KAI RYSSDAL: The Labor Department publishes something called the “Occupational Outlook Handbook.” It’s revised every two years. It tracks hundreds of jobs in the U.S. economy. In the most recent edition, home health aide is listed as of this country’s fastest-growing professions.
There are about 1.2 million people in that line of work right now. Demand for their services is expected rise 35 percent by 2014, despite long hours and low wages.
On Monday, home health workers — and how they’re paid — will be one topic of oral argument at the Supreme Court, as Ashley Milne-Tyte reports.
ASHLEY MILNE-TYTE: Looking at her now, it’s hard to imagine Evelyn Coke taking care of someone else. The former home health aide is 73, a frail, shrunken figure dwarfed by the couch she’s sitting on.
She admits her memory isn’t what it was. But she looks back with nostalgia on the job she did for 20 years, after she immigrated to the U.S. from Jamaica.
EVELYN COKE: I cook, I bathe sick people, I go shopping for them, I wash their clothes, and I always take the best care.
But Coke says the agency she worked for didn’t take care of her. She says her bosses rarely paid her overtime when she worked overnights and weekends.
Under New York State law, home health aides are entitled to overtime based on the state minimum wage. But most states don’t have any such law, so most aides don’t get any overtime.
Coke’s Supreme Court case seeks to ensure that every aide in the country is entitled to federal minimum wage and overtime pay — that is, time-and-a-half on their actual hourly wage.
Craig Becker is Evelyn Coke’s lawyer. He says the job of caring for someone at home used to revolve around an informal network of children and neighbors, but now it’s an industry.
CRAIG BECKER: Giving them the basic protections which all other workers have, and ensuring that they make a decent wage, is going to lead to more workers taking up this occupation, and staying in it.
But the agencies that employ the aides, and the government, say paying aides more will mean many seniors won’t be able to afford care.
What’s more, the agencies say, if they had to shell out all that overtime, they’d go out of business. You see, agencies get around two-thirds of their costs covered by Medicare and Medicaid.
David Grabowski teaches health care economics at Harvard Medical School. He says if the Court decides aides are entitled to overtime:
DAVID GRABOWSKI: Home health care agencies aren’t going to be able to directly pass these costs back to Medicare. Medicare is going to have to make a decision to actually increase the rates that they pay these home health care agencies.
The question is, will they do that?
Lorie Reynolds hopes so. Reynolds is 44, and has been an aide for eight years. At the moment, she works on Long Island, for a woman who’s debilitated after having had a stroke.
Reynolds doesn’t want to switch professions, because she really loves the job.
LORIE REYNOLDS: I’ve always found it as a blessing to be around older people and anybody that can’t help themselves. I don’t care where they from or who they are. If I can do something for you, that’s just joy for me also.
But she doesn’t love the money. She earns 8.50 an hour, which is better than the pay of some aides she knows. She says when aides feel under appreciated, patients can suffer.
REYNOLDS: I ride the bus, and I hear the women saying, “For what I’m making, I’m not going in there doing this and I’m not goin’ in there doing that.” And I feel, if they were making better income, if their wages was better, their attitude would be a little more different.
Harvard Medical School’s David Grabowski agrees the status-quo is far from ideal. But, he says, if the Supreme Court rules in favor of overtime for aides:
GRABOWSKI:The burden, then, really shifts to the agencies and the payers of these services. Agencies are basically left with two options: they can either deliver fewer services or they can raise prices.
Neither of which is good news for patients. Of course, he says, if Medicare and Medicaid decided to increase their reimbursement to agencies, there would be fewer problems. But, he says, given that both programs have tried to limit home health spending recently, he’s not that optimistic.
In New York, I’m Ashley Milne-Tyte for Marketplace.
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