The Obama administration announced Thursday it plans to extend minimum wage and overtime protection to more than 2 million workers who provide in-home care to frail and disabled people.
These home health and personal care aides give baths, dispense medicine, cook food and run errands — increasingly complex tasks in a fast-aging society. Many work for private agencies funded through public programs like Medicaid and Medicare.
But since 1974, the workers have been lumped in with babysitters as a class of "companions'' exempt from the Fair Labor Standards Act.
"As the home care business has changed over the years, the law hasn't changed to keep up,'' President Barack Obama said in a statement. "Employers are allowed to pay these workers less than minimum wage with no overtime. That's just wrong in this country.''
But some advocates for elderly and disabled people worry that higher labor costs could lead to cutbacks in service.
"This is a double-edged sword,'' said Sally Gronda, director of the Area Agency on Aging for Pinellas and Pasco County. "I support people getting a livable wage, but we have no extra money unless the Legislature gives us more money. The governor has kept all our programs at level funding and I want seniors to get service.''
The home care labor force is already one of largest but lowest paid in the country, according to the 2010 census. About 90 percent are women, and many have no health insurance.
Projections show the home care labor force growing to about 4.3 million by 2018, more than K-12 teachers, public safety employees, fast-food and cashier workers.
The change, which does not require the consent of Congress, would take effect next year after a public comment period. Its impact will vary from state to state and from employer to employer.
Florida had about 130,000 such workers in 2010, earning an average of $9.42 an hour, according to the Paraprofessional Healthcare Institute, a nonprofit advocacy group.
That compares to $12.73 an hour in New Jersey, the highest for home care workers, and the lowest of $8.15 in West Virginia.
Florida's minimum wage is $7.31 an hour — well below the average home care worker's pay. Still, the rule change has far-reaching effects by requiring overtime pay and hourly compensation for drive time to and from a client's home.
Alexis Garcia, 22, of St. Petersburg cares for Eric Biggs about 60 hours a week, seven days a week. Biggs, 51, has cerebral palsy. In the morning, she gets him out of bed and into a wheelchair, bathes and feeds him.
Then she dashes home to help care for her grandparents and her sister's two young boys. At 4:30 p.m., she heads back to Biggs' Kenneth City apartment for light housework, dinner and bedtime.
For this, Advantage Home Assisted Care of Largo, pays her about $8.50 an hour, without overtime. Florida's Agency for Persons with Disabilities reimburses Advantage about $14.04 to cover its overhead, but has been cutting back on coverage and reimbursement for five years, says Advantage's assistant administrator, Jennifer Finnen.
The state authorizes only 35 hours a week of care for Biggs.
"We know he needs 60 hours but we can't bill for it,'' Finnen says. So Advantage swallows the other 25 hours, losing money, she said.
If her company must pay overtime on top of that, "we just can't do it with Alexis anymore,'' Finnen said.
If the new rules happen, Garcia will be cut to 40 hours a week and Advantage will hire another aide to cover the other 20.
"That would really hurt me a lot,'' Garcia said. "I actually took on an extra 15 hours in February this year because I needed the extra money.''
She doubts she can make it up by working part-time at another agency. "Not a lot of other people have the flexibility I need,'' she said. "I watch my nephews.''
Working long hours without overtime risks burnout, said Deane Beebe, spokeswoman for the paraprofessional institute.
"The real issue with this industry is that it can't keep workers,'' Beebe said. "By taking this step, we are professionalizing this workforce in order to build it.''
The law would apply only to employees of companies, Beebe said, not to private arrangements.
Frank Stoker, president of Care Team Home Care of Tampa, welcomed the change.
His company already pays its workers $10 to $14 an hour with overtime, he said, but many of his competitors do not.
"This will take that unfair advantage out of this,'' Stoker said. "I don't care who you are, you should be paid properly.''