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Will Regulating Home Care Workers Cost Jobs?


I'm Michel Martin and this is TELL ME MORE from NPR News. Coming up, we are going to continue to mark the two year anniversary of that devastating earthquake in Haiti. We'll talk about the role that art is playing in the country's rebuilding efforts. That conversation is a little later in the program.

But first, this is a conversation that we think will hit home for many people who are elderly or disabled or are caring for someone who is. These days, many people, either privately or with the help of government funds, hire someone to help with tasks like bathing, dressing, eating, taking medicine - even going to appointments.

But there's a big question about how much these workers should be paid. They are currently exempt from federal overtime and minimum wage protections, much like babysitters are, but last month, the Obama administration proposed regulations that would include home care workers under the Fair Labor Standards Act, which means they would have to be paid minimum wage and overtime.

Now, many supporters and home care workers say this is long overdue, but the proposal also has some families worried about being able to afford the help they need at a time when the population is aging. Families are often spread out and everybody in the household who can work outside the home is already doing so.

We wanted to talk more about all this, so we're joined now by Sam Hananel. He covers labor for the Associated Press. He's been reporting on the home care wage proposal.

Also with us is Linda Kunkel. She's the director at Care Options, a private home care agency in Falls Church, Virginia.

And Nicole Lee, who hired a home care worker for her father after he was diagnosed with lung cancer. She's also executive director of TransAfrica Forum. That's a social justice organization for people of African descent.

Welcome to you all. Thank you all so much for joining us.

NICOLE LEE: Thank you for having us.

LINDA KUNKEL: Thank you.

SAM HANANEL: Thank you having us.

MARTIN: Sam, I'm going to start with you. What would actually change under this proposal?

HANANEL: Well, as you mentioned, since 1974, under federal law, these health care workers who work for the elderly at home have been one of the few professions exempt, specifically from minimum wage and overtime laws, so under this, they would have to now actually get minimum wage and overtime.

My sense is it could be overtime after 40 hours, so for example, you could work for three days in a row and then you would have to have some time off, unless your company was going to pay you overtime for that.

MARTIN: And could you just refresh our memories about why it is that home care workers have been exempt from these wage protections to this point?

HANANEL: Sure. And as you mentioned, back in the 1970s, they called them companion caregivers. These were really akin more to babysitters at the time. They were not considered true professionals. They were expected, to really, just spend a few hours here and there helping out around the house with folks who are elderly, but things have changed dramatically over the last 30 or 40 years.

The first change is that the number of elderly people in this country has really skyrocketed, and with that, there are now some two million home care workers who care for these folks.

And the other change is that the nature of the work really has become much more to be taken seriously. It's not just playing cards or going for a walk with, you know, an older person. It's really almost like being a nurse at times in terms of how tough the profession can be, so there is a sense in the Obama administration that it was time for these folks to be treated like most other professions in terms of getting overtime and minimum wage pay.

MARTIN: Linda Kunkel, why don't you pick up the thread there? Tell us a little bit about the kinds of jobs that the people who work for your agency do. Is that about right?

KUNKEL: Well, we are really a personal care agency, so our aides are doing personal care. They're bathing, they're dressing, they're assisting them in their activities of daily living in their home and, you know, your little 93 year old lady who's been living in her home all these years doesn't want to leave it and go to a sterile environment where she's going to have to put up with somebody else's schedule and somebody else's meals. She really wants to age in place and the family wants to be able to try to do that.

But it's a private pay industry. We are not paid by insurances. Long term care insurance can contribute to this, but most people don't have long term care policies, so it's usually something that they're paying for out of their pocket.

MARTIN: Okay. Nicole, you also have young children.

LEE: Yes.

MARTIN: So you have experience with hiring people to help you with the children. Was hiring someone to help with your dad a very different experience?

LEE: Well, it was and actually, interestingly enough, we actually had not hired anyone for our infant daughter before we hired someone for our father. My father actually moved from upstate New York to Washington, D.C. to help us with our daughter and, at that point, he was diagnosed with lung cancer.

