Misguided Push to Limit In Home Options for People with Disabilities
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By Kelly Buckland
Every day, thousands of American families face the difficult decision of how to secure in home services for themselves or a loved one. For an individual with disabilities or an elderly person, remaining in the home rather than an institutionalized setting is of paramount importance.
Hiring someone to help with daily tasks can make it possible for people
to remain in their homes.
Unfortunately, this essential option for in home support is being
threatened by the Administration without meaningful consideration of the
impact it could have on the disability community. If successful, their
policy change will sharply increase the costs of in-home services, force
people with disabilities to bring multiple people into their homes,
reduce the availability of family and friend attendants and cut the take
home pay of attendants.
At issue is an exemption in a 75-year-old law called the "Fair Labor
Standards Act," which guarantees qualified workers a minimum wage and
overtime pay. When it was passed, this law included an exemption for
those providing "companionship services," a category that included
in-home personal assistance services.
The reason for the carve out is simple enough: This class of services
isn't like a normal 9-to-5 job. In-home attendants often work odd hours
and it may often be a family member they're working for. They grow close
to the people they work for and the continuity of care they provide an
individual with disabilities is vitally important.
Today, there are more than 56 million individuals with disabilities in
the U.S. Many of them will need assistance at some point to stay in their
own homes. Also, the needs of the elderly continue to grow, and that
number will climb sharply as baby boomers retire. Now, national long-term
care costs already top $342 billion a year. Home and community-based
services - which are more cost-effective - can be one answer to control
costs, but not if the Administration gets its way on the Labor
Department's proposed rule.
Those who want to close this companionship exemption in the Fair Labor
Standards Act argue that in-home workers deserve the same rights to
minimum wage and overtime protections as other domestic workers. This
campaign has good intentions, but NCIL believes the way the current rule
is written, it would have disastrous unintended consequences and make
in-home services unaffordable for many individuals with disabilities and
This rule change would effectively eliminate the "live-in companion"
model, where an attendant lives with an individual which for many
families is an ideal arrangement.
If this exemption is eliminated, NCIL and many others in the disability
community believe it will significantly impact the continuity of care
provided to individuals with disabilities, particularly people with the
most significant disabilities. Providers simply will not be able to
afford the overtime pay given existing reimbursement levels and will need
to replace home care workers before they reach overtime eligibility.
Also, it could potentially add to the out of pocket costs for
individuals, and according to the Administration's own analysis, the rule
change will force some individuals to leave their own homes and go into
Experts who've studied the rule note that it could even end up limiting
the ability of individuals with disabilities and seniors to enlist family
and friends to work in paid positions, putting another critically
important option at risk.
This rule change would add significant new costs to the already
cash-strapped state Medicaid programs. Today, Medicaid is the single
biggest payer for long term services and supports, spending $140 billion
every year on this important service. The National Association of
Medicaid Directors has warned that subjecting in-home providers to these
labor laws would significantly raise program expenses. And they agree
that this rule change will force people with disabilities and seniors
into more expensive institutional settings.
A cumbersome, one-size-fits-all federal in-home worker rule will put the
most desired option, staying in one's home, in jeopardy and drive up
costs for the Medicaid program. The Administration should resist this
effort and work with the disability community on common sense solutions.
Kelly Buckland is the executive director of the National Council on
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