Home Health Care
Please go to: Are Home-Care Aides Exempt from the Minimum Wage and Overtime Laws? for another article on this topic.
(1/18/19)- About three-quarters of U. S. workers face some kind of caregiving responsibility according to a recent study from a pair of Harvard Business School researchers. Joseph Fuller, a Harvard Business School professor was a co-author of the study.
The Census Bureau projects that for every 100 working aged Americans, aged 18 to 64, there will be72 people outside that range in 2030, up from 59 in 2010.
(2/7/18)- About one-quarter of home-care workers in nursing homes, assisted living facilities and home care agencies are foreign born, according to an analysis of census bureau data by P.H.I., a New York based data firm.
P.H.I data also reported that the median wage for home care workers was $10.49 an hour in 2016, and does not include any benefits. With an aging population in this country, there is going to be a greater and greater demand for these fabulous workers, but where are they going to come from?
(12/22/17)- About one quarter of women 45 to 64 years old, and one in seven in the 35 to 44 year age group are caring for an older relative, according to the American Time Use Survey from the U.S.Bureau of Labor Statistics (https://www.bls.gov/tus/)
(10/28/15)- A survey by Genworth, an insurance company concluded that home health aides and homemakers charge a median rate of $20 per hour. When the writer of this article employed a home care aide supplied by an agency, I paid $22 per hour, and that was 2 years ago.
That same survey indicated that the average nursing home charged $220 per day, and $120 for an assisted living facility.
Medicare provides a list and evaluation of health-care agencies through its Home Health Compare site. You can find nearby agencies through a Zip Code search, and see patient quality care ratings and re-hospitalization rates.
Medicare provides home-care aide coverage, but for only 4 hours a day, for a patient under home hospice..
(10/10/14)- The Obama administration announced that it would delay enforcement of its plan to extend minimum wage benefits and overtime protections to the nation’s nearly two million home-care workers. The Labor Department had announced a year ago these new rules and protections would go into effect nationwide on January 1, 2015, but now stated that it would not enforce the rules for 6 months, from January 1 to June 30.
From July 1 through December 31, 2015 the Labor Department would “exercise its discretion” in whether to bring enforcement actions against any employer who does not pay the minimum wage or overtime pay.
Under the new rule, home-care workers would have to receive the federal minimum wage of $7.25 an hour and time and a half when they work more than 40 hours a week. Fifteen states have state minimum wage and overtime protection for home-care workers; six others and the District of Columbia require that they receive at least the minimum wage.
(9/2/14)- The Service Employees International Union (SEIU) won a victory this past Tuesday when 27,000 home-care workers in Minnesota voted in favor of unionizing. The union now represents 600,000 home-care workers in about 20 states, out of its total membership of 1.9 million workers. Many of the workers are paid through Medicaid.
There are now challenges pending against the unionization of these workers in Illinois, Mich., Mass., and Washington. The Minn., vote was 3,543 to 2,306 in favor of unionization according to state officials. The U.S. Supreme Court ruled 5-4 in June that home-care workers in Illinois aren’t full-fledged public employees and can’t be forced to pay union dues.
(8/29/14)- The U.S. Labor Department predicts that there will be nearly 50% more home health care workers by 2022, which is the equivalent of nearly 1 million more of these professionals than there are today. Turnover is around 40% to 65% each year, according to experts and researchers, while the median annual wage is $20,000, which is more than $5,000 below the other health-care support occupations the Labor Department tracks.
(5/6/14)- Genworth Financial’s latest annual report showed a median rate of $19 per hour for a hired home-maker, who does household tasks, such as cooking and cleaning. Even though their report indicated about a little over $20 per hour for a home-health aide, who helps administer personal care for the patient, we were paying more than that for the home-health aides I was writing about in the item dated 2/8/13 below. As I wrote in that item, we could not have managed without them.
The cost of home caregiving has gone up only about 1% annually over the last 5 years, compared with an increase of 4% a year for institutional care, according to the report, for that same period of time. The home-health care aides we used for my wife were hired through an agency, which took care of all the payroll details for them. To find an agency in your local area, you can find one through the federal government’s Eldercare Locator site.
The cost of hiring a home-health care aide will be affected by federal rules extending minimum wage and overtime protection to many of these workers next January.
(1/23/14)- The U.S. Supreme Court heard oral arguments in a case in which Illinois public sector home health care union members are arguing that they can’t be forced to pay union membership dues when some members do not agree with the union’s collective bargaining position. The health care worker provided services to Medicaid recipients. Please keep in mind that a state and the federal government share the cost of Medicaid beneficiaries.
In a case decided in 1977, (Abood v. Detroit Board of Education), the Supreme Court ruled that teachers who declined to join a union could be required to help pay for the union‘s collective bargaining efforts to prevent freeloading and ensure “labor peace” The lawyer for the appellants, William L. Messinger of the National Right to Work Legal Foundation argued that requiring the workers to pay union dues would be a violation of their First Amendment rights.
