U.S. Department of Labor 

Wage and Hour Division 

 (Revised July 2009) 

Fact Sheet #53 – The Health Care Industry and Hours Worked 

The Fair Labor Standards Act (FLSA) requires covered employers to pay non exempt employees at least the 

federal minimum wage of $7.25 per hour effective July 24, 2009, for all hours worked and overtime pay for

for hours worked over 40 in a workweek. The FLSA is administered by the Wage and Hour Division of the

U.S. Department of Labor. 

Hospitals and other institutions “primarily engaged in the care of the sick, the aged, or the mentally ill” are 

covered employers under Section 3(s)(1)(B) of the FLSA. Thus, hospitals, residential care establishments, 

skilled nursing facilities, nursing facilities, assisted living facilities, residential care facilities and intermediate 

care facilities for mental retardation and developmentally disabled must comply with the minimum wage, 

overtime and youth employment requirements of the FLSA. 

Summary 

This fact sheet provides guidance regarding common FLSA violations found by the Wage and Hour Division 

during investigations in the health care industry relating to the failure to pay employees for all hours worked. 

Nonexempt employees must be paid for all hours worked in a workweek. In general, “hours worked” includes 

all time an employee must be on duty, on the employer premises, or at any other prescribed place of work. Also 

included is any additional time the employee is “suffered or permitted” to work. The FLSA requires employers 

to pay for hours actually worked, but there is no requirement for payment of holidays, vacation, sick or personal 

time. 

The failure to properly count and pay for all hours that an employee works may result in a minimum wage

violation if the employee’s hourly rate falls below the required federal minimum wage when his or her total 

compensation is divided by all hours worked. More likely, the failure to count all hours worked will result in an 

overtime violation because employers have not fully accounted for hours worked in excess of 40 during the 

workweek. 

Rounding Hours Worked 

Some employers track employee hours worked in 15 minute increments, and the FLSA allows an employer to 

round employee time to the nearest quarter hour. However, an employer may violate the FLSA minimum wage

and overtime pay requirements if the employer always rounds down. Employee time from 1 to 7 minutes may 

be rounded down, and thus not counted as hours worked, but employee time from 8 to 14 minutes must be 

rounded up and counted as a quarter hour of work time. See Regulations 29 CFR 785.48(b). 

Example #1: 

An intermediate care facility docks employees by a full quarter hour (15 minutes) when they start work 

more than seven minutes after the start of their scheduled shift. Does this practice comply with the 

FLSA requirements? Yes, as long as the employees’ time is rounded up a full quarter hour when the 

employee starts working from 8 to 14 minutes before their shift or if the employee works from 8 to 14 

minutes beyond the scheduled end of their shift. 

Example #2: 
An employee’s schedule is 7 a.m. to 3:30 p.m. with a thirty minute unpaid lunch break. The employee 

receives overtime compensation after 40 hours in a workweek. The employee clocks in 10 minutes early 

every day and clocks out 7 minutes late each day. The employer follows the standard rounding rules. Is 

the employee entitled to overtime compensation? Yes. If the employer rounds back a quarter hour each 

morning to 6:45 a.m. and rounds back each evening to 3:30 p.m., the employee will show a total of 

41.25 hours worked during that workweek. The employee will be entitled to additional overtime

compensation for the 1.25 hours over 40. 

Example #3: 

An employer only records and pays for time if employees work in full 15 minute increments. An 

employee paid $10 per hour is scheduled to work 8 hours a day Monday through Friday, for a total of 40 

hours a week. The employee always clocks out 12 minutes after the end of her shift. The employee is 

paid $400 per week. Does this comply with the FLSA? No, the employer has violated the overtime 

requirements. The employee worked an hour each week (12 minutes times 5) that was not compensated. 

The employer has not violated the minimum wage requirement because the employee was paid $9.75 

per hour ($400 divided by 41 hours). However, the employer owes the employee for one hour of 

overtime each week. 

Travel Time 

Time spent by an employee in travel as part of his principal activity, such as travel from jobsite to jobsite during 

the workday, must be considered as hours worked. An employee who travels from home before the regular 

workday and returns home at the end of the workday is engaged in ordinary home-to-work travel. This is not 

considered hours worked. See Regulations 29 CFR 785.33. 

Example #4: 

A licensed practical nurse (LPN) works at an assisted living facility which has a “sister facility” 20 

miles away. There have been times that the LPN has been asked to fill in for someone at the other 

facility after she completes her shift at her normal work site. It takes her 30 minutes to drive to the other 

facility. The travel time is not recorded on her time sheet. Is this a violation of the FLSA? Yes. The 

travel time must be considered part of the hours worked. 

Training and Seminars 

Attendance at lectures, meetings, training programs and similar activities are viewed as working time unless all 

of the following criteria are met: 

• Attendance is outside of the employee’s regular working hours; 

• Attendance is in fact voluntary; 

• The course, lecture, or meeting is not directly related to the employee’s job; and 

• The employee does not perform any productive work during such attendance. 

 

See Regulations 29 CFR 785.27. 

