This article was written by Craig Falk.  Craig is the President of Craig Cares, a premier provider of In-Home Caregivers In Sacramento that serves the area in and around Sacramento, California.   Craig was the founder of Craig Cares and has been helping elderly clients remain in their homes since 2002 with in-home care workers so they don’t have to move to nursing homes.  Craig is widely respected as an expert in the In-Home Care industry and his company is accredited as a Certified Home Care Aide Organization by CAHSAH, the California Association for Health Services at Home.

Introduction

There are proposed new regulations and laws which, if they take effect, will significantly impact the private-sector non-medical in-home caregiver industry in California  and hurt the workers who perform this very important and valuable work.  The proposed new burdens for the industry include a Federal Department of Labor regulation change that has been ordered by President Obama (currently in a public comment period) and a California Assembly Bill (AB 889) authored by California Assembly Member Tom Amiano (D-San Francisco), currently being considered by the state legislature.

Both of these propose to require that in-home care workers that work as employees of in-home care companies (1) be paid at least minimum wage, and (2) be paid overtime.  They only apply to caregivers who work as employees of home care companies but not to workers hired privately by clients and their families.

There’s No Question That In-Home Caregivers Should Be Paid At Least Minimum Wage

Caregivers should be paid at least minimum wage, and they are.  The federal minimum wage is $7.25 an hour and the California minimum wage is $8.00 an hour.  In my agency,  and most agencies, the beginning caregiver wage is $10.00 an hour.  That’s 38% above the federal minimum wage and 25% above the California minimum wage.

So the more significant issue is overtime, not the minimum wage.

Should Non-Medical In-Home Caregivers Be Paid Overtime?

The Federal proposed change would require that non-medical in-home caregivers who work for home care companies be paid overtime if they work more than 40 hours per week.  The proposed state change (AB 889) would require that non-medical in-home caregivers who work for home care companies be paid overtime if they work more than eight hours per day or more than 40 hours per week.

In much of the debate I’ve heard, proponents of eliminating the Companion Exemption refer to caregivers as “home health care” workers.  By the labor code’s own definition, caregivers provide only “non-medial” care giving services.  I believe it is only fair to be clear there is a distinction between “non-medical” caregivers and “home health care” workers who are RN’s, LVN’s, Physical Therapists, and Social Workers.  These positions require a much higher level of education and are governed my entirely different labor codes.

Should non-medical in-home caregivers be paid OT?  This is a more complicated question.  At first glance it seems obvious they should be paid OT.  I certainly thought so when I first heard about the issue over ten years ago.  However, the premise of the OT exemption is that there is routinely a significant amount of downtime for shifts that are greater than four hours.

For example, during a 12 hour shift the caregiver may be actively working less than 50% of the time.  Remember, nearly all in-home caregivers work for only one client at a time.  They have vastly different working conditions than employees in retail environments or caregivers working in nursing homes who care for at least 8 residents at a time.

After ten years in this business, I now believe the OT exemption is fair.  I do know that 12 hour shifts, without OT, are far more popular with caregivers than 4, or even 8 hour shifts.  I also know that if the OT exemption is removed we will rarely schedule caregivers for more than 8 hours a day or 40 hours a week as is the case in any industry where OT is required.

Should Non-Medical In-Home Caregivers Be Paid For Sleeping?

Is it reasonable to deduct sleep time for a caregiver?  Live in caregivers stay at the home of their client for three to four days straight.  They have their own room, bed, and their food is supplied.

It is true the caregiver is required to stay in the house, including at night, in case the client needs their help.  Currently sleep time can be deducted for caregivers in the same way as ambulance drivers or apartment complex managers.  The federal government has provided clear guidelines as to when sleep time can be deducted from paid time.  The caregiver must get 8 hours of sleep, of which five hours must be continuous, and not be awakened to assist the client more than one to two times a night on a regular basis.

Live In shifts are not for everyone.  For some in-home caregivers, family responsibilities prevent them from working Live In shifts.  For many in-home caregivers,  Live In shifts are preferred as they can make $30,000 a year working four days a week.

The proposed changes in AB 889 would eliminate Live In shifts.  The only option would be to staff round the clock care with three 8 hour shifts daily.  A client would have three different caregivers every day and at least six over the course of a week.  Maximum yearly pay for one of these caregivers would be less than $17,000.

Why Should Overtime Be Required For Caregivers Working For In-Home Care Companies, But Not For Caregivers Working Privately?

While the current proposal to remove the Companion Exemption applies to caregivers working for agencies, caregivers working privately for individual families remain exempt from OT.  That is not fair.  The working conditions are the same.  The caregiver already has more protection when working for an agency.  It makes no sense to create even greater protections for caregivers working for agencies, but none for those working privately.

