Home health-care workers, who for years have been exempt from minimum wage and overtime laws because of a stipulation that classified them as similar to casual babysitters, will soon be eligible for fatter paychecks.
The Labor Department announced this week that the nearly 2 million workers who provide in-home care for people who are elderly, sick or disabled will be subject to the Fair Labor Standards Act's minimum wage and overtime protections starting in January of 2015.
The move is a major victory for advocates of in-home health-care workers. They have long argued that the fast-growing profession has evolved beyond its origins providing informal companionship to elderly people and into a much more complex job providing medical and other care.
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"Now you have millions of home-care workers … doing this as a means to support themselves and their families," said Steve Edelstein, national policy director for the Paraprofessional Healthcare Institute, which has been advocating for the change.
But opponents say the new protections will make in-home care more expensive for families and government programs such as Medicaid that pay for such services, and that it could result in a reduction in covered services.
"What this means for patients is less care. What it means for aides and caregivers is less work and reduced compensation," Andrea Devoti, chair of the National Association for Home Care & Hospice, a trade group for home-care agencies, said in an email to NBCNews.com.
Fifteen states already provide minimum wage and overtime protections under state law, according to the Paraprofessional Healthcare Institute.
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The Bureau of Labor Statistics is predicting that the market for home health-care workers will explode in the coming years. Experts say that makes sense because baby boomers are aging and more people are looking for ways to get care for chronic conditions in their own homes rather than nursing facilities.
The jobs are largely low wage. The median pay for home health- and personal-care aides in 2010 was $9.70 an hour, or $20,170 a year, according to the BLS. The Labor Department says 90 percent of direct-care workers are women, and 50 percent are minorities.
Marcee Ramirez said she earns a set rate of $110 to $120 a day as a live-in home health aide for a patient in Andover, N.J., with advanced Alzheimer's disease. She said her 13-hour day includes bathing, changing, feeding and moving her patient.
Ramirez, 33, said her pay is the equivalent to the hourly rate she would receive for working eight hours, but the logic is that it's a fair rate because she also receives room and board as a live-in aide.
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New Jersey is one of the states that already provides overtime and minimum wage protections to health-care workers, and Ramirez said she used to get overtime when she worked hourly jobs. But when she took this live-in position, she became a salaried, rather than hourly, employee.
Still, Ramirez thinks workers like her should be paid from the time their clients wake up to the time they go to bed.
She said most of the approximately 20 people she did her initial training with in 2009 have quit because of things like not getting paid enough for travel time or not being able to get enough hours. But she feels like this is the profession for her.
"I keep in this job because I love what I do," she said. "I have a passion for it."