And so we were actually in a position where we did have to hire a nanny and a home health care person at the same time because his health deteriorated very quickly. He was so quickly diagnosed as really not having a lot of treatment options. We actually got into the hospice programs very quickly and that's where we encountered the home health care field.

MARTIN: Can I just say I'm sorry.

LEE: Oh, thank you.

MARTIN: That must have been hard.

LEE: Thank you. You know, it was difficult, but it's a person who lived a wonderful life, so my father was 71 when he passed away. He was a young man, so he really needed someone who could keep up with him and also could watch as he needed more assistance and we found that with our home health care aide. It actually made his death experience, frankly, a positive one, in a way, because of her care.

MARTIN: Well, give me an example of the kind of work that she did. And if you're just joining us, this is TELL ME MORE from NPR News. We're talking about a new proposal by the Obama administration that would require home health workers to be paid minimum wage and overtime. That's different from the way the law is now. Home care workers now are among the few professions that are exempt from these laws.

My guests are Nicole Lee, who hired a home care worker for her father. That's who was speaking just now. Also with us, Linda Kunkel from Care Options. That's a home care agency in Falls Church, Virginia, a private agency. And Sam Hananel, who's a labor reporter with the Associated Press and is reporting on this.

So tell us about some of the work that she did, if you don't mind.

LEE: Well, like Linda was saying, I think, in the beginning, there was a lot of companion care, so my father, although was sick, he wanted to go everywhere and Washington, D.C. was new to him, so he wanted to walk around. He wanted to go to different cafes. He also wanted to do laundry. He was a very active person, but we knew he couldn't do those things by himself.

There was one case where he did go by himself and he came home injured and so we knew that it was important that he had someone with him at all times. And so that went on for a bit, but then, very quickly, it became his inability to get out of bed and to make sure that she was there to help him get out of bed and bathe him and feed him when my husband and I, who both work full time jobs, couldn't be there.

MARTIN: Did the hours get longer as he got sicker?

LEE: Absolutely, absolutely.

MARTIN: Like from what to what? Give us an example.

LEE: It went from six hours a day to, I believe, the maximum was 12, but he had 24 hour care, so we actually had on another home health care worker because he needed the 24 hour assistance.

MARTIN: So did she get overtime when she went above a certain number of hours? How did that work with your relationship? Or did she get straight time no matter what?

LEE: Sure. My understanding, because she was not paid directly by us - she was paid by the hospice program. So my understanding was that she did not get overtime for those hours and this was actually the first time I actually understood the way that home health care workers were treated.

MARTIN: Linda Kunkel, you run a home care agency.


MARTIN: Do you have concerns about this or do you think it's right and fair and about time?

KUNKEL: This is a very costly endeavor for families and they are really very much trying to maintain their family in their home environment and not many people can afford those, so I think that, to say, oh, we should just pay them overtime - I think it's really going to pass on a huge cost to the consumer who already can hardly afford to do this. That amount of money is just going to...

MARTIN: Well, just playing devil's advocate for a minute, just raising some of the issues that Sam Hananel raised, that the Obama administration raised. Their argument is that this work is more complex. It can be literally back breaking because, as people become sicker, they sometimes need to be lifted and so forth. It's a job that needs to be paid accordingly. How do you answer?

KUNKEL: And our argument to that is that we are paying our employees extremely well. We take care of their benefits and they get 10 percent of their salary every year that gets put into a pension plan for them. They're continuing their education. We give them educational credits every month to keep up on their learning about Alzheimer's or dementia or about the elderly. And we're well above the minimum wage, so that's not an issue for us.

MARTIN: And, Sam, to this point, we were talking about this earlier. I am surprised by how little has actually been written about this whole area, the home health area, given how much of the population now requires it. Is that your sense, as well, Sam, that it's actually kind of a new area to sort of think about and cover seriously?

