New regulations requiring payment of overtime wages for homecare aides, while well intentioned, will likely have some unintended, negative consequences for elderly clients.
Without a doubt, nursing assistants, charged with caring for elderly clients at home, work hard and shoulder heavy responsibilities. Caregivers deserve to receive fair wages for the essential care they provide. The issue at hand involves payment of overtime for caregivers working on a "Live-In" basis for seniors. The term "Live-In" applies to caregivers who go to an elderly client's home and stay for a number of days at a time. This arrangement greatly benefits many seniors who prefer the security of having someone with them at night for urgent needs. Seniors with dementia or impaired memory function typically need Live-In care to insure safety and prevent falls. "Live-In" care is only offered to clients who sleep well through the night and typically do not require assistance during night time hours. Clients who have frequent needs during the night are required to have care billed on an hourly basis so that the caregiver can also be compensated appropriately. If 24 hr care is provided on an hourly basis, several caregivers are required to cover the shifts; (2) 12 hour shifts per day. While technically, present in the client's home for at least 24 hours, A "Live-In" caregiver is able to sleep 8 hours at night and has some downtime in the evening hours. These caregivers are paid a flat, daily rate for this service. Historically, they have been exempt from overtime pay due to the fact that they have rest time and are not actively working at all times.
How will this change affect Elderly Clients?
Clients receiving In-Home Care services will definitely take a hit in their pocket books. The former companionship exemption was a significant factor in helping to keep senior home care affordable. With overtime pay now required for hours in excess of 40, clients will pay significantly more or get used to having numerous caregivers rotating in and out of their homes. For most seniors and their families, continuity of care is considered critical. A continuous stream of different caregivers can be confusing for an elderly client and possibly elevate anxiety levels. Communication regarding a client's changing needs is more challenging when multiple caregivers are involved. Faced with these negatives, many families may decide to hire their own, private caregivers to care for their seniors. Private caregivers may not have the training and credentials of those retained through an agency. Hiring home care workers under the table could expose some seniors to abuse, fraud or substandard care since supervision and agency oversight is lost. What is a senior to do when a private caregiver gets sick or doesn't show up for work? In all likelihood, the elderly client will be left to fend for himself unless family or friends are available to step in.
Due to expense or hassle, many families may turn away from in-home care altogether and turn to assisted living or nursing care institutions instead. Research data indicates that given a choice an overwhelming majority of seniors would prefer to remain at home with assistance. Loss of independence and control combined with less personal attention make institutional living less appealing to the senior population.
What about the truly wonderful people who have been earning their incomes as Live-In caregivers through In-Home Care agencies? Will they actually benefit from the new overtime provision? Probably not. The overall demand for Live-In assistance will likely decline sharply as costs increase significantly. These caregivers will likely be forced into "underground" or private hire situations to find assignments without the numerous protections offered by reputable agencies.
Who will really benefit from removing the overtime exemption for home care workers? Its unclear but quite possibly the only benefactor will turn out to be SEIU, the largest and fastest growing member of the AFL-CIO. Politics as usual? Let's hope not; the lives of seniors, the disabled and chronically ill will be impacted.