Blog April 18, 2018

What a Fight for Home Care Worker Protections Taught Us

By Robert Espinoza


Large-scale policy victories often take years, if not decades, to achieve.

But they’re no less sweet when they become reality.

In August 2015, the U.S. Court of Appeals for the District of Columbia Circuit unanimously affirmed a federal rule that extended minimum wage and overtime protections under the Fair Labor Standards Act (FLSA) to nearly two million home care workers. The rule had been issued in October 2013 by the U.S. Department of Labor (DOL) yet faced a protracted, two-year legal struggle that delayed its implementation. Home care workers themselves had been waiting much longer to obtain these protections under FLSA, having been excluded from this law for more than 40 years.

Wins of this magnitude transpire because activists and industry leaders make them happen—and PHI and the Eldercare Workforce Alliance were key players in a broad coalition that steered the home care ruling. (The coalition also included the National Domestic Workers Alliance, the National Employment Law Project, Caring Across Generations, and SEIU, among others.) PHI was cited more than 40 times in the original findings issued by the Department of Labor when it announced its intent to rectify this decades-long exclusion. The Eldercare Workforce Alliance brought the force of its broader constituency—physicians, nurses, social workers, and other health care professionals working with older people—to this pivotal policy fight.

And we won.

In fact, the FLSA rule might be the most important legal win for home care workers since the National Academy of Medicine issued its seminal 2008 report, Retooling for an Aging America: Building the Health Care Workforce. This report provided a visionary roadmap to strengthen the nation’s health care workforce in support of older people.

On the 10-year anniversary of this report’s release, it’s important to reflect on how far we’ve come—and what still needs to be done. Here are five takeaways from this victory.

  1. More than ever, home care workers need higher wages to make ends meet—and to deliver high-quality care.

Under the FLSA rule, home care workers are entitled to the federal minimum wage, overtime pay, and reimbursement for travel time between cases—three key aspects of compensation for home care workers. Without adequate compensation, home care workers struggle in their jobs and in their lives. (Here are the many reasons this rule mattered to home care workers and the people who depend on them every day.)

  1. A growing workforce shortage in home care is threatening the sector—and low wages are one driving factor.

Chronically low wages—about $10.50 an hour, nationally—drive many home care workers into poverty and out of this sector. Home care providers are increasingly reporting challenges in finding and keeping home care workers—a shortage that is spreading across states. In turn, older people and people with disabilities struggle to access the supports they need.

  1. Wage and overtime protections are only two parts of the broader transformation needed to elevate the role of home care workers.

As well as higher wages, home care workers need good benefits, reliable schedules, transportation and childcare supports, and more training and advancement opportunities. This sector also need workforce solutions that support these workers as primarily womenpeople of color, and immigrants. The entire field needs financing reform, beginning with increased Medicaid funding and adequate reimbursement rates for home care providers. And this is only the start.

  1. Aging, long-term services and supports, workers’ rights, and disability rights advocates must work together when crafting solutions for our sector.

The profound challenges facing home care workers cannot be fixed with any single-issue “silver bullet” solution. Workers, older people, people with disabilities, and families all deserve approaches that speak to their needs and aspirations, and leave none of them behind.

  1. We can imagine ­and achieve solutions that improve both the quality of the home care job and the quality of supports we all receive.

Where do we go from here? Since February 2017, PHI’s #60CaregiverIssues campaign has been positing ideas to begin fixing the growing workforce shortage in home care. The Eldercare Workforce Alliance also has a range of online resources to support health care professionals in aging. The FLSA rule win—as with many victories in our country’s history—was sparked by leaders who imagined a better world and then began making it happen.


Robert Espinoza is the Vice President of Policy at PHI (Paraprofessional Healthcare Institute), a national research and consulting organization and the nation’s leading expert on the direct care workforce. In 2009, PHI and the American Geriatrics Society (AGS) co-founded the Eldercare Workforce Alliance (EWA), with the goal of working to prepare both the health care and long-term care systems to support older Americans and their families.