HANANEL: Yeah. I mean, I think it's becoming something that more people are concerned about, especially you look at the statistics, the size of the U.S. population. Over 65 is expected to nearly double in the next 20 years. It is becoming more and more of an issue that people are concerned about and paying attention to.

MARTIN: Linda Kunkel, you were making the point about how, on paper, perhaps these employees may not be paid or may not be required to be paid minimum wage, but in fact, many people make a lot more than that.

I just want to play you a clip from a person who reached out to us on Facebook. His name is Paul Hogavane (ph) from Hudson, Massachusetts. He says his insurance would not cover a full time home health worker and this is the consequence. Here it is.

PAUL HOGAVANE: I employed home health workers for several years to help me with my teenage son, who has Duchenne's Muscular Dystrophy. Because I could not get enough home health care coverage for a full work schedule, I worked only part time. I think the thing that impacted us the most was that I simply had to keep cutting back on my own work hours in order to provide the care that he needed on an almost around the clock basis.

MARTIN: Linda, that speaks to your point. Could you just give us a sense of how much a family who has a home care worker, a home care aide, full time could be paying? Obviously, that's going to vary depending on where you live and how much care you're getting. But, say, a major urban area. Let's say like that.

KUNKEL: Well, I mean, our hourly rate is about $20 an hour and our live-in rate is $220 a day, so that's what they're paying. You know, we're the sandwich generation. We're getting, of course, stuck taking care of parents and also raising kids and, as this gentleman said, the economy has really made it such that people have already been cutting back.

And what we're worried about is, by pushing this, people are going to - not being able to afford our rates, they're going to go to the - what we call the underground. They're going to find the care workers that Susie knew from church or, you know, whoever is going to come in and they're not going to have background checks. They're not going to have papers. Their taxes may not be being paid. They're not going to have the education and the supervision.

My nurses go out and supervise these aides monthly and you've got a registered nurse who's available to you as the direct supervision to make sure that the care plan that you've put together for your loved one is actually being followed through on.

MARTIN: Nicole, though, what about the other side of this? This is something that I know that you raised because you work in the social justice area. The White House says that 92 percent of home care workers are women. They're disproportionately African American or immigrant. Is there a sense now that these workers are subject to exploitation?

LEE: I actually have members who are home health care workers and they describe really having long hours, being stressed. This is not easy to take care of these people.

MARTIN: So you think minimum wage and overtime is right and fair?

LEE: Absolutely.

MARTIN: But let me push you on this point. Were you worried about the cost? Were you worried, at some point, that you would not be able to afford the care that your father needed?

LEE: I was worried about both costs. I was worried about the cost for my child and the cost for my father and the cost for the medicines and the cost for every - for just the entire package of care. But one thing that I've always worried about is making sure that the people who are on the front lines taking care of my daughter and, at the time, taking care of my father, are well taken care of.

It's superhuman to expect working class people to not be paid appropriately and also do a great job and I wanted my father to have the best care that I could provide and so I was willing to make the sacrifices to make sure that happened.

MARTIN: Well, Sam - obviously, that's an argument that Sam Hananel with the Associated Press, you've been reporting on this. That's obviously an argument that the Obama administration and particularly the Labor Department found persuasive.

HANANEL: Right. And, certainly, there is a political component to this, as well. This has been an issue that's been kicking around the Labor Department for some time.

In the waning days of the Clinton administration, they actually tried to put this rule up, but they did it so late that, when the Bush administration came in, they put the brakes on it and so a lot of these folks who work at these home health care companies are also in labor unions. And labor unions have been pushing the administration to make this rule. It's been considered a rule that many of these workers did want to have, although there's certainly the argument that the industry has been making, that some workers might lose out on some of the long hours they get now.

MARTIN: Linda Kunkel, what about your - have you had any opportunity to talk to any of the folks who work for you and ask them what they think? What do they say?

KUNKEL: Yeah. They don't feel like they're being taken advantage of. I mean, I think they feel like they're being very well taken care of. What they're actually worried about is that they're going to be able to have to be spending more time away from their families because they're going to have to work two jobs rather than working one job.