Agencies like mine exist to keep seniors safe and comfortable in their own homes.  The proposed federal and state changes would increase the costs to some clients, including those requiring 24 hour care, by 100%.  A Live In caregiver’s potential wages drop by 43%.  Neither clients nor caregivers can afford this.  They would have little choice but to make private employment arrangements.  Not only would both parties lose the protections they enjoy using an agency, but federal and state governments would lose payroll and income taxes.  How can that be fair for anyone?

For professional non-medical in-home caregiver service in the Sacramento area, call Craig Cares at (916) 782-7121!

On December 15, 2011, the White House announced that the U.S. Department of Labor’s Wage and Hour Division will publish a proposed rule that will effectively end the companionship services exemption for home care aides. The proposal will revise the companionship and live-in worker regulations under the Fair Labor Standards Act to more clearly define the tasks that may be performed by an exempt companion, and to limit the companionship exemption to companions employed only by the family or household using the services.

In addition, the Department of Labor proposes that third party employers, such as in-home care staffing agencies, could not claim the companionship exemption or the overtime exemption for live-in domestic workers, even if the employee is jointly employed by the third party and the family or household. Click here to review the proposed rule.

President Obama’s Order Increases In-Home Caregiving Labor Costs

Caregivers employed by employer-model companies such as A Servant’s Heart Care Solutions could work no more than 40 hours per week unless they were paid time-and-a-half overtime pay.  In order for that to be economically feasible, the companies would have to charge the clients and their families a corresponding time-and-a-half overtime rate for all hours worked in excess of 40 hours per week.

As a practical matter, most clients and their families will decide not to pay for the overtime premium, and instead will choose to receive care from more than one caregiver if they need more than 40 hours of caregiving service per week.

Also, employer-model home care companies will not be able to offer more than 40 hours per week of employment to their caregivers.

President Obama’s Order Will Cause Financial Hardship and Lowered Quality of Care For The Elderly

Higher Costs

Clients will have to choose between paying drastically higher bills having more caregivers involved with their care.  The detrimental impact of higher bills is obvious.

Decreased Quality Of Care

The detrimental impact of having more caregivers involved in their care is that the continuity of care that they receive will decrease.  One caregiver can be more effective than two, in most cases, because the client and the caregiver develop a very effective working relationship when only one caregiver has to learn the routines and understand and interpret the client’s expressions and moods.

President Obama’s Order Will Cause Financial Hardship and Lowered Job Quality For Home Care Workers

Having to work for multiple employers

Since employer-model home care companies will have to limit most caregivers to working 40 hours or less per week, caregivers who need more than 40 hours per week of wages in order to make a living will have to work for more than one home care company.

Loss of  afternoon or morning shifts

Most home care clients receive caregiving assistance in four-hour shifts, either in the morning or in the afternoon.  Currently, many caregivers work a four-hour shift in the morning with one client and then drive to a second client to provide four hours of assistance to that second client in the afternoon.

When a caregiver works with one client in the morning and then with a second four-hour shift in the afternoon, the employer is required to pay the caregiver for the time and mileage spent driving from the morning client to the afternoon client.  President Obama’s order means that that travel time will, in effect, be paid at time-and-a-half overtime rates.  Most home care companies will decide either to not to offer two four-hour shifts to their caregivers, or to reduce their hourly wages to cover the difference.

President Obama’s Order Will Cause Financial Harm for Federal and State Governments

Increase in Non-Employer Model Caregiving Companies

There have been numerous Federal and state legislative actions during the past few years that have significantly increased the cost and risks of doing business as employer-model home care companies in California.

President Obama’s order is yet another such action, and is one more reason for employer-model companies to either stop offering employer-model services, or to start offering non-employer model services so that the agencies can offer caregiving help to the public at a rate that the public can afford, while avoiding many of the risks and costs of being the caregivers’ employer.

When caregiving services are provided by a non-employer caregiving agency, the worker may be the client’s employee or an independent contractor depending on the relationship the client has with the worker.  If the client directs and controls the manner and means by which the domestic worker performs his or her work the client may have employer responsibilities, including employment taxes and workers’ compensation, under state and federal law.

Increase in “Underground Economy” Caregiving

Underground Economy” refers to the situations in which families privately hire caregivers and neither they, nor the caregivers, report the wages paid to the caregivers.  The Federal and state governments never receive taxes for those wages.  In effect, there is an entire economic ecosystem that is “underground” and never sees the light of day, from a tax standpoint.

President Obama’s Order Will Harm Seniors and Home Care Workers – So Why Is He Doing It?

That’s a great question.  We hope that the American people ask him that.

• It is very clear that the Elderly and Home Care Workers will suffer hardships and setbacks.
• The main advocates for this change have been the far Left and the unions, who invested heavily in President Obama’s election campaign.
• President Obama is not a stupid person, so he must know how much harm his order will cause for the Elderly and for Home Care Workers.
• So, why is he pushing this agenda?  Who wins?  Please ask President Obama who really benefits from his order.