Example #5: 

A residential care facility offers specialized training on caring for Alzheimer residents. There are two 

workshops: one in the evening for the day shift and one during the day for the evening shift. All 

employees are required to attend. Is this compensable time? Yes, because the training is not voluntary 

and is related to the employees’ jobs. 
Example #6: 

The administrator of a nursing home says specialized patient care training is voluntary, but the nursing 

supervisors expect all employees on their units to attend and schedule times for each employee to go. Is 

the time considered hours worked? Yes, the time would be considered hours worked. When the nursing 

supervisors expect all unit employees to attend and schedule their times, it is not truly voluntary. 

Example #7: 

The dishwasher decides to go to the Alzheimer’s training session after his shift. Must the administrator 

pay for the dishwasher’s time spent at the training session? No, because all four criteria above are met. It 

is not considered hours worked. 

Example #8: 

The administrator provides a Tai Chi course to residents and allows employees to attend during their offduty hours. Do employees have to be paid for the time they attend this course? No, the employees do not 

have to be paid because attendance is voluntary and the other three criteria are met. 

Meal Breaks 

Bona-fide meal periods (typically 30 minutes or more) are not work time, and an employer does not have to pay 

for them. However, the employees must be completely relieved from duty. When choosing to automatically 

deduct 30-minutes per shift, the employer must ensure that the employees are receiving the full meal break. See 

Regulations 29 CFR 785.19. 

Example #9: 

A skilled nursing facility automatically deducts one-half hour for meal breaks each shift. Upon hiring, 

the employer notifies employees of the policy and of their responsibility to take a meal break. Does this 

practice comply with the FLSA? Yes, but the employer is still responsible for ensuring that the 

employees take the 30-minute meal break without interruption. 

Example #10: 

An hourly paid registered nurse works at a nursing home which allows a 30-minute meal break. 

Residents frequently interrupt her meal break with requests for assistance. Must she be paid for these 

frequently interrupted meal breaks? Yes, if employees’ meals are interrupted to the extent that meal 

period is predominately for the benefit of the employer, the employees should be paid for the full 30-

minutes. 

Other Breaks 

Rest periods of short duration, generally running from 5 minutes to about 20 minutes, are common in industry. 

They promote the efficiency of the employee and are customarily paid for as work time. It is immaterial with 

respect to compensability of such breaks whether the employee drinks coffee, smokes, goes to the rest room, 

etc. See Regulations 29 CFR 785.18. 

Example #11: Many third shift nursing home employees who smoke prefer to take three ten-minute 

unpaid smoke breaks instead of their 30-minute unpaid meal break. Is it okay for them to substitute the 

smoke breaks for their meal break? No, the employee must be compensated for the smoke breaks. 

On-Call Time An employee who is required to remain on call on the employer's premises or so close to the 

premises that the employee cannot use the time effectively for his or her own purpose is considered working 

while on-call. An employee who is required to carry a cell phone, or a beeper, or who is allowed to leave a 
message where he or she can be reached is not working (in most cases) while on-call. Additional constraints on 

the employee's freedom could require this time to be compensated. See Regulations 29 CFR 785.17.

Example #12: An assisted living facility has four LPN wellness coordinators who are paid hourly. They 

rotate being on-call each week. They are required to carry a cell phone and be within 45 minutes of the 

facility when they are on-call. They are not paid for all time spent carrying the cell phone but are paid 

for time spent responding to calls and time when they have returned to work at the assisted living 

facility. Does this comply with the FLSA? Yes. 

Unauthorized Hours Worked 

Employees must be paid for work “suffered or permitted” by the employer even if the employer does not 

specifically authorize the work. If the employer knows or has reason to believe that the employee is continuing 

to work, the time is considered hours worked. See Regulation 29 CFR 785.11.

Example #13: 

A residential care facility pays its nurses an hourly rate. Sometimes the residential care facility is short 

staffed and the nurses stay beyond their scheduled shift to work on patients’ charts. This results in the 

nurses working overtime. The director of nursing knows additional time is being worked, but believes 

no overtime is due because the nurses did not obtain prior authorization to work the additional hours as 

required by company policy. Is this correct? No. The nurses must be paid time-and-one-half for all 

FLSA overtime hours worked. 

Example #14: 

An hourly paid office clerk is working on a skilled nursing home’s quarterly budget reports. Rather than stay 

late in the office, she takes work home and finishes the work in the evening. She does not record the hours she 

works at home. The office manager knows the clerk is working at home, but since she does not ask for pay, 

assumes she is doing it “on her own.” Should the clerk’s time working at home be counted? Yes. The clerk was 

“suffered and permitted” to work, so her time must be considered hours worked even thought she worked at 

home and the time was unscheduled. See Regulations 29 CFR 785.12. 

Where to Obtain Additional Information 

For additional information, visit our Wage and Hour Division Website: http://www.wagehour.dol.gov

and/or call our toll-free information and helpline, available 8 a.m. to 5 p.m. in your time zone, 1-866-

4USWAGE (1-866-487-9243). 

The FLSA statute appears at 29 U.S.C. § 201 et seq. The federal regulations regarding hours worked appear in 

29 C.F.R. Part 785. 

When the state laws differ from the federal FLSA an employer must comply with the higher standard. Links to 

your state labor department can be found at www.dol.gov/whd/contacts/state_of.htm. 

This publication is for general information and is not to be considered in the same light as official statements of 

position contained in the regulations. 

U.S. Department of Labor

Frances Perkins Building 

200 Constitution Avenue, NW 

Washington, DC 20210 

1-866-4-USWAGE

 TTY: 1-866-487-9243

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