Through an app on her phone, Angela Engram clocks in and out of her shifts as an in-home caregiver.
The woman she cares for has suffered from strokes and other health issues, and she needs help with shopping, cooking, cleaning, bathing, managing doctor's visits and making sure she takes her medications. This work falls on Engram, who attends church with her and considers her to be like "her daughter right now."
"We provide life-sustaining things for these people," Engram said. "If her medical alert button goes off at two o'clock in the morning and that night she doesn't have overnight staff, medical alert calls me and I have to go over to her house. We make it possible for them to be able to stay at home."
Engram makes $13.50 an hour for her shifts. She credits her union, SEIU Healthcare Pennsylvania, for a few raises, but receiving overtime pay is critical.
"If I was to lose my overtime pay, I would not be able to live off of $13.50 an hour," Engram said. "And right now I do live in low-income housing, but I still have to use the food bank."
Most home care aides weren't eligible for minimum wage and overtime protections from the Fair Labor Standards Act under a "companionship" exemption until 2013. The Obama administration passed a rule that included this group of in-home caretaking workers under the FLSA and required agencies employing home care workers to pay minimum wage and time and a half when an aide worked more than 40 hours a week.
In July, the U.S. Department of Labor proposed a new rule to overturn the 2013 regulation. The department also told its investigators to stop enforcing the current rule on the books.
"The non-enforcement policy announcement is essentially making what they plan to do through the legal process effective now already," said Samantha Sanders, director of government affairs and advocacy at Economic Policy Institute, a nonprofit think tank focused on economic issues that impact workers.
"Most of these workers are going to rely on the federal government to enforce their rights on this," Sanders said.
In Pennsylvania, though, home care workers will continue to be protected and entitled to minimum wage and overtime under the Pennsylvania Minimum Wage Act.
However, wage theft — or failing to pay workers mandatory minimum wage or overtime — is "rampant in the home care sector" in Pennsylvania, according to the state Department of Labor and Industry. Without the resources and support from the federal Department of Labor, the extra load would fall on the state's 35 investigators who already take on roughly 6,000 complaints a year under the various labor laws they enforce — straining their capacity to "complete these investigations in a timely manner," according to the Department of Labor and Industry.
Low wages, high turnover
Home care workers take care of children, older people or those with disabilities or illness by cooking meals, running errands, cleaning homes, arranging and driving to medical appointments, and other tasks that help their clients to live independently in their own homes.
These workers are typically employed through either private or nonprofit agencies or, like Engram, through a participant-directed program, in which people can directly hire their caregiver. Such programs are administered through the Pennsylvania Department of Human Services.
It's an industry marked by a high demand and a high turnover rate of workers — reaching 79% in 2023, according to an industry survey.
And in Pennsylvania, there are around 242,570 home health aides who make an average wage of $15.11, according to Bureau of Labor Statistics data.
The need for care workers is particularly strong in the Pittsburgh region. Allegheny County has the second-highest concentration of older adults in the United States, behind only Palm Beach County in Florida — 20.8% of the county's population is 65 years of age or older, according to the most recent U.S. Census data.
This aging population has led to a growing need for home care workers, with an estimated 32,640 job openings in the state each year from 2022-2032, according to the Occupational Information Network, or O*NET, the Department of Labor's occupational database.
While it's not the only source, Medicaid is a significant payer for home care agencies, and it funds participant-direct care services in Pennsylvania. Medicaid reimburses agencies at a fixed rate to provide services. Medicaid reimbursement rates "have not kept pace with rising wages, regulatory demands, and the true cost of delivering care," according to the Pennsylvania Homecare Association, an organization that represents agencies that employ home care workers. The reimbursement rate in Pennsylvania is lower than surrounding states, which has led to a push by the industry to urge lawmakers in Harrisburg to increase this rate.
The way in which an employer makes a profit is, in large part, the difference between what the employer is paid by the state to provide a service and what it pays its home care workers.
"The bad actors out there stretch [the reimbursement] to find ways to exploit and extract as much profit out of it as possible, which always means exploiting the worker," said Silas Russell, executive vice president and director of policy and research at SEIU Healthcare PA. "By either not paying them overtime, not paying them the proper wage or by the way they do deductions."
Rampant wage theft
Home care jobs are performed under complex conditions, with workers often isolated and vulnerable to exploitation, according to the state Department of Labor and Industry.
Investigating these bad actors has been a combined effort of the federal Department of Labor — by enforcing the FLSA — and the Pennsylvania Department of Labor and Industry, by enforcing the Pennsylvania Minimum Wage Act.
Employers who fail to pay workers mandatory minimum wages and overtime are ripe within the industry. A recent review of DLI case assignments shows that from January 1, 2023, to present, at least 38% of all Minimum Wage Act complaints the Department received have involved companies in the home care industry.
But much of this work has been taken up by the federal Department of Labor's enforcement of FLSA under the 2013 rule. For example, in 2022, the labor department ordered Everest Home Care, a Pittsburgh-area home care agency, to pay $1.4 million in back pay and damages to 218 workers after the employer failed to pay them overtime and covered up the wage theft.
Since 2023, the labor department found dozens of companies in violation of the law and doled out hundreds of thousands of dollars in civil penalties in Pennsylvania, according to its enforcement data.
The Pennsylvania Homecare Association supports overturning the 2013 rule, stating that the law "forced many agencies to end live-in care models due to financial strain — raising private pay costs for families seeking care and severely limiting access to around-the-clock care in many instances."
The public comment period of the rescission of the 2013 rule ends on Sept. 2. After that, the Department of Labor will review the comments and decide whether or not to keep the rule on the books. But the non-enforcement order of the current rule and the repeal of dozens of proposed labor-law and workplace safety rules within the labor department and across the federal government signal a broad deregulation plan, according to Sanders.
But the law won't change in Pennsylvania. Since taking office in 2023, Gov. Josh Shapiro has increased funding to the Bureau of Labor Law Compliance, and the number of investigators rose from 27 to 35, each of whom takes on about 200 complaints each year. But taking on more cases "could affect the time needed to complete each investigation," according to DLI.
Workers who believe they haven't been paid their required wages can file a complaint online. DLI investigates those claims, and if the employer owes the worker money, the department takes action to collect the money that's owed.
"They do not lose the protection that the state has, and that is as strong as what the federal government has been enforcing," Russell said. "They should look to the state to continue to enforce that. I think the question is, how do we protect and improve the quality of jobs and make sure that home care workers are treated fairly?"
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