Tag Archives: home health care

Home Health Workers: In Demand But Not Protected

In the nearly 20 years I’ve spent organizing long term care workers, I hadn’t really personally experienced the difficulty of being a care giver.   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 care giving in the hope 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 as well 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.  Ten 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 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 workers 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 to receive care at home. Employment in care giving is expected to grow by 70% from 2010 to 2020, much faster than average for all occupations. Over one million workers in this industry have no health insurance. 90% of direct care workers are women, and many are primary breadwinners in their families. Caregivers are paid minimum wage or, if they’re lucky, just slightly above.  Earning such low wages with no health insurance means that 46% of direct care workers 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, 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 in his/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 a revising a Labor Department rule that would provide FLSA 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% 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

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

Welcome to the Informal Economy

It’s graduation season, and while commencement speakers encourage graduates to work hard and pursue their dreams, most new grads are worried about finding a decent job.  All their professors can suggest is that students use internships to gain valuable work experience and be prepared to have five jobs by the time they are 35.

Here’s the reality, grads: things are worse than you fear.  When you’re 35, you could still be looking for a good job. You’ll have a family to support, your salary could well be lower than you expect, and you’ll receive little or no pension contributions or health care benefits. Taken together, episodic work with little opportunity for advancement and poor wages and benefits reflect the characteristics of work life once found largely in the informal economy but now becoming all too common in the formal economy.

According to UNESCO, the informal economy involves the largely unregulated exchange of goods and services and is characterized by intermittent employment, short job ladders, and substandard wages and working conditions.  Historically, the informal economy has referred primarily to workers paid under the table, like many nannies or home health care aides, itinerant workers, and those involved in black market exchanges. But increasingly, the conditions of the informal economy are being experienced in the formal economy, though they are generally ignored or hidden by such glossy terms as consulting, internships, subcontracting, and privatization.

The economic crisis is pushing more people into the informal economy. USA Today reported that in 2010 only 45.4% of Americans and 66.8% of men had jobs. Both statistics are among the lowest on record, and now the United States has a lower share of prime age men in the work force than any other G-7 nation. According to David Brooks, writing in the New York Times, this is the result of early retirements, work disability, the decline of manufacturing jobs, and poor job fits in the new economy. Regardless of the reasons, the number of unemployed and underemployed people, who are most likely to participate in the informal economy, is growing in every sector and profession as the recession/regional depression continues. Many of those who do not have jobs are finding ways to support themselves, at least minimally, within the informal economy.  They have no choice.

At the same time, employers are taking advantage of desperate, young, less expensive workers, often hired on a temporary or contract basis, who are displacing older professional and non-professional workers or simply allowing companies to avoid committing to permanent hires.

As companies resist hiring full-time workers, and as young workers clamor for any possible job opportunity, internships have become increasingly significant in American business, and informal economy conditions apply to many internships.  According to the Economic Policy Institute, 1 to 2 million people today work as interns in the United States, and most are either unpaid and poorly-paid. In his book, Intern Nation, Ross Perlin reports that internships usually don’t conform to labor regulations, contribute to socio-economic inequalities, and rarely provide a useful job ladder – conditions that are typical in the informal economy. Offering college credit in lieu of an hourly wage does not necessarily mean that employers are free to ignore wage and hour restrictions. The U.S. Department of Labor has begun to take note of these problems and plans to increase regulation of unpaid internships nationwide.

Another growing category of informal workers is home-based caregivers. While some work through employment agencies, home-based employment is largely unregulated and dominated by non-white and female workers who earn low wages and no benefits. As more families need help caring for young children, disabled family members, and aging parents, demand for home-based care services has grown. Personal home and health care employment now exceeds 3 million and is projected to be the largest sector of new job growth between 2008 and 2018, with 1.1 million new jobs.  In the last decade, these workers have won union organizing and bargaining rights, but Steve Early reports that there is bi-partisan support among many current governors to rescind executive orders or pursue legislation undermining these workers’ attempts to improve their working conditions.  As a result, their wages will decline, their working conditions worsen, and they will sink even deeper into the informal economy.

So what is to be done? A number of labor and social justice organizations have formed the Excluded Workers Congress with goal of organizing workers in the informal economy, connecting them with grassroots movements, and developing strategic responses to informalization. They aim to challenge discrimination in the current labor market, build support for ongoing campaigns to improve working conditions, expand labor rights for excluded workers, and advocate for policies that support all workers’ right to organize.

Acorn International’s founder Wade Rathke suggests that there is no quick fix for the informal economy.  Rather than offering programs to retrain informal workers to enter the shrinking formal economy, he argues, we should “embrace the informal economy and engage in survival strategies that provide sustainable livelihoods and community redevelopment.” With short timelines and low investment, communities could organize  “localized informal workshops, training, production, marketing, and sales that can provide dignified, remunerative work for millions.” The work would range from home repair and rehab to food and bio-diesel production to recycling and technical repair services. He also advocates social networking to facilitate the sharing of job information, dispatch, and distribution and micro-lending adapted to broader social and community purposes. Put differently, he thinks the solution to the problems of the informal economy lies in changing the conditions of the work, not the workers.  Rathke wants to make work in the informal economy legal and formalized.

Most certainly, Rathke’s ideas may seem out of the box in advanced economies that often look for quick fixes. But as we in Youngstown know from more than 30 years experience, large-scale, structural economic problems don’t have easy solutions. On the other hand, the solutions Rathke advocates have helped alleviate poverty in developing nations. They may offer a more sustainable model of economic recovery, one that acknowledges significant structural and social changes.

That doesn’t offer much immediate hope for this spring’s graduating class or those being displaced within the formal economy.  The jobs outlook remains bleak.  But their long-term prospects might be better if, instead of normalizing the poor working conditions of the informal economy, we organized to ensure decent wages, reliable pensions, good health care, and greater opportunities for workers across the spectrum.

John Russo, Center for Working-Class Studies