Report: Home Health Agencies Battle Against Worker Overtime Proposal

By Jane Norman, CQ HealthBeat Associate Editor

A survey by the home health care industry released Monday suggests that under an Obama administration proposal, sick people who need in-home care will turn to under-the-table providers and legal workers’ overtime pay will be cut.

In addition, the proposed rule “will force many seniors and people with disabilities into assisted living or institutional care because of the increased cost of in-home care,” Shelle Womble, chairwoman of the Private Duty Home Care Association of America, said in a statement.

Her industry group and the National Private Duty Association released the survey in what’s a first shot at an attempt by the administration to develop new regulations for a 1.8-million-member health care workforce that provides care in the home.

President Obama announced in December that a Department of Labor proposed rule would for the first time extend minimum-wage and overtime protections to in-home workers employed by staffing agencies (See related story, CQ HealthBeat, Dec. 15, 2011). For decades, such “companionship” aides have been considered the equivalent of occasional baby sitters, even if they provide health services such as wound care or tube feeding.

While some states regulate these workers’ overtime and minimum-wage pay, not all do, and Democrats believe the industry has been unfairly excluded from federal pay protection.

The industry does not agree. Business costs would rise and be passed on to elderly and ill clients, says the survey, which was conducted in December by a company called Home Care Pulse. “Clients/patients will seek out services from the underground economy through untrained, unsupervised and unskilled workers creating risk of elder abuse and mistreatment of people with disabilities,” it warns.

The survey included more than 1,400 home care agencies and says most of them are small businesses with annual revenues of $5 million or less. Some provide services paid for by family members out of pocket or by insurance, while others are paid by Medicare and Medicaid or the Veterans’ Health Administration. More than half say they don’t now pay overtime, and a majority of those agencies say they will cut workers’ overtime hours if the rule goes into effect.

Click here to access the impact survey.

“We cannot afford to pay overtime,” one survey respondent was quoted as saying. “Patients and workers are not going to be happy with the restrictions we will impose, and ultimately patient care will suffer.”

If agencies have to pay overtime, they will have to hire more staff members, and that will affect continuity of care for the sick, the survey says. Agencies might also cut back on benefits and pay increases, drop out of Medicaid, or stop offering live-in services, the survey says.

It recommends that implementation of the proposed rule be suspended until the full impact of it can be assessed.


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