Federally Mandatory Paid Sick Leave Would ‘Add Fuel to the Fire’ for In-Home Care Providers

As the national concern over COVID-19 — the coronavirus — continues to grow, U.S. lawmakers have introduced legislation that would require all employers to provide paid sick leave to workers. If passed, the bills would likely place a bigger squeeze on the country’s home-based care providers, which often operate on razor-thin profit margins.

On Friday, Rep. Rosa DeLauro (D-Conn.) and Sen. Patty Murray (D-Wash.) introduced bills in the House and Senate that would require all employers to allow workers to earn seven days of paid sick days annually.

Furthermore, the twin bills would require all employers to grant workers an additional 14 paid sick days in times of a public health emergency. The legislation also calls for employers to make sure that sick leave includes days when the school of an employee’s child is closed because of a public health emergency and periods of quarantine.


Globally, the coronavirus has reportedly affected more than 108,000 people and counting. As of Tuesday afternoon, the number of reported cases in the United States soared past 800.

“No one should face the impossible choice of caring for their health or keeping their paycheck or job, especially when a sudden public health crisis occurs,” Rep. DeLauro said in a statement. “But millions of hard-working people must make this decision every time they get sick or a family member needs care. Low-income workers and their families could be hit even harder by the virus, as low wage jobs are at the forefront of not providing sick leave benefits.”

In general, many home-based care providers already offer paid leave as a benefit to help with employee recruitment and retention. At the same time, many states and municipalities already require employers to offer paid family and sick leave.


While health authorities and other experts recommend that people who may be infected stay home to curb the spread of coronavirus, past research suggests that’s not always possible for in-home care workers.

Between 2012 and 2017, only about 35% of home care workers were able to take paid leave, according to research from PHI, a New York-based direct care workforce advocacy organization.

Mandates may exist on the state and local levels, but a federal requirement would likely increase the cost of doing business on relatively low-margin, fractionalized home health and home care industries populated by many mom-and-pop employers, Angelo Spinola, an attorney and shareholder at San Francisco-based Littler Mendelson told Home Health Care News.

That’s especially true for home health providers transitioning to the Patient-Driven Groupings Model (PDGM).

“We are already seeing market consolidation as a result of PDGM and certain regulatory burdens that make it challenging for a smaller provider to keep up, and I fear this would add more fuel to the fire,” Spinola said in an email. “If these agencies are over-regulated to the point of going out of business, our seniors and their families may be forced to the grey market of less qualified, unsupervised caregivers.”

Matt Wolfe, a partner at law firm Parker Poe, agreed.

“While well-intentioned, unfunded mandates on employers tend to shift costs to consumers,” Wolfe told HHCN, also in an email. “But home health, home care and hospice providers largely dependent on governmental payers like Medicare and Medicaid do not have the ability to shift costs … to consumers. The result is that these providers are squeezed.”

Despite the concerns surrounding costs to providers, a recent study published in the National Bureau of Economic Research found that the cost to employers is relatively small in states with mandated paid sick leave laws.

In fact, the study — using data from the Labor Department’s National Compensation survey — found that employees in those states only took two more sick days a year. The average cost to employers was 20 cents per hour worked.

In reality, home-based care providers likely won’t have to adhere to a federally mandated sick leave policy.

A handful of lawmakers have tried passing similar legislation in the past, but those efforts have failed due to the current composition of Congress and divisive political climate.

“This has largely been a state, city and county issue with little traction from the feds because a paid sick leave mandate has not been popular with Republicans,” Spinola said. “Previous versions of these bills have not gained traction, so these new proposals appear to be an attempt to capitalize on the coronavirus scare to achieve new momentum.”

Apart from the recently introduced bills, home-based care providers in many states — Oregon, California, Connecticut, Illinois, New York and others — also facing possible domestic workers’ bill of rights legislation. Often, such bills mandate paid sick time, in addition to things like increased minimum wage and paid rest after consecutive days working.

Additionally, House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Chuck Schumer (D-NY.) have publicly urged President Donald Trump to address the safety needs of American workers, laying out a number of health measures, including paid sick leave, in a recent joint statement.

Although providers are concerned about the costs associated with mandatory paid sick leave, they’d likely help prevent the continued spread of COVID-19 and other outbreaks when they happen, as health care workers are especially vulnerable to viruses.

Across California, dozens of health care workers have been quarantined at home because of possible coronavirus exposure, according to NPR.

Meanwhile, an outbreak at a long-term care facility in Kirkland, Washington, led to more than a quarter of the city’s fire department being quarantined.

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