My parents are in their nineties, and between them they’re coping with 17 chronic diseases. It’s a difficult situation, especially because they live so far away, in California. Of course, I do whatever I can to help them, but with 3,000 miles between us, my options are limited. Fortunately, my brother lives within a few minutes of my parents’ home and can check in on them regularly—but again, he has his own life, family, and career to look after. There is only so much time he can devote to caregiving.
The situation would be nearly impossible to manage if it weren’t for Iman and Hugo, two home health aides we have employed to help out. These wonderful gentlemen, both from Indonesia and now in their sixties, provide my parents with excellent care around the clock, seven days a week, allowing them to remain safely and comfortably at home—as is their wish. I am immeasurably grateful for and appreciative of all they have done for us and do everything within my power to make sure they receive fair compensation for their hard and often selfless work.
Every day, all across America, a vast group of people like Iman and Hugo tirelessly serve the needs of our elderly, infirm, and disabled. And their number is increasing. In fact, they are the fastest-growing occupational group in the country. By 2018, the number of home care aides in the U.S. will increase to more than 2.5 million. That’s not surprising, considering how quickly our elderly population is expanding.
What is surprising is how we have chosen to treat these critically important workers. You would think that as a nation we would be doing all we can to reward their efforts with respect, appreciation, and fair compensation. You would think—but you would be wrong.
In fact, just the opposite is true. As a nation, we have marginalized our direct care workers and singled them out for unfair treatment. Consider this: on average, home care aides earn less than $10 an hour, do not receive time-and-a-half for overtime (even though they may find themselves working 24-hour shifts), and while they are part of our health care workforce, a third have no health insurance coverage should they, themselves, require care. They’re not even guaranteed to receive the minimum wage. Why? Because a sweeping 1974 Congressional amendment to the Fair Labor Standards Act (FLSA) designated home care aides as “companions” rather than workers, and thereby excluded them from the protection afforded to everyone else by FLSA. Subsequent Department of Labor regulations made the problem even worse by radically broadening the companionship exemption.
The law has not gone unchallenged. In 2007, a retired home-care aide named Evelyn Coke sued her employer for decades of unpaid overtime. The case went all the way to the Supreme Court. Unfortunately, in a highly publicized, unanimous decision, the nine justices ruled to uphold the 1974 exclusion. They pointed out, however, that the Secretary of Labor has complete authority to rescind the exclusion with the stroke of a pen. And of course, Congress has the same power. So the question is: why, three years after the high court’s decision, is the law still in force?
One reason may be that a large number of home care aides come from demographic groups that have little power to demand fair treatment or affect public policy: immigrants, both legal and illegal, and as a recent New York Times article pointed out, older adults who financially can’t afford to retire. It’s not uncommon to find a 65-year-old woman providing care to one who is 85.
The harm done by leaving this law in place ultimately reaches far beyond the home care workers themselves. As the Boomer generation passes age 65 and swells the ranks of older Americans, the need for aides to help meet their living and health requirements is becoming critical. But can we really expect high-quality workers to continue gravitating toward an occupation that exploits them and gives them so little in return?
It’s time to act. The law needs to change. Third party, for-profit home care providers will certainly object that the resulting higher labor costs will drive them out of business, but in individual states that have passed their own protective labor laws, this hasn’t been the case. In February 2010, Steven Dawson, president of PHI (a Hartford Foundation grantee organization that works to improve the lives of people who need home or residential care by improving the lives of the care workers) wrote a letter to the New York Times stating, “It is long past time for President Obama to instruct the Labor Department to provide home care aides minimal work force protections through the Fair Labor Standards Act.”
Given the facts of the situation, who could disagree?