Advocates fear long delay for rule on home-care worker pay

Those awaiting the Obama administration's decision on whether to guarantee home-care workers at least the federal minimum wage and overtime pay could be in for a long summer.

The Office of Management and Budget's 90-day window to review a final rule on the matter passed without action on April 15. It has been more than a year since President Barack Obama announced he would work toward ensuring workers in the $84 billion-a-year home-care business would receive minimum wage and overtime protections.

The policy dates back to 1938, and home-care worker advocates argue the law didn't account for the growth of the industry. Home-care jobs are increasing at a faster rate than any other industry within the healthcare sector, according to Labor Department figures, adding nearly 6,800 jobs in March. Advocates don't know when a rule could be issued, and they are frustrated.

“I've never seen such a clear instance in which we have accepted and condoned the exploitation of literally millions of people whose services are vital to our communities, to our families, to certainly our public programs,” said Bruce Vladeck, the former director of HHS' Health Care Financing Administration (now the CMS).

Vladeck, speaking during a conference call organized by the Service Employees International Union and the professional advocacy group Paraprofessional Healthcare Institute, said they fear home-care lobbyists could make it a long wait before any action is taken.

Fifteen states, including Massachusetts, already offer home-care workers minimum wage and overtime protections without restrictions, but advocates want the same policies across the country.

The Labor Department's draft rule also proposed lifting an exemption that bars live-in companions from earning overtime. Home-care trade groups vehemently oppose lifting the exemption and argue the rule was designed to protect consumers from paying high salaries and overtime to family caretakers who live under the same roof.

Last week, the National Association of Medicaid Directors sent a letter to OMB to review the rule further. They want a more detailed analysis of how changes would affect the home-care industry. The directors also worry that the proposed rule would discourage state policymakers from developing new programs for home- and community-based services under the guidance of the National Association of States United for Aging and Disabilities. Federal funds from Medicare and Medicaid pay for the majority of home-care services.

“We want to ensure that any changes in this area are cost-effective, operational, allow adequate implementation time and do not disrupt the services made available through these carefully designed programs,” the letter read. “We strongly urge OMB to direct DOL to undertake more comprehensive impact analysis of the proposed rule and consider alternatives to the proposed changes.”

Jim Mark, national president of the trade group Private Care Association, said the proposed rule doesn't take into account how the changes would affect the industry and consumers.

“There's more to this than just workers' rights issues, there's this whole continuum about how it would affect the disabled community, the elderly community, small businesses, as well as caregivers,” Mark said.

Not everyone in the industry envisions dire consequences for paying workers higher salaries. Joining the conference call with SEIU and the worker advocates was Paul Dzialo, president and CEO of Affinity Home Health Care, which has three offices in Massachusetts. Dzialo said happy workers keep patients out of nursing homes.

Home-care worker Pauline Beck, who cares for two clients in Oakland, Calif., said she met then-Sen. Obama in 2008 and said she's convinced the president will deliver a rule that offers minimum wage and overtime protections, although she's getting anxious. “But I'm not worried because I know he's going to do the best he can,” Beck said.

Follow Ashok Selvam on Twitter: @MH_aselvam