Home Care Workers: Recognizing Historical Marginalization and Valuing Their Work

By Associate Professor Jeounghee Kim in honor of Women's History Month 

Women have been in the paid labor force for more than 100 years, and the share of women among all workers went up from 20% in 1920 to about 47% in 2020 [1, 2]. Although women made an enormous stride in the labor market over the century, they are still concentrated in caring jobs. In 1920, the most common occupation for women was in the domestic and personal service industry. A hundred years later in 2018, one of the most common jobs for women still includes the same job, only called differently as home care work [1]. The home care occupation was originated from indentured or enslaved female laborers in Colonial America and slowly transitioned into paid domestic service work after the civil war and abolishment of slavery. With the arrival of the Medicaid, Medicare, and Older Americans Act in the 1960s, the contemporary home care field began to take shape [3, 4, 5].

The home care workforce is made up of one of the most vulnerable workers in the economy; they are mostly racial minorities and immigrant women working within employers’ homes to provide elderly care, childcare, and housekeeping services [6]. Yet, their work makes other work possible by freeing up the time and attention of other workers who have family members with personal care needs. Although the occupation is an integral part of the economy directly supporting the families and the institutions that the families work for, historical sexism and racism in the labor market made the work invisible and undervalued. The average hourly wage for the workforce hovers around $11-12, and high physical and emotional demands of caregiving work, and lack of employment benefits and economic mobility leave most of the workers trapped in poverty and welfare dependency [6].

The current status of home care workers reflects their historical marginalization in the American welfare system. The workers were excluded from the National Labor Relations Act of 1935 designed to grant employees the rights to form unions and collectively bargain for higher wages and better working conditions [7]. In 1938 when the Fair Labor Standards Act (FLSA) was passed, the workers were excluded again from its minimum wage and overtime pay guarantees. The exclusion was based on Southern Democrats’ fear during the New Deal era that the law would increase the political power and wages of domestic workers. Excluding domestic workers from important national policies continued into the civil rights movement era. The Civil Rights Act of 1964 was enacted to prevent employment discrimination, but domestic workers – who are mostly sole employees of their employers - were once again excluded because the Act targeted employers with at least 15 employees [7]. In 1974, Congress finally amended the FLSA to include domestic workers, but this time, the amendment exempted caregivers of the elderly and children considering that they were companions of people who need personal care rather than workers [7]. These continuous exclusions from important protective policies condoned decades-long violations of the workers’ rights such as wage theft and harassment on the job within the direct care industry [8].

In the late 1990s, home care workers began building a nationwide coalition with grassroots communities to fight back the labor market injustice. The National Domestic Workers Alliance was born out of the organizing efforts of the coalition. With Service Employees International Union (SEIU), the coalition led Bill of Rights campaigns in the 2000s and 2010s [9, 10]. By 2019, nine states enacted their Domestic Workers’ Bill of Rights to ensure that domestic workers are provided with written contracts, minimum wage and overtime pay guarantees, and protection from harassment on the job [6]. The demand for more than 3.5 million home care and other direct care workers has been on the rise from both private households and public programs such as Medicaid or Medicare. Even the Patient Protection and Affordable Care Act emphasized the urgency of workforce development for home care workers [11]. President Obama, who had once shadowed a home care worker, came to understand the real demands and value of home care work. In December 2011, he announced his support for extended coverage of the FLSA for home care workers [12]. Within two years of the announcement, the U.S. Department of Labor created the home care rules of 2013 for the home care workers hired by for-profit agencies. The implementation of the rules, however, was stalled by a lawsuit against the Department from home care associations, arguing that the rules would raise home care costs as well as the institutionalization of people with long-term care needs.

It took until January 2016 for the U.S. Department of Labor to win the lawsuit and to finally begin enforcing the home care rules. In January 2020, the Department made a further announcement that the home care workers jointly hired by Medicaid and consumers are also covered by the FLSA [13]. Taking more than 80 years, this is a monumental victory in history for home care workers and all women in the caring industry. Enforcement of the rules remains to be monitored, and its impacts on home care workers’ job qualities need to be evaluated. With an increasing number of older adults who wish to age in their homes and communities, we will continue to rely on home care workers. It is time that we recognize and value their work. Raising their wages and compensations and helping them escape poverty and welfare dependency is the most basic thing to do. 

References

1. U.S. Department of Labor (n.d.). 100 years of working women. https://www.dol.gov/agencies/wb/data/occupations-decades-100
2. U.S. Department of Labor (n.d.). Women of working age https://www.dol.gov/agencies/wb/data/latest-annual-data/working-women#Labor-Force-by-Sex-Race-and-Hispanic-Ethnicity
3. University of Pennsylvania School of Nursing (n.d.). Home Care https://www.nursing.upenn.edu/nhhc/home-care/
4. Ousley, L. (2006). The business of housekeeping: The mistress, the domestic worker, and the construction of class. Legacy, 23(2), 132-147. https://www.jstor.org/stable/25679571
5. Boris, E., & Klein, J. (2006). Organizing home care: Low-waged workers in the welfare state. Politics and Society, 34(1), 81–108. https://doi.org/10.1177/0032329205284757
6. Kim, J. (2020). Informal employment and the earnings of home‐based home care workers in the United States. Industrial Relations Journal, 51(4), 283-300. https://doi.org/10.1111/irj.12299
7. England, K., & Alcorn, C. (2018). Growing care gaps, shrinking state? Home care workers and the Fair Labor Standards Act. Cambridge Journal of Regions, Economy and Society, 11(3), 443-457. https://doi.org/10.1093/cjres/rsy027
8. Burnham, L., & Theodore, N. (2012). Home economics: The invisible and unregulated world of domestic work. National Domestic Workers Alliance. Center for Urban Economic Development, University of Illinois at Chicago. https://humantraffickinghotline.org/resources/home-economics-invisible-a...
9. Hobden, C. (2010). Winning fair labour standards for domestic workers: Lessons learned from the campaign for a domestic worker bill of rights in New York State. Geneva: ILO. https://www.ilo.org/actrav/info/pubs/WCMS_149488/lang--en/index.htm
10. Poo, A.-J. (2011). A Twenty-First Century Organizing Model. New Labor Forum, 20(1), 51–55. https://doi.org/10.4179/NLF.201.0000008
11. Patient Protection and Affordable Care Act of 2010, Pub L. 111-148, Title V: Health Care Workforce (2010). https://www.hhs.gov/sites/default/files/ppacacon.pdf
12. Compton, M. (2011, December 15). Ensuring fair pay for home care workers. The Whitehouse: President Barack Obama https://obamawhitehouse.archives.gov/blog/2011/12/15/ensuring-fair-pay-homecare-workers
13. Joint employer status under the Fair Labor Standards Act, 29 C.F.R. 791 (2020) https://www.govinfo.gov/content/pkg/FR-2020-01-16/pdf/2019-28343.pdf
     

This story was created in partnership with Rutgers School of Social Work's Inclusion, Intersectionality, Diversity, Equity, and Advancement (IIDEA) Committee in support of our commitment to diversity, equity, and inclusion.