The online magazine “Life As A Human” just published a great article about the difficult financial condition of United States Social Security system.  The article, titled “Raising the Retirement Age in America is Robbing Peter to Pay Paul” is a concise and insightful summary of the problems and false assumptions associated with the theory that raising the minimum Social Security retirement age is a fair and reasonable solution for reducing the government’s budget deficit.

The article, which is subtitled, ” Abandoning the elderly is no way to balance a budget“, starts off by saying,

“Proposals to raise the minimum age for collecting both minimum and full Social Security benefits in are gaining increasing traction across the political spectrum. This looks like a comparatively painless way to address an intractable underlying problem: a large birth cohort entering retirement in the middle of a recession, which pushed forward by many years the date at which benefits exceeded payroll taxes. The Federal Government raised payroll taxes and supposedly stockpiled a surplus during the 1990s in anticipation of just such a crunch, but unfortunately they loaned the surplus to themselves, spent it on other programs, and are now faced with empty coffers and the prospect of having to borrow money to cover their debt to today’s retirees.”

Later, the article goes on to say,

“Charging the maintenance of [the people who should be able to receive Social Security benefits], who contributed faithfully to the retirement program which is now broke, to Social Security Disability, or extended unemployment, or entitlement programs such as section 8 housing, or heavily subsidized private insurance under “Obamacare” does not save the public any money and multiplies the bureaucratic headaches. The alternative is to tolerate high levels of poverty and unmet healthcare needs among the elderly. ”

The article sums up the situation by concluding,

“The people advocating raising the retirement age are making many assumptions, including projecting an economic recovery which so far has failed to materialize. One way or another, the system is going to have to produce a way of distributing intergenerational benefits and obligations in a way that is sustainable and affordable, across the entire spectrum of the American population. Raising the Social Security retirement age and throwing a large number of older people onto social safety net programs that are even more stressed is not the answer.”

Do yourself a favor and read the entire article.  It’s very thought-provoking and well worth it.

Medicare changes could benefit seniors:

With the regularly occurring changes in the medical field, attentive care for seniors in Oceanside is more important than ever. By making sure that you are kept up to date with the changes in medical policies, you can save hundreds each year by taking advantage of new programs and discounts that are offered. Medicare has recently changed its drug plan policies to benefit seniors. As of the beginning of November, Medicare has started their open enrollment period for the year that allows seniors to change their medication and health plan policies. The window to make these changes will only last through December 7^th, but by changing the policies to accommodate the medications that are being taken; you may be able to save up to $500 in the next year if you switch Medicare plans.

What to consider when choosing a senior health care plan:

When making the change from one policy to another, there are several things that can make attentive care for seniors in Oceanside more affordable. First, if medications have changed over the past year, a new plan may be better suited for the new medications. By getting a plan that covers only what is necessary; seniors can reduce their care costs and can save on their medications.

Second, you should compare rates and coverage details between plans to make sure that what you need is covered, but nothing additional is being paid for. Attentive care for seniors in Oceanside can be expensive, and by eliminating costs for benefits that are not needed, these attentive care costs can be lessened greatly.

Finally, in order to further reduce costs, you should make sure that your medical information is up to date and that you have had a recent physical examination. If you are in a healthy condition for your age, you can often get more affordable health care, especially if you do not take significant amounts of medication each day.

What this means for you:

Within the next month and a half, you can discuss with a professional what changes should be made to your Medicare plan. By calling your Medicare representative and asking about the open enrollment and how you can benefit from it, you may be able to save hundreds. This can help reduce attentive care costs for seniors in Oceanside and leave cash in your pocket for other important expenses.

Republicans are speaking out against the Obama administration and House Minority Leader Nancy Pelosi (D-Calif.) in response to a Daily Caller article reporting that 19% of recently issued federal health takeover reform law waivers went to businesses in Pelosi’s district, The Hill‘s “Healthwatch” reports.

According to the Daily Caller article, 38 of the 204 new waivers went to businesses located in Pelosi’s San Francisco-area district.

The article prompted criticism from Republican leaders, who suggested that the Obama administration was practicing favoritism by granting a substantial number of health reform waivers to Pelosi’s constituents.

Michael Steel — spokesperson for House Speaker John Boehner (R-Ohio) — said, “It looks like ObamaCare’s backroom sweetheart deals didn’t end when it became law.”

See more:  GOP Speaks Out Against Reform Waivers Granted to Pelosi’s S.F. District

Mon, May 9 2011

By Ros Krasny

BOSTON (Reuters) – Almost everyone in Massachusetts has health insurance under a state mandate, but many doctors do not accept the subsidized insurance programs available to low-income residents, a new study shows.

