As the nation focuses on health reform, a debate over the pay of workers providing in-home care to the elderly and sick brews below the surface.
When my dying, 83-year old mother said she wanted to spend the limited time she had left at home, rather than in the hospital where she had spent the previous month being poked, prodded and intubated in a futile attempt to get relief for end-stage emphysema, my siblings and I scrambled to help support her wishes. We hired a local agency to provide aides to tend to her basic needs. But forced to make many decisions on the spot, we had little time to research the provider we chose. It turns out we were lucky, and so, I'm convinced, was our mom.
Because my mother lived in Maryland, the agency that supplied the so-called in-home companions was required to abide by a state law requiring that these workers be paid at least the state's minimum wage, as well as time-and-a-half for overtime. If my mother had lived just a few miles away, in Washington, D.C., or where I live, in Virginia, the workers caring for her would have received no such guarantee.
Nearly half of the nation's two million in-home care aides don't have the benefit of minimum wage and overtime protections most hourly workers in other professions take for granted. That's because federal law likens such workers to babysitters and regards the work they perform to be an avocation, not a job. Maryland is among only 14 states that require minimum wage and overtime for the kind of employees who perform the many unpleasant services that many sick and disabled people unfortunately tend to need.
In December, the U.S. Labor Department proposed closing the loophole in federal wage and hour rules and expanding protections for in-home caregivers. Defending the plan to the unabashedly hostile Republican members of a House panel last month, Nancy Leppink, the [acting] chief of Labor's wage and hour division, testified that the reasoning behind the 1970s policy is now obsolete. Legislative history shows that the current law and its regulations were put in place with the understanding that those who performed so-called "companionship services" were not breadwinners responsible for their own family's support. Rather, lawmakers had in mind the proverbial kindly neighbor who would look in on an elderly person from time to time and perhaps engage in a game of cards.
But much has changed over the last forty years. The increasingly aging population, and a better understanding of their complex needs, has spurred the growth of the kind of in-home care business my family hired. In 1975, fewer than 50 of these agencies existed nationwide, according to government statistics. In 2009, there were nearly 6,600. The need for such workers is expected to increase as people live longer and seek out more affordable and appropriate alternatives to nursing homes.
I suspect that many of the people who rely on the services of home companions now, or who will need them at some point, are like my mother. After being released from the hospital, she spent most of her last two months in a morphine-induced fog. Her aides were kept busy turning her to prevent bed sores, bathing her, changing her diapers and bed linens and spoon feeding her.
Critics of the administration's proposal tend to dust off the same arguments those who oppose the minimum wage and other workplace protections always use. A report by the International Franchise Association in February claims it will drive up the cost of such services and make home care unaffordable. That would be a convincing point -- if it were true. Demand for such services continues to grow, including in the states that have enacted minimum wage and overtime laws.
Some also claim that requiring agencies to pay overtime actually lowers workers' take home pay. These critics say that, absent minimum wage requirements, caregivers in states like Virginia can bolster their pay by working extra-long shifts. If overtime laws came into effect, this argument goes, they would not be given the option of working those extra hours.
However, an increase in minimum wage might make up the difference and preclude the need for workers to put in those extra hours. And those employees who still needed to work a second job would be free to do so.
It's been more than a year since my mother passed away and the grieving process continues. But I take heart in knowing that the workers who cared for her were paid a minimum wage and would receive extra pay in the event they were asked to work longer hours. I have no way of knowing for sure, but as a result of Maryland's minimum wage and overtime protections, I'm confident the company we hired was able to attract a better crop of workers than its competitors in Virginia and the District.