Workers in the home health care industry _ one of the country's fastest growing professions _ would be guaranteed minimum wage and overtime protections under new rules proposed Thursday by the Obama administration.
The move would boost living standards for nearly 2 million employees who help the elderly and disabled with daily tasks such as taking medication, caring for wounds or preparing meals. But some health service companies warned that higher pay could also mean higher costs for clients who can least afford it.
"They deserve to be treated fairly," said President Barack Obama at a White House ceremony surrounded by more than a dozen home health care workers. "They deserve to be paid fairly for a service that many older Americans couldn't live without."
It was the latest in a series of steps Obama has taken to try to boost the economy or help workers without going through Congress, where his jobs bill has stalled.
Home health care aides have been exempt from federal wage laws since 1974, when they were considered companions to the elderly and compared to neighborhood baby sitters. But the number of full-time home care workers has surged, along with the rapid growth of retirees who prefer care at home instead of at institutions.
As the jobs have evolved, home care providers have greater responsibilities helping clients with physical, developmental and intellectual disabilities and people with chronic or terminal illnesses.
"These are real jobs as part of a huge and growing industry," said Steve Edelstein, National Policy Director for the Paraprofessional Healthcare Institute in New York. "They deserve the same basic labor protections that other workers enjoy."
Unions and advocacy groups say nearly half of all home care workers live at or below the poverty level and receive public benefits such as food stamps and Medicaid. More than 90 percent of home care workers are women. About 30 percent are black, and 12 percent are Hispanic.
Republican lawmakers said Obama's plan would result in fewer work hours for home care workers and higher costs for taxpayers.
"Our nation's elderly may pay the greatest price in the form of more costly services and fewer opportunities to obtain the care they need in the comfort of their own homes," said a joint statement from Reps. John Kline, R-Minn., and Tim Walberg, R-Mich., who oppose the rules.
Tough working conditions, low wages and high turnover make it challenging to meet the growing demand for home care for the elderly. With the size of the U.S. population over 65 expected to nearly double in the next 20 years, millions more will rely on long-term health care from in-home workers.
"This proposal will draw more qualified professionals into the in-home care-giving profession, and it will improve the quality of care for our loved ones," said Labor Secretary Hilda Solis.
Currently, 29 states don't require minimum wage or overtime for home health care workers.
Health services companies that employ home care workers say they have major concerns that the proposed rules would drive up costs for elderly clients who can ill afford it.
"We are in full support of adequate and fair wages of those doing such admirable work," said Jordan Lindsey, a spokesman for the California Association for Health Services at Home. "However, it needs to be carefully balanced with the unique needs of seniors and people with disabilities who need home care and keeping that type of care affordable."
For a patient with dementia who needs 24-hour care, for example, a family is currently allowed to pay home aides at a flat hourly rate. If overtime rules apply, Lindsey said, it could triple the cost of care.
Labor officials said a rule change would have a minimal effect on Medicare and Medicaid, increasing costs by less than two tenths of 1 percent of what federal and state governments spend on the programs.
There is a 60-day period for public comments on the rules before the Labor Department considers them for final approval early next year.
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