Labor Policies Threaten Home Care Providers: ‘Agencies Are Truly Getting the Worst of Both Ends’

Home-based care providers are dealing with an ongoing pandemic and simultaneously tackling vaccine education, procurement and distribution. Now, a slew of legislative labor provisions are threatening to disrupt both home health and home care agencies across the country.

After President Joe Biden was inaugurated, his administration released a fact sheet that said “workers have a federally guaranteed right to refuse employment that will jeopardize their health, and if they do so, they will still qualify for unemployment insurance.” He urged the U.S. Department of Labor (DOL) to solidify that concept, though no updates on that have been provided yet.

The effort was a part of the “new executive actions” to “deliver economic relief for American families and businesses amid the COVID-19 crises,” according to the fact sheet.


It came on the heels of news that a potential $100 hike to weekly unemployment benefit add-ons would be implemented in March, when the current spending bill expires.

The Biden administration additionally laid the groundwork for a $15 minimum wage, which would give a pay increase to most home-based care workers. And while a wage increase for home-based care workers would be welcomed by many employers, without coinciding reimbursement increases for providers, it could place agencies in a precarious position.

“I wonder who will worry about the many clients that will get reduced or no care,” Kunu Kaushal, the CEO and founder of Senior Solutions Home Care, told Home Health Care News. “What executive order will arm agencies with resources to answer the need for staff to provide personal care?”


The Biden administration has publicly and repeatedly recognized the value of home-based care.. But providers are worried that right now, only half of the equation is being considered.

“There’s a real inconsistency within the various arms of the government that really needs to be addressed,” Angelo Spinola, co-chair of the home health and home care industry group at the law firm Littler Mendelson, told HHCN. “And if we want to increase wages, which I think in many instances is a good idea, … there also needs to be some mechanism to keep care costs affordable. And right now, it’s one side of the equation without a lot of consideration of the other.”

This type of legislation isn’t only gaining momentum at the federal level, either. In Maryland, for instance, the General Assembly met Thursday to discuss a newly presented bill with similar provisions to Biden’s fact sheet.

Dubbed the “Maryland Essential Workers’ Protection Act,” its objectives include requiring employers to mandate certain hazard pay to workers and giving essential workers the right to refuse to work under certain circumstances, among others.

Giving providers a chance

Legislation — whether on a state or federal level — can have a variety of effects on industries, from the top down.

Allowing essential workers to opt out of working — when there is work available — could have a negative impact on seniors across the country, as demand for home-based care increases.

“I think it is a legitimate concern,” Spinola said. “It can create a real disincentive to work for some people. And when you couple that with … states that are effectively taking the position that if you had a reasonable fear or concern about COVID, then you didn’t have a requirement to show up for work, even when work was available for you — that creates a very significant issue in this industry.”

Staffing is already a persisting, chief concern for both home health and home care providers. Legislation that makes it easier to collect unemployment when there is work available makes the environment even worse, experts argue.

“We’re already in a situation where we have a shortage of caregivers compared to the demand,” Spinola said. “So when you continue to carve into the workforce, by giving folks options like this, it creates a real problem for providing adequate care for our seniors. So I do think it’s a viable concern that we should be focused on.”

Providers also have a responsibility to make work as safe as possible for their aides and caregivers. These workers are “altruistic” people, as Spinola put it. They want to work and make a difference.

Therefore, they should be provided work environments that are as comfortable as possible, and agencies should find ways to pay them more when possible — not less.

But the state lawmakers and the federal government need to meet them halfway.

“Politics aside, policy has to balance the intended and unintended consequences,” Kaushal said. “[Agencies] don’t get reimbursements to pay $15 and we certainly can’t compete with ‘sit at home and collect’ either. Agencies are truly getting the worst of both ends.”

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