Rethinking Care

Welcome to the “care economy” — the booming service sector that has emerged from America's rapidly graying boomer population.

Growing older is hard, and taking care of an aging loved one is hard work. For those of us who are aging or living with a disability, your family might hire a caregiver for day-to-day support: getting out of bed, minding medications, bathing and cooking meals — and sometimes serving as a medic, housekeeper, therapist and closest companion, too. Yet for all the loving care that health aide gives every day, she’ll be lucky if she takes home enough money to make this month’s rent.

Welcome to the “care economy” — the booming service sector that has emerged from America’s rapidly graying boomer population. On the surface, in-home elder and disability services offer a more family-oriented, community-based alternative to a traditional nursing home. But for the care worker, this apparently progressive model also means workdays that never end, along with the twisting of sensitive interpersonal relationships of care into a massive, barely regulated industry, rife with exploitation.

But the industry is shifting. The Obama administration just closed a longstanding labor-law loophole to provide federal minimum wage and overtime pay to home care workers, starting next January. The widely hailed rule change affects potentially two million workers — typically low-income women, including formal nursing aides and domestic workers providing medical services. It’s a step toward dismantling exclusionary laws that have for generations pressed poor women to the margins of the workforce.

Direct care workers typically earn only around $20,000 annually, with few opportunities for career advancement. Many are primary breadwinners but must rely on public assistance to scrape by. Even those hired by third-party healthcare agencies and financed by Medicaid are routinely shorted on wages or forced to work withering schedules.

Currently twenty-one states and Washington, DC provide some wage and hour protections to care workers. But strengthened national labor laws (the first such expansion since domestic worker regulations were reformed in 1974) will help boost wages nationwide and strengthen oversight.

But despite incremental reforms, home care workers still lack many standard federal protections for the right to unionize and workplace safety and health standards.

Moreover, many of the indignities they experience on the job are deeply ingrained in the society that lies outside the home. The epithets that a worker’s client occasionally spits at her reflect a legacy of racial and gender marginalization in domestic work. The sector has historically been associated with poor women of color and, more recently, immigrants; not surprisingly, nannies and housekeepers were originally completely excluded from the landmark Depression-Era Fair Labor Standards Act.

Likewise, when a boss arbitrarily shorts a care worker’s wages, locks her in the basement, or puts his hand down her shirt and threatens to fire her if she tells, she may have essentially no legal recourse. Because as a low-wage worker without union representation — or perhaps an undocumented migrant working “off the books” — she toils in the “gray economy,” virtually invisible under the law and constantly vulnerable to abuse.

One New York-based home care worker recently described her job in a report by the labor advocacy group ALIGN NY: “[The clients] treat us like we are disposable. Like a napkin, to use and throw away.”

Nonetheless, many aides remain deeply devoted to their profession as a serious labor of love. At a recent press conference on the minimum-wage reform, Lauralyn Clark of Virginia reflected on what drives her to work arduous round-the-clock shifts for her client: “I would hope that if the time came that I needed someone to care for me, I would be able to stay at home and not have to go into a nursing home.”

Extending labor protections symbolizes long overdue appreciation for the workers who care for our families when we can’t, for wages no family can really survive on. But their labor challenges will only grow more complex as the “caring professions” become more commercialized. Decent working conditions help lay the groundwork for a more equitable domestic workplace. But our communities need to rethink of the labor of care as a whole in a post-industrial economy and abandon moldy stereotypes of caregiving as just casual “women’s work.”

And workers are taking the lead; the wage reforms mark a milestone for a rising grassroots movement. Alongside fast-food workers and Wal-Mart strikers, domestic workers have campaigned nationwide for better working conditions, and it’s paying off: The California Senate just passed a domestic workers’ “Bill of Rights” guaranteeing state minimum wage and overtime, following similar legislation passed in New York and Hawaii.

These campaigns are actually supported by many families whom the workers serve, who recognize that the way they treat caregivers will be reflected in the care their loved ones receive. Making the home a fair place to work is the cornerstone of building a just community. Care workers appreciate a decent paycheck, but their dignity on the job is worth far more — to everyone under that roof.