In-home care is one of California’s fastest-growing industries as our population of aging baby boomers, seniors and people with disabilities seeking supportive help at home continues to swell. Home care agencies work hard to match seniors with compatible caregivers so families can have peace of mind that their love ones are provided with the best of care.
However, onerous regulations and legislation are being proposed that could have the unintended consequences of driving up the price of in-home care, sending potential clients away from agencies such as mine that screen, train and conduct background checks of each new hire and toward online services such as Craigslist. When caregivers are hired outside of agencies, there are no consumer protections for the client, and none for the caregiver. That is, the unemployment, disability and worker’s compensation coverage that we as agencies pay for as well as the bonding and liability insurance that we purchase for our caregivers.
At issue is what is commonly called the “companion exemption.” Since 1974, in-home care has been exempt from federal overtime laws because of the nature of the job. Today, if a family needs 24-hour care for a loved one, they pay a flat daily rate. If the companion exemption is removed and overtime rules are applied, the cost of the care would double or triple.
In California, a bill sponsored by Assemblyman Tom Ammiano (D-San Francisco) not only calls for the removal of home care workers from the companion exemption, it also would mandate that workers be able to leave for lunch and be provided with 15-minute breaks – a costly proposal to implement because agencies would have to provide a second caregiver to cover each break.
The bill, AB 889, also requires that in-home care aides have eight hours of uninterrupted sleep. This is virtually impossible to promise given that seniors or people with disabilities often need assistance in the middle of the night. If a worker legally could not be awakened, the patient is put at extreme risk of suffering unnecessarily.
Also moving through the California Legislature is SB 411 by Sen. Curren Price (D-Los Angeles), a bill that would require the certification of all home care workers. Requiring the state to certify each worker when they number in the hundreds of thousands would create a bottleneck that would severely restrict access to care for our most vulnerable citizens. And we find it stunning that the legislation applies only to the private sector that pay for the care themselves – those who often are middle class and earn too much to quality for government assistance. In Home Supportive Services union workers who serve low-income elderly and disabled adults, and those serving developmentally disabled in government programs, are exempt from this requirement.
Under Price’s legislation, each home care agency would have to pay an annual licensing fee of nearly $4,000 and additional charges of $165 per employee per year. In my case, this would mean an unbelievable $185,000 in additional fees each year. These exorbitant fees would drive up the cost of care for many working families already struggling to pay for the care they need.
While these proposals are unworkable, there is a more reasoned approach to balancing the call for increased regulations and consumer needs. The California Association for Health Services at Home is supporting AB 899 (not to be confused with AB 889) by Assemblywoman Mariko Yamada (D-Davis), chair of the Assembly Committee on Aging and Long Term Care. Yamada’s bill would require that home care organizations be licensed and regulated by the state and be responsible for the caregivers they hire. The estimated $8 million cost of this bill is far less than SB 411’s price tag of $25 million.
According to the California Healthcare Foundation, the number of Californians age 65 and older is likely to more than triple between 2000 and 2050, with the 85-and-older group experiencing the largest increase.
The aging of our population is happening at a time when government is cutting funding for social and safety net services. Is it fair, then, for government to implement unrealistic rules and regulations that only drive up costs for those who will have to pay for any additional help themselves? On behalf of my colleagues and my clients, I would say it is not.
Barry Berger is president of Accredited Home Health Services in Woodland Hills, which provides in-home care. He also is chairman of the California Association for Health Services at Home.