You know how the rising costs of health care have been endlessly debated lately? And you have no doubt heard all the proposals and counter-proposals offered to counteract these trends. It’s almost impossible to have any clear notion of who’s on the right track – the American health care system is massive and endlessly complex, with lots of moving parts and variables, often likened to a patchwork quilt rather than to a well-oiled machine.
Many experts predict that in-home care will play a much bigger part in the lives of our elderly in the future as traditional nursing homes price themselves well beyond the reach of the average family. This sounds okay, actually, as many of us would prefer to stay in our homes and have the caregivers come to us. In fact, the National Bureau of Labor Statistics (BLS) is anticipating a considerable increase in the number of home health care workers in the US over the next decade. In the next nine years, many expect the home health sector to enjoy a 69 percent growth spurt, adding an additional 706,300 jobs by 2020.
This sounds great, given the stalled economy. Job creation talk is everywhere. Many families, too, are in real need of help. But will any of us be able to afford it? Remember that Medicare only covers home health aide services when they are given along with doctor-prescribed skilled nursing care or therapy (occupational, speech, physical). And only temporary or intermittent care is covered. Medicare does not pay for round the clock in-home care services.
The BLS found that in 2008, the average hourly cost of a certified home health aide was $32. A non-certified home health aide cost $19 per hour. This is pricey, and that was four years ago. Clearly, at these rates, and depending on the level of care and the services provided, home health care could cost an elderly patient and his or her family many hundreds (even thousands) of dollars each week.
The US Department of Labor (DOL) has also been making itself heard on the subject of home health care workers. Until now, the workers providing in-home care for the disabled and the elderly have been exempt from the minimum wage and overtime pay requirements of 1975’s Fair Labor Standard’s Act. The theory was (and remains, for the time being) that home care workers, currently classified as ‘companions’, do not qualify for the $7.25 an hour minimum set by the federal government. Nor are they subject to the requirement that they be offered overtime pay if they work for more than 40 hours per week. The DOL begs to differ.
Their research shows that the very low wages paid to health care workers is seriously undermining the department’s initiatives to improve the quality of care extended to the disabled and the elderly. The DOL also argues that the ‘companion’ classification be overturned as home health care aides are trained and skilled workers, providing many more services beyond simple companionship.
Still other interested organizations, including the National Association for Home Care and Hospice (NAHC), worry that overturning the ‘companion exemption’ would see the cost of in-home care skyrocket and make it well beyond the reach of many. The timing couldn’t be worse. In their press release on the subject, the NAHC states that raising the costs for the providers without increasing the government reimbursement they receive would very likely shift the cost of the wage increase to the people paying for the care – not a good plan.
One last thing: many states have already made the move to do away with the ‘companion exemption’, so who knows what a big national mandate would accomplish in terms of the overall cost of home health care for our elderly. And many reputable home health agencies already pay their workers more than the minimum $7.25 an hour. In fact, in 2010, the average pay for a home health care aide was $10.46 an hour.
Hmmm. Despite the sound-bytes, catch-phrases, mantras and slogans, this is far more tricky than it first appears. Cause and effect, behavior and consequences – this we understand. But which cause, which effect? whose behavior, what consequences? About this kind of stuff we could argue all day long. So, we’ll keep you posted.