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Care For The Caring

Lucy in Washington

It seems of late every time we turn around caring for seniors, disabled and the in-firmed are under attack. Take a look at these examples if you don’t believe me:

  • Medicare home health care is facing a 14% cut in reimbursement if proposed re-basing goes into effect.
  • Union backed home care licensing legislation enacted; which has less to do with protections of workers, seniors and disabled than it does with growing union membership.
  • And finally, revocation of the long standing federal companionship exemption slated to go into effect in January 2015 which decreases access to care and does little to protect workers. It is this third issue that led me to Washington and testifying at the Congressional hearing on Workers Protections.

While well-intentioned, the US Department of Labor’s final rule reversing the long standing Companionship exemption under the Fair Labor Standards Act, was made without a real understanding of home care and how this new application of the 40 year old exemption will undermine the exact thing it was meant to protect; the wages and hours our employees work.

As this looms in our near future, these are just a few questions that have been left unanswered:

  • How will entitlement programs such as Medicaid home care benefit pay overtime when there are no increases in reimbursement rates?
  • How will consumer direct care recipients reconcile overtime pay which eats into their precious few dollars allocated for their own care needs?
  • How will seniors who fund their own care in hopes of deferring higher cost institutional care meet the burdens of overtime?
  • Will people who receive care from a home care agency be forced to leave the protections they have and become employers themselves to avoid the cost burden of overtime?

To avoid overtime costs, our workers hours may be cut, not because we as employers don’t want to pay overtime but because we won’t pass along the cost of overtime to our patients. We are not a retail employer who passes on higher costs of a new improved product to the end user. For the most part, we operate at such a low margin absorbing the administrative burden of rising cost of unemployment insurance  (CA employers have been mandated to pay the maximum UI rates regardless of claims for over two years) workers compensation insurances,  all to protect our workers today.

So employers will begin limiting hours worked to 40 hours in a week and in some states (such as CA) hours worked per day also. This is a way for agencies to comply with the new rule and not have to pass on the burden of higher costs to our end users; the frail, elderly and disabled. This is not a win-win but a lose-lose.

So what is the solution? Well here are a few suggestions offered to Congress:

  • Increase Medicaid reimbursement to offset the overtime requirement
  • Provide tax credits to seniors and disabled who fund their own home care to avoid spending down to qualify for Medicaid funded nursing home care.

Finally, start over and look for solutions that create a win-win in protecting our seniors and our devoted home care workers at the same time. It is possible!

So this is why I went to Washington to fight for my employees and for my beloved patients. I went to explain the consequences of a political promise that impacts millions of our countries most vulnerable citizens. I didn’t know what else to do. I am thankful for the relationship the National Association for Home Care and Hospice (NAHC) has with Congress which afforded us this opportunity to express our deep concerns.

Lucy Andrews RN

November 2013