We are often asked about caregiver pay and the difference between hourly and live-in care.  Senior home care agencies employ caregivers and provide for all of their payroll taxes and worker's compensation insurance, as required by law.  This protects both the caregiver and the senior client they are caring for in the event of an on-the-job injury as worker's compensation will provide for the caregiver's needs and the client will not be responsible.  The payroll taxes also provide for the caregiver's retirement benefits through Social Security when they retire.  In addition, senior home care agencies have policies in place to protect the caregivers and to make sure the plan of care can be successfully implemented.

Hourly caregivers work a set schedule of hours each week and are paid an hourly rate.  Live-in caregivers stay with a client for a few days at a time, sleeping at the client's home each night and are paid a flat daily rate for their work.  Usually live-in caregivers will receive meals and their own room to sleep in.

Senior home care agencies do pay for overtime pay for employees who work more than 40 hours per week as hourly employees, as required by law.  However, live-in care is not considered hourly work and is paid at a daily rate and because of this, overtime pay is not provided on an hourly work week for live-in caregivers.

The Fair Labor Standards Act (FLSA) imposes minimum wage and overtime requirements on employers and specifically exempts from overtime any employee employed in domestic service employment to provide companionship services to individuals who, because of age or infirmity are unable to care for themselves.  Live-in caregivers meet this requirement.  The Department of Labor created a controversy with respect to this exemption several years ago when it adopted seemingly conflicting regulations.  One regulation refers to persons who provide services "in or about a private home of the person by whom he or she is employed."  You have to love the legal language - they always seem to take the long way around to get to the point, or maybe they just want to make sure lawyers will always have jobs in order to translate this stuff for us.

The other regulation, which helped confuse matters, expands the coverage to persons who are "employed by an employer or agency other than the family or households using their services."  Legal challenges to this have been made over the years, based on the argument that it is inconsistent to the first regulation.

Then Evelyn Coke, a 73-year-old immigrant from Jamaica, sued New York based Long Island Care at Home for failure to pay her for overtime.  A federal court of appeals ruled in her favor, overturning the Department of Labor regulation, determining that it conflicted with congressional intent.  Then the Supreme Court reversed this, taking us back to where we started:  no overtime pay for companion care services.

It is important to remember that each state maintains their own minimum wage laws and their overtime requirements, and some of these laws are specific to home care workers (this is the the term they use, rather than "caregivers").

The basic rule you can follow is that "companionship services" are exempt from overtime when the care is not hourly.  Companionship services include household work for aged or infirm persons, meal preparation, bed making, laundry and other similar personal services.  General household work is also included, as long as it does not exceed 20 percent of the total weekly hours worked by the companion. 

Most senior home care agencies have policies in place which require live-in caregivers to sleep at least 8 hours at night, with a minimum of getting up twice to assist the client, along with a couple of hours of downtime each evening.  At the point when a senior client needs a caregiver to get up repeatedly at night, which would not allow the caregiver to receive adequate sleep, it is time for the client to switch to hourly care.

Note:  most senior home care agencies do pay for overtime hours at time-and-a-half for hourly caregivers who go past the 40 hour work week, even though depending on the state and the type of care assignment, they may not be required to do so.

 These 10 signs include:

1) Memory changes that disrupt daily life

2) Challenges in planning or solving problems

3) Difficulty completing familiar tasks at home, at work or at leisure

4) Confusion with time or place

5) Trouble understanding visual images and spatial relationships

6) New problems with words in speaking or writing

7) Misplacing things and losing the ability to retrace steps

8) Decreased or poor judgment

9) Withdrawal from work or social activities

10) Changes in mood and personality

This past weekend the Washington Post magazine published an in-depth story about senior caregiving, profiling a 63-year-old caregiver, Marilyn Daniel, who cares for multiple senior clients as a home health aide.  The story mentions the turnover rate of 40 to 60% for direct-care workers and the low pay.  Although the article says caregiving does not pay much more than minimum wage, which is actually inaccurate, as the federal minimum wage is $6.55 per hour and Marilyn Daniel is paid $12.40 per hour, nearly double the federal minimum wage.

Caregiving actually does pay much more than the minimum wage in every state and Caregiverlist provides the minimum wage information in every state to help caregivers negotiate their pay rate.  The highest minimum wage is in Washington state, at $8.55 per hour, followed by Oregon state at $8.40 per hour and then by California, Connecticut, and Massachusetts, all paying $8.00 per hour.  Most state minimum wages are somewhere between $6.55 and $7.25 per hour.

As is often noted, the Bureau of Labor Statistics reports the occupation of senior home care aides as the second-fastest-growing occupation in the U.S.A. with projections for a more than 50 percent increase in caregivers during the next decade.

Payroll taxes are typically another 25% of a caregiver's pay (Social Security, Unemployment, Worker's Compensation Insurance), although a caregiver does not see this money as take-home pay, but rather as payments direct to these benefits.

How much do you think caregivers should be paid?  Should there be set increases according to advanced training completed and skills tests?

seniorcare, caregiver, caregiverpay

Caregivers and family members of those with Alzheimer's Disease will find this upcoming documentary informative and supportive of the challenges of caring for seniors with memory loss.  HBO reports Alzheimer's Disease is the second most feared disease after cancer and more than 5 million Americans are affected by it.  As there is currently no cure for the disease, it is also predicted that this number will more than double in the next 30 years.

This 4-part documentary, The Alzheimer's Project, will air on May 10 - 12 on HBO and includes 15 short films highlighting the latest research for a cure, profiles community programs and looks at 7 individuals who are living with Alzheimer's Disease, including a focus on their caregivers who must cope with the progression of the disease. 

HBO has also launched a website to provide educational information on The Alzheimer's Project. Check it out and spread the word.

Caregivers and seniors can also learn more about caring for those with memory loss by reading the stories caregivers share on Caregiverlist (and you may also share your own story).

A regional gap exists in the U.S. between areas where people have access to a broad number of affordable, long-term healthcare options for seniors, according to a recent study by Genworth Financial.

The study, which involved more than 14,000 nursing homes, assisted living facilities, and home health and adult day health care providers nationwide, found that Midwesterners enjoy more budget-friendly long-term care options than their east and west coast counterparts. 

Here’s a snapshot of the top 10 states for nursing home care availability and choice:

• The cost of care in a nursing home or assisted living facility continues to rise at a rate nearly twice that of the median annual inflation rate of 2.3 percent.  The annual cost for a private nursing home room is $74,208, or $203 per day, representing an increase of 4 percent annually since 2005.  At this rate, the cost is expected to exceed $270,000 a year in 30 years, when the nation's youngest baby boomers will be in their mid-70's.
• It is important to do research to make sure you get the most out of your investment when selecting a nursing home for an aging loved one.  You may review our complete list of  nursing homes, including details on Medicare and Medicaid, the number of beds and the owner of the facility.
• While nursing home and assisted living costs have risen sharply over the past five years, home care costs have remained relatively flat.  The hourly private pay rate for a non-Medicare certified, state licensed home health aides is $18.50. Since 2005, the cost for this type of care has increased an annual rate of just 2 percent.