Home health care workers—more than “companions” and helpers

A group of Senators wish to deprive home health care workers of minimum wage and overtime protections. Just whom do these Senators expect will bathe them when they get old?

Ten years ago, I conducted a survey of low-income new mothers in Flint, Michigan, as part of an infant mortality reduction effort there. I was astonished by the heavy percentage employed as home health care workers, assisting elderly or disabled people.  Since then I’ve met more than a few women and men who make their living bathing the disabled, cleaning seniors’ homes, and more.

This is important, sometimes difficult work. It’s not incredibly well-paid or respected. It’s also work that many of us will someday need. Today’s New York Times includes an beautifully-written and important op-ed by Eileen Boris and Jennifer Klein, titled Home-Care Workers Aren’t Just “Companions.”

Boris and Klein note that the home health and personal care workforce includes 2.5 million people. It’s the second-fastest-growing job category in the country. For complicated, but rather shameful historical reasons, these women and men do not enjoy basic labor protections that other workers take for granted. People who perform personal care work in other people’s homes, and those who receive these services, are both rather stigmatized groups. Both are poorly-positioned in the political process to demand better conditions.

At one level, the home care industry is able to employ people at less favorable wages and working conditions. At another level, though, it’s wrong to point fingers at the industry. We taxpayers and consumers are complicit in, and benefit from, these exploitative arrangements. It’s also about honoring the dignity of work–including the hard work that many of us do caring for our own loved ones or for others who cannot do basic tasks for themselves.

President Obama has proposed to change Department of Labor regulations to address this problem. House and Senate Republicans oppose these measures. Nebraska Senator Johanns and others have introduced the Companionship Exemption Protection Act, which would in its own words, “preserve the companionship services exemption for minimum wage and overtime pay under the Fair Labor Standards Act of 1938.” Reading the particulars here is fairly cringe-inducing to anyone who has seen (say) The Help:

‘companionship services’ as used in section 13(a)(15), means those services which provide fellowship, care, and protection for individuals who, because of advanced age or physical or mental infirmity, are unable to care for themselves, including but not limited to, non-medical in-home care or household work related to the care of the aged or infirm individuals (such as meal preparation, bed making, washing of clothes, errands, assistance to appointments, laundry, medication reminders, bathing, assistance with incontinence and grooming, and other similar services). Such term may also include the performance of general household work.

The last time I wrote about Senator Johanns, he was arguing that the Affordable Care Act imposed intolerable burdens through the “1099 collation calamity.” Apparently, those annoying tax forms imposed greater burdens than does the lack of minimum wages or overtime pay for millions of people who perform intimate care tasks.

Just whom does the Senator and his co-sponsors expect to bathe and clean them when they get old?

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

10 thoughts on “Home health care workers—more than “companions” and helpers”

  1. > Just whom does the Senator and his co-sponsors expect to bathe and clean them when they get old?

    This is a rhetorical question, right? I mean, it’s a bit like asking how David Koch will afford medical coverage when he develops a chronic condition or something. US Senators can rest serene in the knowledge that questions like this will never be an issue for them and theirs.

  2. Harold, thanks for posting this. You’re right, of course, about the powerlessness of these home health aides and the fact that, of all the people who are sent into patients’ homes by home care agencies – from RNs through LPNs and down to HHAs – it’s only the lowest paid, i.e. those most in need of an overtime boost, who are exempt from the law’s overtime requirement. It’s absurd and outrageous and fixing this will be one of the noblest things the Obama Administration does.
    A side note: FLSA allows states to set higher floors on wages, which is why many states have minimum wages higher than the federal min wage -and this can also apply to OT pay. In Pennsylvania, the Minimum Wage Act has a narrower exemption and the state courts have shot down homecare agencies that tried to wiggle out of paying OT to their HHAs. I’m no fan of federalism but if Johanns somehow gets his despicable way, I hope interested advocates will look to state law as a backup plan.

  3. I lost my mother three years ago. Before she went into a hospice she had a home health care attendant. After she went into the hospice, the home health care attendant visited her regularly, notwithstanding the fact that she had lost her assignment when mom went into the hospice. This woman was an angel.

