On January 1, 2016, the Department of Labor rule extending federal wage protections to the nation’s home health care workers under the Fair Labor Standards Act was fully enforced after a period of discretionary enforcement that began October 12. Home care workers now are entitled to the federal minimum wage and time-and-a-half pay for overtime beyond 40 hours per week.
These new government protections are positive for several important reasons, the first of which is that they recognize home health care as professional work that should be held to high standards and compensated fairly. The wage requirements provide income security to caregivers, most of whom locally are women and many of whom immigrated to America in search of a livable wage. In addition, it is an important first step in preparing for the reality that with 76 million “Baby Boomers” born between 1946 and 1964, there will be a need in the years to come for more home health caregivers than ever before. Fair wage protections will make it easier to recruit and retain good workers.
However, these regulations also have some worrisome consequences for both clients and caregivers, the most troubling of which is the impact on continuity of care. Continuity, which is so important for patients with Alzheimer’s and other disorders related to old age, is now a privilege for only those who can afford it. It now costs 50 percent more to have the same caregiver work in a client’s home beyond 40 hours per week, an increase steep enough to force all but the wealthiest clients to avoid overtime rates by hiring consecutive caregivers limited to 40 hours each. The ramifications are most dramatic for clients who need around-the-clock care.
In the past, it was not unusual for some caregivers to stay beyond 40 hours, after the week’s hardest work was done, and be a companion for someone who otherwise would be spending the hours alone. Overtime rules have eliminated that opportunity for many, forcing them to get additional work as independent contractors with other providers. The result is that they are working harder than before to make the same amount of money, which raises concern for their wellbeing and consequently for client care.
Since the new regulations were approved in October 2015, our agency has received many calls from wealth managers, attorneys and families who help manage the lives of elderly clients and want to make sure they are working with a home healthcare agency that operates lawfully and provides only W-2 employees. Most providers in the state utilize independent contractors, not employees.
Florida is one of only a handful of states that allows the nurse registry model for home care in which caregivers are independent contractors, meaning they are not supervised, insured, bonded, and in many instances, not paid overtime for hours worked over 40 per pay period. This model of care puts the consumer at risk of being responsible for payroll taxes, overtime pay, and of being liable for a work place injury or covering the costs of missing items. Alternative Home Health Care maintains an employee model and only provides W-2 employees to ensure our clients and their homes are fully protected.
There are many reasons why employee-based models are best for clients and caregivers. Having full-time employees on the payroll gives the home health care agency more control over service delivery. We are responsible for payroll taxes, overtime pay, and worker’s compensation insurance, in addition to providing benefits such as major medical insurance and a 401k. Unlike nurse registries, we have the ability to address clients’ questions and concerns and provide supervision and direction to our caregivers.
In the home health industry, happy caregivers mean happy clients. Agencies, caregivers and clients currently are trying to adapt to the new regulations and protect the aging population from any sort of deficient care. The transition is challenging, but we remain hopeful that it will be positive for everyone in the long run.
