High-risk patients and their home care workers are in grave danger of contracting COVID -19 due to the well-intentioned, but ultimately problematic, 2015 repeal of the Companionship Services Exemption (CSE) under the Fair Labor Standard Act (FSLA).
The provision, established by Congress in 1974, exempted home care workers (caregivers) from FLSA by allowing a caregiver to work for an elderly or disabled person for an extended period without the patient having to pay overtime.
The exemption was essential to the continuity of care, keeping the relationship one-on-one, patient to caregiver. It made care affordable, allowing these individuals to maximize their independence, avoiding institutionalization.
For over 45 years, the CSE balanced the interests of patients and their caregivers.
Joseph Bensmihen, national president of the Private Care Association, who lives with a disability, says, "Now more than ever the risk cuts two ways when it comes to home care. A multitude of caregivers at a single home increases patient exposure to COVID-19. Conversely, workers are at higher risk, not knowing the health of those who have come and gone in a home before their shift."
During a recent House Ways and Means Committee hearing it was estimated that round-the-clock home care, with overtime, could cost a family $180,000 per year.
Government programs, like Medicare, do not cover the cost of private in-home care. Without the CSE, those in need of extended hours of care cannot afford one-on-one home care, putting their lives at risk. In the world of COVID-19, the already shattered term, continuity of care, has led to an exponential domino effect on the health and safety — of both patients and their caregivers.
Denise Ben-Haim, a Boca Raton, Florida, woman, who arranged home care for her 92-year-old father, says, "My father insists on having multiple caregivers, so he doesn't have to pay overtime. It's hard to get three excellent matches for one person. Before, he had one caregiver for a year. It has become very complicated and very costly."
The repeal of the exemption has brought dangerous complications to caring for Mom and Dad, or Grandma and Grandpa. According to Nilda Gonzalez, a home care worker from, West Palm Beach, Florida, "With this new law, a lot of people are working under the table. That's the scary part. You hear about the abuse.
"That's one of the consequences we're facing now. If the exemption was reinstated, I could work longer in one house with one client instead of having to go to five different houses in one day."
The ramifications of removing the exemption are all too real for one owner of a South Florida home care company, preferring to remain anonymous.
Recently, two home care workers were jeopardized when the patient they both worked for contracted COVID-19 and was hospitalized. The home care workers, and four other patients they had been caring for, had to self-quarantine for 14 days, leaving the patients without continuity of care.
The repeal of the exemption intended to raise wages for home care workers.
Instead, it caused them a massive injustice. Dawn Ingram, a caregiver from, Coral Springs, Florida, says, "Right now, I'm only working 40 hours. I'm actually earning just over half of what I usually got from a 60-hour shift."
Marsha Davidson, a caregiver from Lauderhill, Florida, says, "before the exemption was eliminated, I would work 96 hours a week and life was beautiful. I was able to pay my rent, my bills, and take care of my daughter. It wasn't exhausting because when you get to know your patient, you have a routine, and everything goes by like that.
"We would go out for lunch, sit at the pool, and do a lot of fun stuff."
Bensmihen, says "To keep home care affordable for the masses, not just for the elite, and to reduce the risk of patients and home care workers contracting COVID-19, it is imperative that the U.S. Department of Labor act quickly to reinstate the Companionship Services Exemption."
Liz Goodman-Pilkington is a television producer and reporter with special emphasis on healthcare communications.
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