Healthcare and Home Care: The 8/80 System, Shift Coverage and EVV

Healthcare and home care employers have to track time in ways most businesses never face: 8/80 overtime for hospitals and residential care, shifts that cross midnight, around-the-clock coverage and, for Medicaid home care, electronic visit verification (EVV). The common thread is accurate records of when each worker started and stopped, at each location.

This article explains how the 8/80 system works with a numeric example, why shift coverage creates overtime risk, what EVV requires, and which breaks and shift rules to watch. It is general information, not legal advice. State rules on staffing, breaks and mandatory overtime vary, so check with counsel or your state labor department.

The 8/80 system for hospitals and residential care

Most employers count overtime after 40 hours in a workweek. Hospitals and residential care establishments may instead use the 8/80 system under 29 CFR 778.601, but only by prior agreement with the employee. Under it, overtime at 1.5 times the regular rate is owed for hours over 8 in a workday and over 80 in a 14-day period.

Because the rule applies by agreement, keep the agreement on file and record the 14-day period start. If you cannot show the agreement, the standard 40-hour workweek applies. See federal overtime rules for the baseline.

An 8/80 example with numbers

This example is hypothetical. A nurse earns $40.00 per hour and works seven 12-hour shifts in a 14-day period, which is 84 hours. Under 8/80, each shift has 8 regular hours and 4 overtime hours: 7 x 4 = 28 overtime hours and 56 regular hours. Pay is (56 x $40.00) + (28 x $60.00) = $2,240.00 + $1,680.00 = $3,920.00.

Under the standard 40-hour week, suppose the shifts fall as 4 in week one (48 hours) and 3 in week two (36 hours). Overtime is 8 hours: (76 x $40.00) + (8 x $60.00) = $3,040.00 + $480.00 = $3,520.00. The $400.00 difference per nurse per period shows why the choice of system, and the accuracy of daily hours, matters.

Shift coverage and overtime risk

Hospitals, nursing homes and group homes cannot leave a post empty. When a colleague calls out, someone stays late or comes in, and the shift extends. Each of these changes can push a worker over the daily or weekly threshold. Supervisors need to see hours so far this week before they approve extra time.

Shifts that cross midnight create another trap: the hours belong to the workweek in which they were worked, and a shift that straddles the end of the workweek must be split correctly. A fixed workweek of 168 hours and a system that handles night shifts avoid errors. See shift differentials and night shifts.

Breaks, meal periods and on-call time

Short rest breaks of 5 to 20 minutes are paid. Meal periods of 30 minutes or more can be unpaid only if the worker is fully relieved of duty. A nurse who eats at the station while watching monitors is not relieved, and the time should be paid. Auto-deducting a meal break from every shift is risky in healthcare for that reason.

On-call time depends on how restricted the worker is. If the employee must stay on the premises or cannot use the time for personal purposes, it is typically paid. If the employee is free to go and can be reached by phone, the time is often unpaid, though facts and state rules vary. Read on-call time and reporting time pay.

Home care, live-in workers and EVV

Home care aides often work alone, in clients' homes, with travel between visits. Travel between clients during the workday is generally hours worked, and the first and last trips depend on the facts. Overtime rules for home care workers employed directly by agencies are covered by the FLSA, while live-in workers have special rules, so check the details.

For Medicaid-funded personal care and home health services, the 21st Century Cures Act requires electronic visit verification: a record of the type of service, the individual receiving it, the date, the location, the individual providing it, and the time the visit begins and ends. States choose approved EVV systems, so confirm what your state requires before you rely on any other app for billing.

Staffing levels are another source of risk. Some states regulate nurse staffing ratios or limit mandatory overtime, and facilities may have their own policies. Time data also supports staffing decisions: hours by unit, shift and week show where overtime is concentrated and where hiring would cost less than overtime.

Seasonal flu, call-outs and agency staff

Call-outs peak in cold and flu season, and agency or per-diem staff fill the gaps. Decide in advance who is an employee and who is supplied by an agency, because the party that controls the work and pays the worker has the wage and hour duties. See employee or independent contractor for how classification works.

Track per-diem employees like any other nonexempt worker: hours, rate, overtime and breaks. An informal "come in when we call" arrangement does not remove the recordkeeping duty, and unrecorded hours are the most common source of back wage claims in staffing-heavy settings.

Records, retention and audits

Healthcare employers face wage and hour audits plus payer audits. Keep payroll records for 3 years and time cards for 2 years under 29 CFR Part 516, with longer periods where your state requires, and keep schedules, shift swaps and approvals together. A trail that shows who approved extra hours is your defense in a claim.

Leave tracking is the other burden. FMLA applies to employers with 50 or more employees within 75 miles, and eligible employees need 12 months of service and 1,250 hours in the prior 12 months. Intermittent leave must be tracked in increments, which is common in healthcare. See FMLA leave tracking.

Check state rules on mandatory overtime and rest between shifts too. Some states limit how long a nurse can be required to work, and some employers set their own rest rules. Time data that shows hours since the last shift helps supervisors avoid scheduling someone who has not had enough rest.

How SimpleWorkshift Helps Healthcare and Home Care Teams

SimpleWorkshift lets staff clock in and out from the iOS or Android app or the web, with GPS location captured with each entry. Managers plan work schedules per employee, handle shift changes, and see time entries and exceptions in real time, so a nurse about to cross a daily threshold is visible before the shift extends.

Overtime and night shift differentials are calculated automatically, and PTO tracking, absence tracking and a time bank sit in the same place. SimpleWorkshift does not replace a state-approved EVV system where one is required, but it gives you accurate hours for payroll closing. Try it free for 30 days at simpleworkshift.com.