Trump’s Department of Labor Is Trying to Slash Protections for Home Health Workers

Part of the Series

The Struggle for Caregiving Equity

Thirty-two-year-old Long Island resident Kathleen Downes, creator of The Squeaky Wheelchair blog, is a licensed social worker who is involved in a host of local and national advocacy efforts.

As someone with quadriplegic cerebral palsy, she needs help getting in and out of bed, bathing, dressing, doing her hair, and preparing meals. Thankfully, she says, she receives a small amount of help through a New York State Medicaid Program called CDPAP, the Consumer Directed Personal Assistance Program.

“I live with my parents,” Downes told Truthout, “because, even with my diagnosis, the state only authorizes care for 35 hours a week. It’s shameful since I need 24-hour assistance. Right now, my 62-year-old mother is the only person on my payroll. She makes $19.80 an hour and has to rely on my father’s employer health plan because the job does not provide benefits.”

But as inadequate as this is, Downes says the situation may soon get worse: A rule promulgated by the Department of Labor (DOL) in May could decimate the home care industry by removing minimum wage and overtime protections that in-home health care workers like her mom have been entitled to since 2015.

“The DOL rule change reflects a viewpoint that undervalues home health workers and the work they do, but it also reflects an undervaluing of people, like me, who are cared for,” Downes says. “Those lawmakers who support the rules change don’t see our lives as worthwhile, and they seem hellbent on moving us backwards.”

According to PHI, a national organization that focuses on improving care for people with disabilities and the elderly, the DOL proposal reinstates a 1938 Fair Labor Standards Act exemption for home care workers, personal care assistants, and home health aides and will “reverse a decade of progress and perpetuate historically rooted views about whose labor deserves to be valued and whose does not.”

“Removing minimum wage and overtime protections puts these workers back in the shadows.”

“We are headed toward disaster,” Reena Arora, director of care policy at the National Domestic Workers Alliance, told Truthout. “The rule seems very disconnected from reality. Removing minimum wage and overtime protections puts these workers back in the shadows.”

Under the original Fair Labor Standards Act — a law that many consider the centerpiece of the New Deal — home care workers were deemed “companions” rather than workers, and were thus excluded from wage and hour laws. Agricultural workers, maids, and other domestic workers were also exempted.

The American Civil Liberties Union calls this “a legacy of the original American sin of slavery.”

And it is. In fact, when the Fair Labor Standards Act was initially passed 87 years ago, this carve-out pleased the Southern segregationists then serving in Congress, assuring them that the majority of jobs once performed by enslaved people would not be bound by labor protections.

It took 75 years, until 2013, for the law to finally mandate minimum wage and overtime protections for those who had been excluded. But even then, there were roadblocks, and despite being announced in 2013, it took until October 13, 2015, for the change to take effect.

A decade later, 2.9 million personal care and home health workers — 85 percent of them female and 64 percent of them immigrants — assist millions of U.S. residents in their homes.

This number is expected to skyrocket over the next few decades.

Indeed, experts estimate that 738,100 new jobs in home care will be needed by 2032, making home care the fastest-growing occupational sector in the country.

“The proposed rule comes at a time when demand for home care is expected to rapidly increase due to a growing aging population relying on the industry to receive critical services and support,” staff at the National Employment Law Project wrote in a 12-page letter opposing the proposed change.

Calling the proposal “arbitrary and capricious,” the National Employment Law Project underscored the fact that home care is big business, noting that the industry is expected to grow in value from $107.7 billion in 2025 to $176.3 billion by 2037. At the same time, the organization reports that the work itself remains low-paid, with a quarter of health aides living below the federal poverty line and half receiving Supplemental Nutrition Assistance Program (SNAP) benefits in 2023. What’s more, they write that the current median wage is $16.13 an hour, or $21,889 annually. Worse, the letter adds, wage theft is endemic; in 2024 alone, the DOL collected $735,762 in back wages and damages from five industry employers. This benefited 173 workers who had been denied the pay they’d earned. “Rescinding the 2013 rule would embolden unscrupulous employers to continue to take advantage of workers, underpay them, and result in increased turnover and shortages,” the letter concludes.

“Rescinding the 2013 rule would embolden unscrupulous employers to continue to take advantage of workers.”

Mimi Whittaker, the Frank H.T. Rhodes Law Fellow at the National Employment Law Project, told Truthout that 5,553 comments were submitted to the Department of Labor in response to the proposed rule change. “DOL is supposed to review the comments, carefully consider them, and then issue a final rule,” she said. “In some cases, this can take years, but in this case, we’re guessing the final rule will be issued in a few months.”

Moreover, she adds that the fact that this change was announced following massive cuts to Medicaid and SNAP adds insult to injury.

“This impacts a drastically underpaid workforce that is doing essential work,” Whittaker says. “There are already large shortages in home care because these jobs are so underpaid. In some places, the turnover rate is 80 percent because the quality of the jobs is so poor. These jobs need to provide a living wage to workers, but some of the agencies that hire home health workers line their pockets with Medicaid dollars. This is extremely frustrating for workers who are doing a difficult job and who know that they can make the same money, or more, doing an easier, but less gratifying, job.”

