HEATHER MADDEN: Revisiting The Home Care Rule: A Regulatory Shift To Support Aging In Place

Far too many seniors today are priced out of hiring in-home companions by the 2013 Home Care Rule, especially those who don’t require skilled nursing but would benefit from routine assistance and regular human interaction.

The Department of Labor’s proposed recession of this Obama administration relic could change that: by taking away the red tape that has added needless hurdles to senior care for over a decade, America’s aging population and America’s working population alike could reap the benefits of a more workable and affordable structure.

Home care has not always been so administratively complex. In 1974, Congress amended the Fair Labor Standards Act (FLSA) to include minimum wage and overtime requirements for many domestic workers, but carved out an exemption for those offering companionship services to the elderly or disabled. In 1975, the Department of Labor defined these services as “fellowship, care, and protection”—essentially tasks directly supporting a person’s daily well-being. This exemption also applied to caregivers employed through third-party organizations, such as home care agencies or staffing firms.

That changed in 2013, when the Obama administration’s Department of Labor issued a new rule significantly narrowing the definition for companionship services by removing “care” as a qualifying activity. This new rule stipulated that if a companion spent over 20% of his or her time on non-exempt tasks—such as helping with meals or dressing—they would forfeit the exemption. The rule additionally barred third-party employers from using the exemption entirely. (RELATED: Man Who Severely Beat Elderly Pro-Life Activists Avoids Prison)

This has led to a host of legal and logistical challenges. Households seeking to hire companions now have to maintain meticulous daily time records and navigate complex wage calculations for live-in arrangements, particularly if room and board are part of the companion’s compensation. As a result, many families have opted to forgo assistance entirely or resort to “off the books” arrangements that are outside the legal system, which can lead to exploitation for both families and caregivers as well as potential penalties for noncompliance with tax and labor laws.

Meanwhile, the rising cost of in-home support, often exceeding $80,000 annually for even modest in-home assistance, presents a significant financial challenge for families. Since Medicare does not cover companionship, families often bear its full financial burden, rendering this type of support unattainable for those with fixed or moderate incomes.

Further compounding the issue, the constraints imposed by the 2013 rule have contributed to a shrinking pool of available companions. This shortage not only affects seniors seeking to age in place with basic daily support, but also limits flexible work opportunities for students, retirees, or lower-income individuals who might otherwise be well-suited to live-in arrangements. A more practical framework, as suggested by the Trump administration’s Department of Labor, would reduce these barriers while still ensuring appropriate oversight and standards.

The Department is accepting public comment on the proposal through Sept. 2, 2025, and has requested input on how the 2013 rule has affected access, affordability, and the availability of support services. If it rescinds the rule, returns to the previous definition of companionship, and once again allows caregivers employed through third-party agencies to qualify for the exemption, American seniors will have more choices in their retirement.

The current system fails to adequately support America’s aging population who wish to age in their homes with a companion to provide basic assistance, friendship, and security. But it can be fixed: by restoring flexibility in how companionship is arranged, clearly distinguishing between intensive medical care and supportive presence, we can serve the diverse needs of seniors, allowing more of them to age in place with the dignity they deserve.

Heather Madden is the policy staff director at Independent Women.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of the Daily Caller News Foundation.

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