  4. Gospel of Matthew, Chapter 25, Verses 31-46.

    Don’t these Republican jackasses ever READ those Bibles they’re always waving around?

  5. One of the problems here is that such a simple-sounding job classification covers an enormously wide range of demands. Somewhere you will find a home health aide whose current assignment requires only light housecleaning, meal prep and conversation. (Although of course we shouldn’t undervalue that, any more than we should underpay auditors just because they usually find no major accounting problems.) The next assignment might include an incontinent, combative patient with serious infection-control and medical-device-management issues. But you don’t see those ones called out in the complaints about lazy aides.

    As The Navigator points out, a lot of the problem is about power, as with any personal-service job. When the personal service being provided is protected by closely-guarded guild status (lawyers, doctors, accountants…) the wage tends to rise to match the avoided cost of employing the guild member; when the service is denigrated and unprotected, it falls to the minimum required to still have (some) people perform it.

  6. “At one level, the home care industry is able to employ people at less favorable wages and working conditions. At another level, though, it’s wrong to point fingers at the industry. We taxpayers and consumers are complicit in, and benefit from, these exploitative arrangements. ”
    This is exactly how the Market – that we all participate in – tends to erode, not promote the human dignity of underclass labor. In our rational quest for cheaper services, competition drives down prices, and thus wages for these workers. Because we have a large supply of workers with little human and societal (H/S) capital, they will be the ones to fill these jobs.

    In a perfect world, H/S capital levels would be more evenly distributed across society, placing more pressure on wages to rise. Yet instead, we have a property system in which these workers largely live in the same neighborhood as each other, their children attending the same schools, creating low H/S capital communities which serve essentially as funnels to these low-skill, low-wage occupations.

    To the extent that there is pay equity, these workers have more freedom to live in higher H/S capital communities, thus exposing their children to more opportunity and higher H/S capital schools. Because the cost of paying these workers better is ultimately born by higher H/S communities, it seems the redistribution of wealth becomes even less zero-sum as inequality is actually reduced.

    **As an aside, isn’t there a creepy argument on the right that this sort of inequality is actually *good* for society because it provides a sort of incentive for people to strive and be more productive? In other words, the low pay and devaluing of certain jobs actually function as an inspiration to social mobility. I wonder how many on the right would actually agree with this, whether or not they would admit it?

  7. Excellent post; thanks!

    I do communications work for the Direct Care Alliance, the national advocacy voice of direct care workers–including home care workers. DCA and our allies have been advocating for several years now to get Fair Labor Standards Act protections for home care workers. We are truly grateful to Secretary of Labor Hilda Solis and her staff for the rule they have proposed, which would accomplish just that.

    But we are concerned that the rule could get sidelined or overturned, if it is not enacted soon, if there is a change of administration after November’s election. We are now gathering signatures for a petition we will send to the Department of Labor and the White House, and we could use yours. If you want to see home care workers get minimum wage and overtime protections, please sign our petition (https://www.change.org/petitions/stop-excluding-home-care-aides-from-minimum-wage-and-overtime?utm) urging DOL to enact the rule NOW.

  8. same goes for the CNA who work in group homes and nursing homes. We not only do the cleaning and companionship but the basic nursing. The CNA runs the nursing home, truth be told. We are the eyes, ears, hand and lifeline to the elderly. We are also responsible for postmortem care. We do vitals, are certified in CPR, First Aid and Blood Born Pathogens and we perform certain elements of physical Therapy and even counsel our residents and their family members. We do this for 8-12 people a day and a lot of us pull double shifts. They get away with paying us minimum wage to barely over that! I am not ashamed at all of being a CNA. If we all became RN's then who would care for our elderly. Another sad fact? Hospitals are now phasing out the LPN and giving the CNA her responsibilities, WITHOUT A RAISE! LPN's generally made around $20 hr. Surely with phasing them out they should be able to now afford to pay their CNA the same? They've gotten rid of an entire work force by cutting out the 'middle man' so to speak. Fact is, the CNA is literally a NEEDED worker. RN's cannot do it because they are very busy with paper work and passing meds which can take a very long time…they have to have the CNA to do the nursing for them. I have a petition online to higher wages for the CNA. It's a professional job and should be treated as such. Time to take a stand!

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