We were talking about this before. If you say, well, I'm going to give you Saturday and Sunday off or I'm going to give you two days, three days off, they call and say, well, what other job are you going to put me on? I want to do this.

MARTIN: But what about Linda's point, which is, it's not the same as making a car in a factory, that it's very intimate and personal and that people develop these close relationships.

So, for example, a person might work 24 hours straight one day and then, when a daughter comes in from out of town, have the rest of the week off and still be paid the same, which is not what you would do in another job. What about that argument?

LEE: Yeah. I can imagine that being the case, but I think what is - in our case, what was clear is that our home health care worker did become like a part of the family and she, because of that, did even more and went that extra mile for us all the time. And so, because she did that, I always felt like, okay. We need to make sure she's properly compensated, as well.

MARTIN: But the question, I think, becomes, is this an objective that needs to be accomplished through regulation? And you would argue that it does. Why?

LEE: You know, honestly, I would. And I think, oftentimes, when things are not regulated, people try to play in the margins. I know, frankly, I have thought about it. I've said, well, you know, I have a nanny. Am I going to pay her overtime or am I not going to pay her overtime? It's important to do that. And in any other industry, we do it, so why - I expect that, on my job, I think it's appropriate that it would be done with such important work. I mean, this is the most important work we have is children.

MARTIN: Linda Kunkel, what's your argument for why this does not need to be accomplished through regulations?

KUNKEL: I think it's going back to the consistency and the continuity thing and we're definitely paying them well and we are taking care of them and to have two or three or four people come in a home now where you've had one, I think, is really going to be disruptive to our elderly clients with dementia who are already confused. To minimize the fact that we're not taking care - I think we are taking care of them and we're taking very good care of them. And they do become part of the family because they want to.

MARTIN: Sam Hananel, we've only just scratched the surface of what - you can easily see where this could become a very emotional argument and...

HANANEL: Certainly.

MARTIN: ...my guess is that it will. Where does this go next?

HANANEL: Well, it's, of course, just a proposed rule at this time and, typically, those rules have 60 days for comments. They'll take probably thousands of comments from interested parties and then they'll weigh all those comments and decide whether or not to make a final rule. But it is highly likely that the rule would not be much changed and that you'll see it promulgated officially later this year.

Already, about 16 states have implemented on their own mandatory overtime and minimum wage provisions for these workers. They have sort of gone beyond the federal rule. Those include states like Maryland, California and New York, so you'll probably see a lot of these home care provider companies try to touch base and share stories with their colleagues in other states and see how they've made it work or not work and how they can try to adopt to the new rules.

MARTIN: Sam Hananel covers labor for the Associated Press. Linda Kunkel is the director of care giving services at Care Options. That's a private home care agency in Falls Church, Virginia. That's right outside Washington, D.C. And Nicole Lee is executive director of TransAfrica. That's a social justice and human rights organization. They were all here with me in our Washington, D.C. studios.

Thank you all so much for joining us.

KUNKEL: Thank you.

LEE: Thank you.

HANANEL: Thanks for having me.

KUNKEL: Thanks.


MARTIN: Just ahead, it started as one woman's attempt to both have some fun and maybe teach a few lessons in racial sensitivity. Now, her video has become a YouTube sensation with more than five million views and counting.

FRANCHESCA RAMSEY: Is it, like, bad to do black face? Is that still, like, a thing? My best friend was black. I mean, she's still black.

MARTIN: We'll talk with the creator of the video called "Stuff White Girls Say to Black Girls." That's coming up on TELL ME MORE from NPR News. I'm Michel Martin.


MARTIN: Republican presidential frontrunner Mitt Romney is looking for another big win on the campaign trail in South Carolina, but could rivals like Newt Gingrich trip up his march to the nomination?

NEWT GINGRICH: People want to attack me for my past, that's fine. Romney ought to have to meet the same test.

MARTIN: The Barber Shop guys grade the contenders and weigh in on other news of the week. That's next time on TELL ME MORE.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.