Home Health Care

(7/28/21)-In an article in the July 27 edition of the New York Times entitled “Home Cre Aides Are in Short Supply”, Paula Span writes: “More than 800,000 older and disabled people who qualify for Medicaid are on state waiting lists for home care.”

The Bureau of Labor Statistics predicts there will be more than 1 million new home care jobs by 2029.

Agencies are paying bonuses of up to $500 for new employees, but this won’t attract prospective employees who can find higher pay and better working conditions in other industries.

The Home Care Association estimated in 2018 that up to 80% of home care workers leave their jobs.

When working through an agency, a worker can give up more that 25% of the pay in agency fees. There is a strong belief among the workers that they will not live long enough to make up for the withholding of total amount of Social Security from their pay

(6/12/20)-Home health care aides are considered essential workers during the pandemic, and it is estimated that there are 6 million of them, which is more than people living in nursing homes or assisted living facilities. In an excellent article in the June 9 edition of the NY Times entitled “Navigating Home Aid During the Pandemic by Paula Span, the columnist discusses the plight of workers in the industry/

“Such aides-almost 2.3 million of them according to the research nonprofit firm of P.H.H.-help with everyday nonmedical needs like bathing,, dressing and using the toilet, they may prepare meals, do light housekeeping and remind clients to take their medications.

Even when consumers pay $22.50 an hour (the national average, according to an annual survey by Genworth), a daily four hour visit costs far less per month than a residential facility and may allow family caregivers to keep their jobs.”

“Even more than nursing home employees, home care workers are poorly paid hourly workers (average wage in 2018: 2018 $11.52 an hour, according to P.H.I.) and often lack health insurance: half rely on some form of public assistance.”

(3/29/18)- A Bureau of Labor Statistics analysis reported that among the 10 occupations expected to grow the fastest through 2026 that will require the most new workers, are personal care and home health aides. The analysis estimates that between these two occupations 1.2 million workers will be needed

About 10,000 baby boomers turn 65 every day and more than half will need long term care, according to the Pew Research Center, Where will these workers come from?

(8/22/17)- It is now a little over 10 years since the Supreme Court ruled in favor of Evelyn Coke battled to have home health care workers covered under the Fair Labor Standards Act.. As we noted in our item dated 9/19/13 below, the Obama administration issued regulations that did extend coverage under the act to these workers.

To learn more about Ms. Coke and these workers please go to PHI Quality Care’s blog on her at .

(9/19/13)- Evelyn Coke, who passed away recently and was the appellant in the case that we wrote about in our item dated 6/23/07 would be smiling now, because Obama administration officials announced that it was extending minimum wage and overtime protection to the nation’s nearly 2 million home care workers.

Under the new rule, home care aides, unlike baby sitters, would be covered under the Fair Labor Standards Act, the nation’s main wage and hour law. About 20 states exclude home care workers from their wage and hour laws. The current federal minimum wage is $7.25 an hour.

Under the new rules, which will take effect January 1, 2015, any home care aides hired through home care companies or other third party agencies cannot be exempt from minimum wage and overtime coverage. The exemptions for aides who mainly provide “companionship services” are limited to the individual family or household using the services.

If an aide provides “care” that exceeds 20% of the total hours worked each week, then the worker is to receive minimum wage and overtime protection. “Care” is defined as assisting with the activities of daily living, like dressing, grooming feeding or bathing and assisting with “instrumental activities of daily living,” like meal preparation, driving, light housework, managing finances and assisting with the physical taking of medications.

(6/23/07)- In a 9-0 decision the U.S. Supreme Court upheld federal regulations that exempt home health care aides who work through agencies from minimum-wage and overtime protection. Evelyn Coke, an employee of Long Island Care at Home did not get time-and-a-half for overtime even when she worked 24-hours a day at homes in Great Neck and Manhasset in Long Island. Ms. Coke, 73, initially filed her lawsuit in 2002.

The main issue in the case was whether several 1974 amendments to the Fair Labor Standards Act exempted home care aides employed by agencies from minimum wage and overtime protections. All parties in this dispute agreed that those amendments exempted aides hired directly by the elderly or the infirm.

The Bloomberg administration in New York filed a brief in support of the agency, stating how costly it would be for Medicaid to pay the additional costs if home care aides were to be paid overtime and minimum wages.

Justice Stephen G. Breyer wrote the opinion for the majority in which he acknowledged that the Labor Department had issued conflicting regulations on this matter. Ms. Coke's attorneys cited a recent ruling of the U.S. Court of Appeals for the Second Circuit which had invalidated a regulation exempting the aides from wage protection The circuit court ruled that the regulation clashed with 1974 legislation that broadened minimum wage coverage.

But the Supreme Court overruled the circuit court, saying that Congress's intent was clear with regards to home care aides. Justice Breyer wrote that he court should defer to the department's expertise, and especially to its most recent interpretations, which take the position that the aides should be exempt.

Senator Edward M. Kennedy (Mass.-Dem.) said he would seek to amend the Fair Labor Standards Act to ensure that home aides were protected.

(5/23/07)-The following is a copy of an email that we received from Joseph J. Tomaino of the Tomaino Group:
From: Joseph J. Tomaino
Sent: Saturday, March 17, 2007 9:05 AM
Subject: Nursing Home Article

I was very touched by your article on selecting a nursing home, and I have included a link to it on my web site for people providing care to elders: . I would appreciate it if you put a link to this site on your site if you think it would be of value to your readers. Thanks

Joseph J. Tomaino
The Tomaino Group
Innovative and Practical Solutions
For Leaders of Continuing Care
834 Heritage Court
Yorktown Heights, NY 10598

(7/31/04)- How does your local home health agency compare with other such agencies in the community and in the state that your beloved relative or friend live in? The Centers for Medicare and Medicaid Services (CMS) an agency of the U.S. Department of Health and Human Services has included this information in its site that will help you get some answers to this question.

New York City will add a service through its official Web site for people who take care of elderly relatives, friends and others. The Web site, can be accessed through the city's general government Web site, The site will provide information about local resources, including respite care, support groups, in-home support services and financial and legal assistance.

"Home health care is provided when you have a medical need for skilled nursing care and other services like physical and occupational therapy, speech language therapy, and medical social services provided by a variety of skilled health care professionals at home. Home health care may help you reach and keep your best physical , mental and social well-being."

The CMS now offers comparative information on this topic on this site. The site is entitled "Home Health Compare". The site is broken into statewide comparisons on an individual basis and on a state wide average basis.

It includes such categories as City, Patients who get better at bathing, walking, moving around or who get better at taking their medicines correctly (by mouth). The different criteria that are shown are important in helping you or your loved ones to determine which agencies can help you continue to live at home, and at the same time receive qualified home health care.

The site also includes a complete listing of Medicare-certified home health agencies in your area.


Allan Rubin
updated July 28, 2021

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