For Information About COVID – 19 Click Here

The Home Care “Companion” Debate: Is it over?

The Home Care “Companion” Debate: Is it over? July 4, 2016

Marketing, research and business development consultant in healthcare, human services and senior living.

Employed or Unemployed?

Victory for Home Care?

The recent article in the NYT suggested that home care workers had achieved a victory. The US Supreme Court refused to consider Home Care Association of America v. Weil. That case was the last attempt by a group of home care employers to uphold a prior ruling that home care workers are “companions”, and to avoid paying home care workers minimum wage and overtime pay.

Since 1975 the Department of Labor labeled home care workers as “companions” which allowed them to be paid less than other, comparable service workers.

Employment in Home Care

During the same period, employment of home care workers surged.

home care employment 1996 - 2009







Accessing Needed Home Care

Medicaid HCBS Participation
Medicaid HCBS Participation

Also during the same period, access to home care, especially among the most vulnerable, has become more difficult.

Those who can afford private duty home care, and those with good private insurance coverage will only be impacted if the number of home care workers in particularly dense metropolitan market areas, like New York or Los Angeles declines significantly.



Employment Demand in Home Care

The projected demand for home care employees is enormous:

Employment Demand
Employment Demand in Healthcare – New York State

For profit agencies pay better and can compete more effectively for labor even though on balance the home care provided by for profit agencies is not as good as care provided by not-for-profits.




Certainly the increase wage is a short term boon to home care workers and their families, as these workers have seen a progressive deterioration of their real earnings:

Real Wages: Median, top and bottom decile
Real Wages 1979 – 2014

However, my questions are:

  • Will the increased wage slow employment and
  • Will stable or declining employment decrease access?

Marketing, research and business development consultant in healthcare, human services and senior living.

Share this page

Looking for an outstanding business consultant?