A lack of oversight in the rapidly growing home care workforce could undermine new wage and labor gains for many of the nation’s 2 million workers, according to a new report.

Private agencies employ the vast majority of home care workers, who provide services that are largely paid for by Medicare, Medicaid and other federal and state programs. But the companies are poorly regulated, which could hamper the enforcement of new labor standards, said the National Employment Law Project (NELP), a labor advocacy group.

Home care workers recently gained federal minimum wage and overtime protections after a lengthy battle in the federal courts. The U.S. Department of Labor is expected to begin full enforcement in 2016.

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To ensure that workers can take advantage of the new benefits, stronger oversight of the industry is needed, said Sarah Leberstein, one of the report’s authors.

“We are poised to really improve things for home care workers but we need to make sure that those standards are upheld no matter what the work arrangement is,” she said.

For example, Leberstein said a worker may not benefit from the federal minimum wage and overtime laws if her boss calls her an independent contractor, a classification traditionally not covered by employment laws, and if no enforcement agency questions the designation.

Home care workers are among the fastest-growing occupations, according to the Labor Department.

There are different types, including home health workers who provide medical care, and personal care aides, who help with bathing, eating, shopping and other tasks.

The average wage of the largely female home care workforce is about $10 an hour and nearly 50 percent of them rely on public assistance such as food stamps, according to the Paraprofessional Healthcare Institute, which does research, training and advocacy for direct care workers.

Personal care workers in particular have long been underpaid and have lacked worker protections, unless they happen to be in a union or employed by an agency with good benefits, said Susan Chapman, a professor at UCSF School of Nursing, who was not involved in NELP’s report.

Those poor working conditions, along with an improved economy, have contributed to a shortage of paid workers to care for the aging population, Chapman said.

“If you could work at a coffee house with benefits and higher pay, you would take that job over working in a home care situation,” she said. “The care is valued but the workers are seemingly less valued by our economy.”

Neither the federal nor state governments require home care agencies to report data on workers’ wages and hours, the report said. Without such transparency, they can’t determine the amount of public funds used for agency’s overhead versus employee pay, NELP said.

“As taxpayers, we really should care what is going on with the money that is supposed to be used to provide really critical services for people with disability and older adults,” Leberstein said.

The authors’ recommendations include paying workers $15 per hour and ending government contracts with agencies that have a record of labor violations. The report also recommends that home care agencies be required to produce wage and hour reports on employees.

If governments regulate the agencies more strictly and monitor them more carefully, workers would have a better chance at getting fair pay and decent working conditions, NELP said. Turnover also might be reduced and the quality of care might improve as well.

“We think it’s the federal and state governments that should take the lead in reforming the home care industry,” said Leberstein. “They have a lot of power to do this because they are paying for home care services.”

Kaiser Health News is a nonprofit national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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