Sustainable Home Care - Part 1 - NAELA® News

Sep 19, 2026

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Guidance for families facing dementia or Alzheimer’s planning for at-home care, emphasizing compliance with wage and hour laws, IRS and state income tax reporting, and required insurance coverage. Explains how changes after the 2015 Weil decision affect home care agencies’ minimum wage and overtime exemptions and caregiver scheduling, and outlines alternatives such as hiring a consistent caregiver or managing the family’s role as employer. Includes the Companionship Services Exemption basics and related caregiving definitions.

LanguageEnglish

CategoryLetters

FormatPDF

Pages5

Reading Time2 min

AccessFree to download

Part 1

Sustainable Home Care

Wage and Hour Laws

Concierge Model

Sidebar 1: Companionship Services Exemption

Tax Click on footnotes, statutes and CFR references in the article text, to read the references and resources. By John L. Roberts, CELA Part 1 Sustainable Home Care Help your clients comply with wage and hour laws, taxes, and insurance requirements. I f you have a client who is facing a dementia or Alzheimer’s diagnosis, be prepared if the family wants to talk about caring for their loved one at home. If their plan includes hired caregivers, you’ll need to understand: 1. Your state’s wage and hour laws and the regulations issued by the U.S. Department of Labor; 2. IRS and your state’s income tax reporting and withholding requirements; and 3. Reasons why they must protect themselves and their caregiver with unemployment insurance and workers’ compensation coverage. Wage and Hour Laws Prior to 2015, home care agencies in most states could use wage and hour exemptions to pay less than minimum John L. Roberts, CELA, Springfield, Massachusetts, serves clients in Hampden County, Massachusetts with Medicaid planning, elder law, estate planning, probate and estate settlement. The end of wage and hour exemptions for home care agencies does not necessarily mean the end to flexible and creative home care arrangements. wage to caregivers who lived in their customers’ homes. “They can’t getaway with that anymore without paying overtime,” says Tom Breedlove of [MyHomePay.com](MyHomePay.com), a domestic employee payroll service based in Austin, Texas.“Now, the family may need four or five caregivers a week, and that’s fine if grandma only needs care for several weeks after breaking her hip. But for long-term cognitive cases, it’s a real issue,” Breedlove says. The family may end up deciding,“this doesn’t work for Dad. He doesn’t know all these different caregivers.” Dementia and Alzheimer’s patients can become anxious and disoriented by a parade of new and different caregivers they don’t recognize. The patient needs to know the caregiver’s face and manner. “Meaningful gestures and feelings are easier to express when people understand and value each other.”1 The caregiver needs to know that the patient can’t always express what is going on. For families who need the continuity of a single caregiver, Breedlove says“home care agencies are now giving customers a choice: accept a revolving door of caregivers, because the agency has to schedule around overtime, or pay a higher rate that can cover time-and-a-half.” Homecare agency economics were rocked by the 2015 Weil decision, which ordered summary judgment in favor of the U.S. Department of Labor (DOL) and the DOL’s amended Fair Labor Standards Act (FLSA) regulations that require minimum wage pro- 1 Sharon M. Keigher, The Interests Of Three Stakeholders In Independent Personal Care For Disabled Elders, 23 Journal of Health and Human Services Administration 136, 156 (Fall 2000) (reporting 1996–1997 survey of care workers, disabled elders, and their family members). [https://www.jstor.org/stable/](https://www.jstor.org/stable/)[ ](https://www.jstor.org/stable/)[25780944?seq=1\#page_scan_tab_con](25780944?seq=1#page_scan_tab_con)tents. 14 APR/MAY/JUN 2018 NAELA® News Return to: At-Home Care [page at MassHealthHELP.com](page at MassHealthHELP.com) tection and overtime pay for caregivers and companions who are employed by third-party agencies.2 Home care agencies predicted that ending their FLSA minimum wage and overtime exemptions would “make home care less affordable, and create a perverse incentive for reinstitutionalization of the elderly and disabled.”3 They argued that change “would harm home care workers and recipients,[i]ncentivize employment through informal channels,” rather than homecare agencies,4 and accelerate “turnover due to reduced work hours per shift.”5 But the end of wage and hour exemptions for home care agencies does not necessarily mean the end to flexible and creative home care arrangements.“Many families are now tryi

FAQs

What should families understand when planning at-home care for dementia or Alzheimer’s patients?

Families should understand relevant state wage and hour laws and U.S. Department of Labor regulations, IRS and state income tax withholding and reporting, and the need for unemployment insurance and workers’ compensation coverage.

How did the 2015 Weil decision affect home care agencies’ wage and hour exemptions?

It ordered summary judgment for the U.S. Department of Labor and its amended FLSA regulations, requiring minimum wage and overtime pay for certain caregivers employed by third-party agencies.

What is the Companionship Services Exemption and who can it apply to?

It generally applies to domestic service employees who provide companionship services for individuals unable to care for themselves due to age or infirmity, focusing on fellowship and protection activities within defined limits.

Sep 19, 2026

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