Crisis in Care: Home Health Workers Barely Surviving


In the nearly 20 years I’ve spent organizing long term care workers, I hadn’t really personally experienced the difficulty of being a caregiver. I worked the policy, political, advocacy, organizing, and bargaining pieces in the Union for home care workers. The women I organized were strong and bold and everyone had a story to tell. We told their stories of caregiving in the hopes that the workforce would no longer remain invisible and would begin to be seen as the emerging face of the labor movement along with immigrants and service workers.

I have a story to tell now. My mom and dad are in their 80s and in poor health. Caring for them is the most difficult work I have performed in my life, both mentally and physically. I moved back home two years ago to care for them. 10 years ago I used to fear that they would die. Now I fear that they will live. Each day brings its own lessons in compassion, like when I wake up in the morning and there is no hot water to shower with because Mom got up in the middle of the night and left the water running. Or when I am ready to walk out the door to take my son to pre-school and Dad’s colostomy bag breaks and I have a mess to clean up. Then Dad begins to cry, I try to comfort him, and my son is late for school. I think back to the women I’ve organized and look to them for strength. I do this for free, which prevents me from working full-time elsewhere, but the workers who did this for a living, mostly women and people of color, really aren’t doing much better financially.

Home health workers are among the most in demand but lowest paid in America. There are 2.5 million caregivers in the workforce, and that number will grow over the next decade because of aging baby boomers, many of whom seem to prefer receiving care at home. Employment in caregiving is expected to grow by 70 percent from 2010 to 2020, much faster than average for all occupations. Over one million workers in this industry have no health insurance. 90 percent of direct caregivers are women, and many are primary breadwinners in their families. Caregivers are paid minimum wage or, if they are lucky, just slightly above. Earning such low wages with no health insurance means that 46 percent of direct caregivers rely on some type of government program, such as food stamps, Medicaid, housing, child care, energy assistance, or transportation assistance.

Over one million direct care workers are consigned to near-poverty because of the structure of their employment. The home care workers bathe, change, dress, and feed their clients. They also perform home-making duties, such as cooking, cleaning and shopping. These workers face whatever they have to face depending on the kind of day their clients may be having. Even if the home care agency tells them that they have one hour to get a client dressed, fed and settled into his or her chair for the day, it may take longer. But workers do not leave their clients. Instead, they work “off the clock.”  A home care worker may have four clients for the day but does not get paid for mileage or travel time between clients, much less any benefits for themselves. If the worker’s client becomes ill and is admitted to the hospital, admitted to the nursing home for further care, or dies, or if the family takes the client to their home for the holidays, the worker simply loses that job and does not get paid. There are no sick days and no vacation days.

Home care workers may be employed by an agency or be independent providers. In either case, the work environment includes a number of safety and health hazards: blood-borne pathogens and biological hazards, latex sensitivity, ergonomic hazards from client lifting, violence, hostile animals, and unhygienic and dangerous conditions. They may also face hazards on the road as they drive from client to client.

Unfortunately, these workers have been denied the right to organize and bargain in some states, like Ohio. Home care workers are also excluded from the Fair Labor Standards Act, making them ineligible for overtime, including overnight stays at a client’s home. President Obama spent a day working as a home care worker in California not long after announcing his candidacy in 2007.  Last year, the President proposed revising a Labor Department rule that would provide protections to home care workers, and the final rule is still being deliberated. Guess who opposes the rule change?  The home care agencies. Agencies receive at least $15 billion of Medicaid money annually for personal care services and are happy to have government money, which fueled a 9 percent average yearly increase in revenue between 2001 and 2009. Government becomes harmful, it seems, only when setting a floor under workers’ wages. The fight isn’t about raising the minimum wage or getting overtime legalized - that would still leave home care workers poor. It’s about winning some labor standards, rights and security after decades of losing them.

What happens to this growing element of the working class matters for the shape of our economy, the fate of unionism, and the establishment of a decent standard of living for all.

Debra Timko was a leading health care organizer for 20 years and is now an independent health care researcher studying the lives of health care workers in Northeast Ohio. This has been reposted from the Center for Working Class Studies.

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