In the Abood decision, the court also declared that workers may not be forced to help pay for a union’s purely political activities. Please keep in mind that the Medicaid patients hire the home health care worker, who in turn are paid by Medicaid
(12/29/13)- Ann Carrns, in her article “Seals of Approval for Home Health Care Providers” in the December 28th edition of the N Y Times covered the topic very well, so I am taking the liberty of quoting some of the items in that article:
“The nonprofit Joint Commission (qualitycheck.org), which accredits hospitals and other health providers, is one of three groups recognized by the federal government as accreditors of a variety of home health agencies. Its seal of approval is one route towards the certification a provider needs to receive payments from Medicare, the federal health program for those over 65. The others are the Community Health Accreditation Program ((chappsapps.org) and the Accreditation Commission for Health Care (achc.org/accredited/Locations)…..
Medicaid, the state-federal government program for the poor, does cover longer term home health services, but eligibility and services vary by state”
Bright Star and CareMinders are the 2 large home care operators approved by the Joint Commission for having at least 95% of its franchise locations accredited.
“To become accredited by the Joint Commission, an agency must undergo detailed reviews and on-site visits, including direct observation of patient caregiving, every three years.”…
Agencies pay fees to be evaluated for accreditation, and this in turn could mean higher charges to the consumer using their services.
(6/21/13- The number of home health-care workers is expected to reach 3.2 million by 2020, from the present number of 1.9 million in 2010, according to the Labor Department. The median wage for a home-health worker is $9.70 an hour in 2i010, according to the Labor Department.
Attempts are being made to unionize this industry, but many opponents argue that home-health workers are independent contractors, and therefore ineligible to join unions.
Minnesota passed legislation last month that gave 15,000 of these workers, as well as 7,000 home-child-care providers the ability to join unions if they so desired. Vermont also recently passed legislation enabling them to unionize in that state. Legislators in Wisconsin and Ohio have failed to pass legislation allowing the unionization of home-health care workers.
(2/8/13)- We could not have done it without the magnificent help that we got from my wife Margie's home health aides. Yes there were medical professionals, social workers, friends and relatives, but without the terrific home health care workers, the job would have been many times more difficult.
My wife was diagnosed with breast cancer about 2 years ago. She received hormonal treatment for her affliction and held her own for a little over a year. Gradually she began to lose the battle, so that a few months ago her oncologist told Marge, my son and myself that her condition was terminal. The three of us all agreed that when death came, we hoped it would happen to her in her own bed.
We therefore decided we would enroll her in a home hospice program. We were told it would be difficult, but as I now look back on the events of the last few months, we never imagined it would be as hard as it turned out to be.
Marge was in pain, and the pain level continued to increase inspite of the opiates she was given to alleviate that pain. My son and I could take care of her needs in the evening, but we needed someone to care for her during the weekday hours that I would be at work.
We turned to one of the agencies that was recommended to us, and fortunately enough we got a terrific home care aide from the start. I knew that when I was off at work the aide would take better care of Marge than either Sam or I could give her.
The end came for Marge a little over a week ago, but I will always be thankful that her wish was fulfilled and she passed away in her own bed. It could not have been done without the able assistance of the home care aide. Thank you
(11/12/10)- Judge Christina Reiss of the U.S. District Court in Vermont ruled that Medicare officials had improperly denied coverage for certain home health care services provided to 66-year old Sandra Anderson, a woman who had suffered two strokes.
The judge ruled that even though the patient might have been in stable condition, she still needed home health care to prevent deterioration of her functional abilities. A Medicare beneficiary "need not risk deterioration of her fragile health" to justify continuation of skilled care from home health services.
Jacob S. Speidel, an attorney at the Vermont Legal Aid Society who helped represent Ms. Anderson said: "Medicare often denies coverage for home health services because people have stable chronic conditions. We believe this practice does not comply with Medicare law and regulations."
(7/30/10)- The Center on Budget and Policy Priorities, a research organization, reported that since the onslaught of the recession, at least 25 states and the District of Columbia have curtailed programs that deliver services to the elderly at home. These programs that are being curtailed are intended to enable the elderly and the infirm to continue to live at home rather than being placed in a nursing home or skilled nursing facility.
Because of the number of states that are running deficits, the following are a few examples of the cuts that are taking place:
(5/26/10)- Gentiva Health Servces Inc., one of the nation's largest home-health care companies has agreed to acquire Odyssey HealthCare Inc, which is one of the country's largest hospice-care providers.
The Atlanta, Ga., based Gentiva has been looking to acquire a hospice-care company for several years because it felt that there was a great deal of synergy between the two businesses. Gentiva's Chief Executive Tony Strange said: "Our home health operations overlay with (Odyssey's) hospice locations nicely."
The merger will be a cash acquisition which in turn will create the largest U.S. health-care company focused on home health and hospice services, with more than $1.8 billion in annual revenue, 60% from home health-care services and 40% from hospice operations.
Vitas Healthcare, a division of Chemed Corp. is the largest owner and operator of hospices in the United States.
