Caring for the elderly in America is costly – too costly for many people to afford.
Now, the Trump administration is attempting to tackle that problem by rolling back wage protections for more than 3 million workers who care for seniors and the disabled in their homes.
The Labor Department has proposed rescinding an Obama-era rule that extended coverage of the Fair Labor Standards Act to home care workers. The 2013 rule granted them labor protections most other workers have had since 1938.
Those include the right to earn at least the federal minimum wage of $7.25 an hour and overtime, paid at one-and-a-half times their regular rate when they work more than 40 hours a week. At the time, the Labor Department said the change would fulfill President Obama's promise to "ensure that direct care workers receive a fair day's pay for a fair day's work."
The Trump administration says the rule has not produced the intended benefits and instead created problems, harming employers, workers and the families they serve.
Labor advocates counter that taking away wage protections will drive even more workers out of an industry which already sees annual turnover of about 80%.
Industry group says the rule brought unintended consequences
A lawsuit brought by the Home Care Association of America, which represents 4,300 home care agencies across the country, delayed but did not ultimately block implementation of the 2013 rule.
After it took effect in late 2015, the industry group says, workers saw their earnings drop. Rather than pay overtime, home care agencies capped workers at 40 hours a week to keep costs down for families who pay for care on their own and states that cover home care through Medicaid.
Consequently, caregivers who had been working 60 to 70 hours a week for a single family took on other jobs with other agencies to make up for lost income, disrupting long-term relationships with families. Meanwhile, home care agencies spent more time and money recruiting, hiring and training additional workers, according to the industry group.
Caregiver advocates contend that overtime has never been common in the industry. Only about 10% of caregivers worked more than 40 hours a week before the Obama rule took effect, according to PHI, a research and advocacy nonprofit focused on improving wages for caregivers.
With the proposed rollback of the Obama rule, Kezia Scales, vice president of research and evaluation at PHI, says the Trump administration is signaling that home care workers – 85% of whom are women and two-thirds people of color – aren't deserving of basic employment protections.
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"We are talking about stripping back hard won employment rights from our country's largest workforce and one that is providing arguably some of the most essential services for ourselves and our loved ones," she says.
An industry marked by low wages
When Congress passed the Fair Labor Standards Act in 1938, domestic workers were excluded from coverage to secure the votes of Southern Democrats. In 1974, Congress amended the law to extend coverage to some domestic workers but continued to exclude babysitters and those providing "companionship services."
The Obama Labor Department's view was that professional caregivers' work amounts to far more than simply keeping people company and monitoring their well-being.
"It is real work, but it continues to be seen as not real work," says Haeyoung Yoon, vice president of policy and advocacy at the National Domestic Workers Alliance.
Marilyn Blackett certainly sees herself as far more than a companion for her elderly clients. They typically need help eating, bathing and going to the bathroom. Some need wound care. Others have required hospice care.
"It's not easy work," says Blackett, who learned how to be a caregiver early in life, tending to her grandmother back home in Trinidad and Tobago.
Her wage of less than $20 an hour does not go far in New York City, where she lives and has cared for the elderly for 24 years.
"Pay rent, pay bills, buy food, and when you end up, you end up with nothing," says Blackett, who's now 63 and thinking about when she might be able to retire.
In 2024, the national median wage for home care workers was $16.78 an hour, according to the Labor Department. PHI estimates that half of care workers rely on some form of public assistance.
"They are not making livable wages," says Scales.
The Home Care Association of America does not dispute that wages are low.
"I think everyone agrees that caregivers are angels, and the work that they do for our seniors every day is priceless," says the group's legislative director, Cheryl Stanton, who led the Wage and Hour Division of the Labor Department during the first Trump administration. "We all would like to see caregivers get paid more."
But the challenge, Stanton says, is limited funds. Medicaid subsidizes elder care only for the lowest-income seniors, and states are not required to cover home- and community-based care at all. Some states only cover care in facilities such as nursing homes. Most families pay for care on their own.
"They can't afford to pay overtime rates for caregiving," she says.
$158 million in back wages
PHI researcher Scales agrees affordability is a problem. And with Medicaid funding slashed under Trump, she fears it'll only get worse.
With the population rapidly aging, she says the U.S. needs to reckon with how to pay for care.
"Further marginalizing and devaluing the workforce that provides the services, that is just simply not the answer," says Scales. "They should not carry this affordability problem on their own backs."
Importantly, Scales says, being covered by the Fair Labor Standards Act means home care workers can register complaints when employers aren't meeting the overtime pay or minimum wage requirements. PHI's analysis of Labor Department compliance data found that home care agencies have paid workers nearly $158 million in back wages since the Obama rule took effect.
"Countless more likely benefitted from their employers' proactive compliance," says Scales.
Demand for home care workers to soar
PHI estimates the home care workforce will add 681,000 jobs over the next decade.
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Health economist Amanda Kreider at the University of Pittsburgh says taking away labor protections in such a moment doesn't make sense.
"It would be one thing if we had tons of workers who were ready and willing to do these jobs," she says. "I just don't think that you can increase access in a situation where you have a major labor shortage by reducing the quality of jobs."
In Brooklyn, caregiver Blackett agrees it'll become even harder to find workers if protections are rolled back. Already, she says, no Americans want to do the job.
New York's home care workers are actually in a better position than most. The state has its own Domestic Workers' Bill of Rights ensuring overtime pay and minimum wage for workers even if they are no longer covered by the Fair Labor Standards Act.
Still, Blackett says, home care workers deserve better.
"This is a job, and we have to be recognized as workers," she says.
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