is that extending these wage and hour protections will help chip away at the traditional institutional bias in caring for people with disabilities. When home health workers are treated the same as workers in institutional settings, there won’t be as much incentive to institutionalize people who would be happier in more independent settings.
- Disability Scoop, “Disability Caregivers Get Pay, Overtime Protections,” Michelle Diament, Sept. 18, 2013
- U.S. Department of Labor “Work in Progress” blog, “We Count on Home Care: Extending Protections to Direct Care Workers,” Laura Fortman, Sept. 17, 2013