Despite sultry summer days and vacations, the health wonks are still on the case. Check out the July update of Health Wonk Review: Hot Summer Nights, Cool Summer Drinks. The substantive offerings from all corners of the health policy blogosphere show that the wonks aren’t slacking off. Host Hank Stern does an excellent job of dishing things out at InsureBlog, also offering “a spoonful of sugar to make the medicine go down” in the form of seasonal cocktail recipes. Check it out!
Archive for July, 2015
I’d like to make a bet with you. Here it is. I bet you will answer “Yes” to at least one of the following three questions:
- Do you know anyone who works as a Personal Care Aide or a Home Health Aide?
- Has anyone in your immediate family, now or in the last 10 years, been taken care of by a Personal Care Aide or a Home Health Aide?
- Do you personally know anyone who now or in the last year employed the services of a Personal Care Aide or a Home Health Aide?
I like my odds. According to the Bureau of Labor Statistics, six of the ten fastest growing occupations from 2012 to 2022 will be in the health care industry and numbers two and three on the list are – you guessed it – Personal Care Aides and Home Health Aides, growing by 49% and 48%, respectively, closely following Industrial-Organizational Psychologists, a profession that is expected to grow by 53% during the ten year period.
While Psychologists are projected to have the greatest rate of growth, they’ll only be adding about 900 jobs to the economy. This is dwarfed by the numbers of new jobs for the Aides, 581 thousand and 424 thousand, respectively. Taken together, they’ll be adding more than a million workers to the economy. A hefty number, indeed.
The rate of injury for both of the Aide groups is 2.5 times the rate for all public and private sector workers.¹ You would think that would get somebody’s attention, maybe somebody at OSHA, for example. And, you know what? It did. This from OSHA:
The Occupational Safety and Health Administration (OSHA) announced a new National Emphasis Program (NEP) to focus outreach efforts and inspections on specific hazards in nursing and personal care facilities with high injury and illness rates.
“Nursing and personal care facilities are a growing industry where hazards are known and effective controls are available,” said OSHA Administrator John Henshaw. “The industry also ranks among the highest in terms of injuries and illnesses, with rates about two and a half times (emphasis added) that of all other general industries. By focusing on specific hazards associated with nursing and personal care facilities, we can help bring those rates down.”
Only one problem with that: It was written exactly 13 years ago this month!
Now read this:
Non-fatal injuries to health care workers requiring days away from work are on the rise, according to new data from the Bureau of Labor Statistics released Nov. 9, and OSHA Administrator Dr. David Michaels has vowed to launch a National Emphasis Program on Nursing Home and Residential Care Facilities.
“It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness,” said Michaels.
According to BLS, the incidence rate for health care support workers increased 6 percent to 283 cases per 10,000 full-time workers, almost 2.5 times the rate for all private and public sector workers (emphasis added) at 118 cases per 10,000 full-time workers. The rate among nursing aides, orderlies and attendants rose 7 percent, to 489 per 10,000 workers. Additionally, the rate of musculoskeletal disorder cases with days away from work for nursing aides, orderlies and attendants increased 10 percent to a rate of 249 cases per 10,000 workers.
“The rates of injuries and illnesses among hospital and health care workers underscore OSHA’s concern about the safety and health of these workers,” said Michaels.
That was written by OSHA in November, 2011.
A National Emphasis Program is becoming kind of predictable for OSHA. Maybe we’ll see another one around 2020. Until then, or until ever, Personal and Home Health Aides will be the Cinderellas of the health care universe. Except their story won’t have a “happy ever after” ending, and they’ll never get to meet a Prince.²
¹ And this rate of injury does not include the thousands of Aides who are hired to take care of Grandpa and Grandma in the home and who are paid minimum wage.
² Paying lip service to this issue goes back at least as far as 1997 when the BLS, using 1994 data, published an Issues Paper, and said this:
Overall, the 1994 injury rate in home
health care services (474 lost workday
cases per 10,000 workers) is about 50
percent higher than the injury rate in
hospitals, the institutional setting from
which many home-care patients are
released, and 70 percent greater than the
Related: A Living Wage For Caregivers, New York Times, 10 July 2015
Bill Clinton used to say that (fill in the blank) would last “until the last dog dies.” Well, friends, today’s topic is all about a dog that won’t die, absolutely refuses to die, will outlive us all, cannot be killed. You get the point.
Eleven years ago (I almost feel like writing “in a galaxy far away”), the Insider started to track the illegal practice of misclassifying employees. We found that, while it was almost ubiquitous in the construction industry, its tentacles reached into other industries as well. We saw it as widespread right in our backyard of Massachusetts. We found a 2005 paper addressing the issue in the Maine construction industry published by the Labor and Worklife Program, Harvard Law School and the Harvard School of Public Health. We conducted employer seminars on it in many states.
At the time, we thought it was a pretty egregious practice that would be hard for state Attorneys General to ignore, so it would probably get fixed lickety split. We were half right. It was egregious, and Ags from the majority of states published stern regulations, as did state Departments of Insurance. But “fixed?” Nope.
Then, in 2005, a national class-action lawsuit with hundreds of plaintiffs from 30 states was filed against FedEx Ground alleging that workers were misclassified as independent contractors. This was mother’s milk to us. We had our bogeyman, and his name was Fedex. Since then, we’ve written about this Dorian Grey issue ten times. Here’s an example from 2006
FedEx loses contractor battle in Mass – Last year, my colleague Jon Coppelman blogged that FedEx should beware of Massachusetts when calling drivers “independent contractors.” Last week, the Massachusetts Department of Workforce Development ruled that a FedEx ground driver was not an independent contractor, and was therefore illegally denied unemployment benefits. Of course, this opens a can of worms about the denial of other statutory benefits, like workers comp. This is not the end of the lawsuits by any means. FedEx faces ongoing challenges in multiple states. The moral of the story: if you work with independent contractors, be sure they meet state and federal criteria to qualify as such.
Fast forward to now. Specifically, to Wall Street Journal writer Laura Weber’s 30 June story “Bosses Reclassify Workers To Cut Costs.” Ms. Weber’s story manages to be both objective reporting and poignant at the same time. Here’s an exccerpt:
Employers have long shifted work from employees to independent contractors, often relabeling the workers and slightly altering the conditions of their work, court documents and settlements indicate. Now, businesses are turning to other kinds of employment relationships, such as setting up workers as franchisees or owners of limited liability companies, which helps to shield businesses from tax and labor statutes.
In response, some state and federal agencies are aggressively clamping down on such arrangements, passing local legislation, filing briefs in workers’ own lawsuits, and closely tracking the spread of what they see as questionable employment models.
All this is happening against the backdrop of a broader shifting of risk from employers to workers, who shoulder an increasing share of responsibility for everything from health-insurance premiums to retirement income to job security. Alleged misclassification of workers has been one of the primary battlegrounds of this shift, leading to high-profile lawsuits against Uber Technologies Inc. and FedEx Corp., among others. Both have recently lost or settled big cases. Uber is appealing one decision, and FedEx settled in California for $228 million but is continuing to challenge classification lawsuits in other states.
Today I’m an employee; tomorrow I’m an Independent Contractor; the next day a Franchisee, or, oh, I don’t know, CEO of my own one-person LLC. Not only will the dog not die, his bark is really loud.
Very smart people are cooking up these schemes. I ask you – Do you think they are:
- Bettering the lives of America’s workers?
- Enhancing American productivity?
- Propelling more workers into the ranks of the dwindling middle class?
- Growing shareholder value?
I’d like to know what you think. Write me at firstname.lastname@example.org.