Loven Williams, a personal care assistant from Virginia, submitted a public comment to the Department of Labor echoing this sentiment. “Home care workers are just as important as a nurse in a hospital,” she wrote in opposition to the rule change. “We allow clients to be able to stay in the comfort of their homes when their health starts declining.” Her client, she wrote, needs her to assist with bathing, feeding, medication and toileting. “I make sure all her appointments and needs are met every single day,” she wrote. “Since my client is bedridden, I have to make sure she gets her exercise. It’s physically demanding.”

Similarly, Irma Martinez, a home health aide in Texas, told the Department of Labor that “as it is right now, I can’t take a day off because I need every day of work. My income pays for groceries, rent and other expenses. I love the work I do, but if minimum wage and overtime are cut, I may need to find a job in retail or fast food in order to have a higher wage.”

Both Martinez and Williams note that while the federal minimum wage of $7.25 an hour has remained unchanged since 2009, five states have no state minimum wage whatsoever (Alabama, Louisiana, Mississippi, South Carolina, and Tennessee); three have minimums below $7.25 (Georgia, Oklahoma, and Wyoming); and another 18 have been stuck at $7.25 for 16 years.

Ruth Martin, chief workplace justice officer and senior vice president of MomsRising, told Truthout that the proposed rule has galvanized opposition from a wide cross-section of people, something she attributes to the fact that approximately 8.6 million older adults and people with disabilities currently need in-home help with the activities of daily living.

“I was heartened by the flood of responses to this awfulness,” she said. “The need for home care impacted me personally when my mom was diagnosed with cancer. I am part of the 23 percent of U.S. adults in the so-called ‘sandwich generation’ who are expected to care for aging relatives as well as children. My mom lived in rural Jane Lew, West Virginia, and had little access to home care. We had to rely on a network of church ladies to help. I lived in another state, but I was the only person in my family who had access to paid family and medical leave — I live in one of the 13 states that provide this — so I eventually had to step in.”

Martin adds that she sees the rollback as an extension of the Trump administration’s plan to “deregulate everything” and says she is particularly incensed by groups like the right-wing Independent Women’s Forum that see ending worker protections as a viable way for seniors and the disabled to “reap the benefits of a more workable and affordable structure of fellowship and care.” For Martin, this argument trivializes care work by minimizing what it involves.

That said, care is expensive and while most care recipients are covered by Medicaid — people typically “spend down” their savings to reach the $2,000 asset limit (homes, cars, and wedding and engagement rings are exempted) — most people have no choice but to exhaust their savings because, unlike Medicaid, Medicare only covers home care for a short time and only when a person is transitioning from a hospital to their home.

For some families with resources, long-term care insurance comes into play when in-home care is necessary.

Laura J., a Brooklyn resident whose 92-year-old parents have two home health aides, pays for their care — $30 per hour — out of pocket and then submits invoices to their long-term care insurer for reimbursement. But this option does not come cheap: Care insurance runs Laura’s parents more than $9,000 a year. And even then, a lifetime cap of approximately $300,000 per person controls how much can be spent. Should they live long enough, they, too, will have to “spend down” their savings to become Medicaid eligible.

“I’ve now figured out the paperwork and the bureaucracy of it,” Laura told Truthout. “I fill out the invoices, get the right signatures, and do all the follow-up. It takes vigilance and time because I have to keep an eye out for things that might go wrong. The simplest way to manage this is through an agency, because they do all the paperwork. But I’m trying to help my parents manage without an intermediary. This makes me the glue that keeps things running.”

“Cutbacks to home care are deeply unpopular across party lines. We’re mobilizing, organizing, educating, and doing mutual aid to remind people about what government can be and do.”

Keeping things running, says Smart Ass Cripple blogger, journalist, and activist Mike Ervin, a 69-year-old Illinois resident with spinal muscular atrophy, means managing six Medicaid-funded home care workers a week. Some of his workers, he told Truthout, work from 8:00 am to noon; others work in the afternoon; and a final shift works from 8:00 pm until midnight. “Everything I do in a day happens because someone showed up and helped me get dressed and organized,” he said. “This country seems to be going in a backward direction, and I dread the possibility that I could lose this support.”

The National Employment Law Project, MomsRising, the National Domestic Workers Alliance, and a wide array of unions, disability justice, immigrant rights, women’s and elder advocacy groups are working hard to make sure that this does not happen.

“MomsRising is part of the Care Can’t Wait Coalition, and we’re organizing to change the political climate,” Ruth Martin told Truthout. “Polling shows that cutbacks to home care are deeply unpopular across party lines. We’re mobilizing, organizing, educating, and doing mutual aid to remind people about what government can be and do. We’re in an uphill battle, but we know that we can — and must — create a government that works for the majority of people.”

A correction has been made to clarify that Kathleen Downes has cerebral palsy, not multiple sclerosis.