The Misguided Push to Limit In Home Options for People with Disabilities

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By Kelly Buckland– Every day, thousands of American families face the difficult decision of how to secure in home services for themselves or a loved one. For an individual with disabilities or an elderly person, remaining in the home rather than an institutionalized setting is of paramount importance. Hiring someone to help with daily tasks can make it possible for people to remain in their homes.

Unfortunately, this essential option for in home support is being threatened by the Administration without meaningful consideration of the impact it could have on the disability community. If successful, their policy change will sharply increase the costs of in-home services, force people with disabilities to bring multiple people into their homes, reduce the availability of family and friend attendants and cut the take home pay of attendants.


At issue is an exemption in a 75-year-old law called the “Fair Labor Standards Act,” which guarantees qualified workers a minimum wage and overtime pay. When it was passed, this law included an exemption for those providing “companionship services,” a category that included in-home personal assistance services.

The reason for the carve out is simple enough: This class of services isn’t like a normal 9-to-5 job. In-home attendants often work odd hours and it may often be a family member they’re working for. They grow close to the people they work for and the continuity of care they provide an individual with disabilities is vitally important.

Today, there are more than 56 million individuals with disabilities in the U.S. Many of them will need assistance at some point to stay in their own homes. Also, the needs of the elderly continue to grow, and that number will climb sharply as baby boomers retire. Now, national long-term care costs already top $342 billion a year.  Home and community-based services – which are more cost-effective – can be one answer to control costs, but not if the Administration gets its way on the Labor Department’s proposed rule.

Those who want to close this companionship exemption in the Fair Labor Standards Act argue that in-home workers deserve the same rights to minimum wage and overtime protections as other domestic workers. This campaign has good intentions, but NCIL believes the way the current rule is written, it would have disastrous unintended consequences and make in-home services unaffordable for many individuals with disabilities and seniors.

This rule change would effectively eliminate the “live-in companion” model, where an attendant lives with an individual which for many families is an ideal arrangement.

If this exemption is eliminated, NCIL and many others in the disability community believe it will significantly impact the continuity of care provided to individuals with disabilities, particularly people with the most significant disabilities. Providers simply will not be able to afford the overtime pay given existing reimbursement levels and will need to replace home care workers before they reach overtime eligibility. Also, it could potentially add to the out of pocket costs for individuals, and according to the Administration’s own analysis, the rule change will force some individuals to leave their own homes and go into an institution.

Experts who’ve studied the rule note that it could even end up limiting the ability of individuals with disabilities and seniors to enlist family and friends to work in paid positions, putting another critically important option at risk.

This rule change would add significant new costs to the already cash-strapped state Medicaid programs. Today, Medicaid is the single biggest payer for long term services and supports, spending $140 billion every year on this important service.  The National Association of Medicaid Directors has warned that subjecting in-home providers to these labor laws would significantly raise program expenses. And they agree that this rule change will force people with disabilities and seniors into more expensive institutional settings.

A cumbersome, one-size-fits-all federal in-home worker rule will put the most desired option, staying in one’s home, in jeopardy and drive up costs for the Medicaid program. The Administration should resist this effort and work with the disability community on common sense solutions.

Kelly Buckland is the executive director of the National Council on Independent Living.





  1. The truth of the matter is without the funding of In Home Supportive Services I would not be able to stay home and care for my 3 sons with Autism. Without that funding, I would be forced to go back to work full time to pay the bills,then I would be forced to place the boys in a state run group home. What makes more sense that the state pays me $1800 a month to care for my severely disabled adult sons in my loving home, where they get the best care possible from me. Or to place each of them in a group home run by the state at $5,000 a month per boy for a level 4 home which would be $15,000 monthly????????

  2. The overtime rule will erode the independent living movement for persons with disabilities who rely on personal assistants/caregivers to live in their own homes. The state of California will implement a rule that no in-home care provider can work more than 40 hours a week making it a challenge to live independently, work, travel, and function. This rule will reduce caregiver's pay, require recipients to hire many more caregivers to work fewer hours to not exceed the state imposed 40 hour work week to avoid the overtime pay, and anyone traveling for work or personal business will not be able to leave for more than 3-4 days and than that caregivers won't be able to work for the rest of the week. Family member caregivers will be forced to institutionalize their children and adults with disabilities will be forced to hire more people and non-relatives to receive the help they need to live in the community. This rule will cut the ability of anyone with a disability to afford to hire a live-in caregiver because the overtime pay would make it prohibitive to do so. So the institutions will have a new crop of residents for their nursing and group homes! This is sickening!!!

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