Residents in some areas also face long waits in getting doctors’ appointments, or find that overstretched primary care practices are not taking on new patients.  Many primary care doctors do not accept MassHealth, the state’s version of Medicaid, and even less accept Commonwealth Care and Commonwealth Choice, programs for low- and moderate-income residents.

More than half of primary care practices are not taking new patients, especially patients for whose treatment they will be paid at a much lower level than for those carrying private health insurance.  New patient wait times in Massachusetts jumped between 2006 and 2007 after the initial implementation of the state health care reform law, and have remained high. As a result, the rate of emergency room visits to receive care has also stayed high.

The complete report, “2011 Patient Access to Health Care Survey” can be viewed on the Massachusetts Medical Society website.

www.bit.ly/mqZno4 .

Some small businesses in California are unaware of the small-business provisions in the federal health reform law, while others have questions about their eligibility for the reform law’s benefits, the Modesto Bee reports.

Background

The overhaul includes two provisions designed to benefit small businesses. They are:

• Tax credits designed to help small businesses cover health care costs for their employees; and
• A state health insurance exchange, which aims to help individuals and small businesses compare and purchase health insurance plans.

Unaware of Benefits

Elizabeth Echols — regional administrator of the U.S. Small Business Administration — said California has about 500,000 small businesses that could be eligible for the tax credits.

However, about 57% of small businesses in California are not familiar with the tax credits, and 62% are not aware of the state’s forthcoming health benefit exchange, according to a recent survey by Pacific Community Ventures (Amaro, Modesto Bee, 5/8).

Qualifying for the Benefits

In addition, some small business owners have been surprised to learn that they do not meet the criteria for the tax credits in the reform law.

To qualify, average salaries for employees at a small business must be $50,000 or less (Amaro [1], Modesto Bee, 5/9). In addition, employers must have fewer than the equivalent of 25 full-time workers (Modesto Bee, 5/8).

Some small business owners who did qualify for and receive the tax credit say the credit did not cover a substantial portion of their employee health benefit costs (Amaro [2], Modesto Bee, 5/9).

Read more: Uncertainty Surrounds Small-Business Benefits in Health Reform Law

Failure to obtain informed consent and delays in diagnosis and treatment are among the causes of more than a dozen million-dollar malpractice payouts by the Department of Veterans Affairs, according to a spreadsheet of VA data published by the Project On Government Oversight.

The data, obtained through the federal Freedom of Information Act (FOIA) and published April 29 as part of the watchdog group’s “FOIA Fridays” series, details more than 12,000 claims against the VA from 1989 – 2008, with several thousand related to medical malpractice. The spreadsheet includes 16 cases that had payouts of $1 million or more.

Clinical negligence isn’t the only complaint against the agency. Veterans have long complained about its many bureaucratic hoops. But the VA isn’t hiding its failures — rather, it’s publicizing them. The agency recently hired one of its most vocal critics to blog about his frustrations with the department. Alex Horton, a 25-year-old soldier, is now airing his grievances on Vantage Point, theWashington Post reports.

For more:
- read the Project On Government Oversight article
- download a spreadsheet of VA malpractice data
- check out the the Washington Post article

Related Articles:
Study: VA hospitals overstate quality claims
Using malpractice claims data to dodge mistakes
Hospital malpractice claims stabilize

Hospital emergency rooms, the theory goes, get overcrowded because people without health insurance have no place else to go.

But that’s not the view of the doctors who staff those emergency departments.

The real problem, according to a new survey from the American College of Emergency Physicians, isn’t caused by people who don’t have insurance — it’s caused by people who do, but still can’t find a doctor to treat them……Since these insured patients are more — not less — likely to use the emergency department, 89 percent of physicians in the survey said they believe the number of visits to emergency rooms will increase as the new health law is implemented. (The findings also echoed the results of a December survey of more than 600 emergency department administrators by the Schumacher Group.)

“The results are significant,” said ACEP President Sandra Schneider in prepared comments. “They confirm what we are witnessing in Massachusetts — that visits to emergency rooms are going to increase across the country, despite the advent of health care reform, and that health insurance coverage does not guarantee access to medical care.”

See: Emergency Room Doctors Say Health Law Will Make ER Crowding Worse

The LA Times has drawn attention to the extraordinary compensation package of yet another public hospital CEO, this time in Salinas County. According to the article:

“Pension reform advocates are calling attention to the retirement package of Samuel Downing, president and CEO of the Salinas Valley Memorial Healthcare System. Downing received a $3 million retirement payment two years ago when he turned 65, and he continued working at an annual salary of $668,000. He will receive another payment of about $900,000 when he retires this week, as well as an annual pension of $150,000. Officials at the public health care system say such payouts are necessary to attract and retain talent.”

Read more: http://www.californiahealthline.org/articles/2011/4/28/salinas-health-system-ceos-pension-sheds-light-on-issue.aspx#ixzz1KuxSIx8w”