(5/8/08)- New York State Attorney General Andrew M. Cuomo's office announced that it had brought a criminal indictment against one of the state's largest Brooklyn based home health care employment agencies. The indictment alleges that the company, Nursing Personnel Home Care, coordinated with corrupt training programs to certify prospective aides without requiring them to complete training as required under the state law for certification.
Under the state law, aides must complete 65 hours of training, including 16 hours of supervised practical training conducted by a registered nurse, but there is no central registry in the state to account for who has been accredited.
The company and its president Walter Greenfeld, are charged with first-degree grand larceny and offering a false instrument for filing. Mr. Cuomo also filed a civil lawsuit against the company and its shareholders to recover what he said was more than $30 million in improperly billed Medicaid funds. In addition to Mr. Greenfeld, the suit names the principal owner, Isaac Schwartz, and others associated with the company. Both the criminal indictment and the civil lawsuit were filed in State Supreme Court in Brooklyn.
(11/1/07)- According to the 2008 edition of Medicare & You, Home Health Services are: "Limited to reasonable and necessary part-time or intermittent skilled care or continuing need for physical therapy, occupational therapy, or speech-related pathology ordered by the doctor and provided by a Medicare-certified home health agency. Home health services may also include medical social services, home health aide services, or other services, durable medical equipment (such as wheelchairs, hospital beds, oxygen and walkers), and medical supplies for use at home".
You pay nothing for home health care services, but you are responsible for 20% of the cost of the Medicare-approved amount for durable medical equipment.
(10/12/07)- Please also see our article: "Are Home Care Aides Exempt from the Minimum Wage and Overtime Laws"
4/24/00)-The Congressional Budget Office has just released data showing that the spending by Medicare for home health care has dropped by 45% in the last 2 fiscal years. In 1999 the spending dropped to $9.7 billion, from $14.9 billion in 1998 and from $17.5 billion in 1997. The sharp decline in spending has been attributed to the changes that Congress adapted in Medicare spending under the Balanced Budget Act of 1997. The changes, which we discuss below limited payments to home care agencies that provide medical and social services to homebound people. The question now arises have these cutbacks been too severe and therefore are they too harmful? About 3 million people received home health care services in 1998 down from 3.6 million in 1997.
Senator Sue Collins (Rep.-Me.) is leading a bipartisan effort to eliminate the 15% automatic cut that is due to go into effect this year. Similar legislation has been introduced in the House by Representative Wes Watkins (Rep.-Wis.) and William J. Jefferson (Dem.-La.). A federal district court ruled last month that home health agencies in 9 states have improperly reduced or terminated home health benefits for thousands of Medicare patients without giving them any notice of the cutbacks or of their right to appeal. Home health care agencies have reported that they have been avoiding sicker patients who have chronic costly conditions because they do not receive adequate reimbursements under the new system. They do not want to accept patients who have costly long-term needs. Before the change in the law the CBO had predicted that Medicare would spend $127 billion on home health care from 1998 to 2002. It now estimates that Medicare will spend only $58 billion during that same period of time.
Medicare officials stated that under a proposed new payments system this would change. Under the "episode of care" system home health care agencies would get a fixed amount of money for each 60 day period with payments adjusted to reflect the severity of a person's illness.
Many Medicare beneficiaries would prefer to remain at home rather than be treated in a hospital or skilled nursing facility. This is an option that is available to the beneficiary, if and only if he/she meets the requirements that have been established for this benefit.
Medicare will pay for home health visits only if:
Both the physician and the certified home health agency draw up the plan of care. It specifically states the type, frequency and length of care that you need. It covers everything from your diet to the type of home medical equipment that you need. The plan can last for a maximum of 62 days. It than is renewed at expiration if there is a new plan.
If you are enrolled in a Medicare HMO, your choice of home health agency is limited to those certified agencies that are affiliated with the HMO.
Effective October 1, 1997, Medicare will pay for covered home health service as long as it is considered medically reasonable and necessary. There are however limits on the number of days and hours of care that you can receive in any week for certain types of services. The services are covered on either of one of two basis:
The home health agency will send your claim to Medicare. If you are enrolled in both Medicare Part A and Part B the first 100 home health visits are paid under Medicare Part A, if you have had at least a 3 day consecutive day stay in a hospital. You must start home health services within 14 days of discharge from the hospital for Medicare Part A to pay. After using up the 100 visits under Part A, Medicare part B will pay if you still meet the coverage guidelines.
If you meet all the requirements for coverage, Medicare will cover the following types of services:
Medicare does not pay for custodial care unless you are also getting skilled care such as nursing or therapy and the custodial care is related to the treatment of your illness or injury.
You are responsible for the costs that Medicare does not cover and a 20% co-insurance payment on Durable Medical Equipment, if you need it. The home health agency must tell you orally and in writing how much of the bill will be covered by Medicare, and how much you are responsible for yourself. If the physician spends extra time overseeing the plan of care he can charge you for doing it.
Much of the information for this article was obtained from the booklet "Medicare Home Health Benefits"
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin
updated January 18, 2019