Decent Care

In this blog entry, Karla Erickson, author of How We Die Now, writes about the big step toward decent care taken last month when home health care aides were granted federal protection.

In the late 1990s, a McJob—a low paid job with few future prospects like a fast-food job– was the most common way to earn a living in the United States. Quietly and quickly, the fastest growing job category has shifted to a form of work that is far less visible and, until now, far more precarious: home health aide.

For many of us, the mention of home health aide may bring to mind a bouncy 18-year-old girl in a candy striper uniform, but we would be wrong. Home health aides are overwhelmingly female, overwhelmingly women of color, and are women, not girls, often with families of their own. Up until now they have worked in the shadow economy: a barely regulated space lacking all of the protections of even a McJob. No insurance, no minimum wage, and no overtime protection.

Up until September 17, 2013, this work has been treated as not work, or at least not work that rises to the level of receiving federal protections for workers. This shadowy, off-the- record approach to home health work has had several costs. First, it linked home health aides’ labor to a long history of underpaid, indentured and enslaved labor in the home. Second, it reduced the complex work of caring for dependent adults to something that women—and particularly women of color–are naturally good at doing. Why pay well for work that is intrinsically rewarding? And finally, it was indecent. Failing to offer even the most minimal support and defenses to the people who work to care for the most frail among us is a sorry statement on our society. It devalues care, the home, and frail people in one fell swoop.

So thanks to a suit brought by Evelyn Coke, home health workers will now have federal rights. Coke worked for most of her life in other people’s houses to make sure their bodies were clean, clothed, safe, and fed, but she never had the protection of the Fair Labor Standards Act. This moves her and her compatriots one step away from servants, and elevates them to the status of a McJob.

This major victory is one more step toward decency. Labor rights activists often work toward dignity, and I’m not sure we are there yet, but decency, yes. Home health aides link back to a tradition of capitalizing on the caring labor of racial minority women in homes by paying poorly or not paying at all for their service and sometimes-loving care. Racial minority women and particularly recent immigrant women have often been employed in informal labor arrangements that included extraordinarily long days, working over holidays, wages well below the minimum wage, and absolutely no access to recourse if they were treated unfairly. This act is one step away from that history.

The work that home health aides do is intimate, but working in the shadow economy has routinely put them in danger of exploitation, injury, and abuse. We talk about decent service, decent care, but until the passage of this law, we have not had the decency as a society to protect or even recognize the emotional, spiritual, psychological, and physical labor of the people who work in our homes and aide us in being people. Home health aides are the quiet assistants who ready us for living if we are recovering from an injury or need help with the activities of daily living and the management of disease. They ride buses, and drive their own cars to the homes of mainly elderly, but any person who needs some help to get through their day. They spend hours bent over, raising and turning bodies, cleaning sheets, changing clothes, ministering to others. Today they did not get their due. But they did move a giant step closer to being treated decently, which after all, is what we expect and ask from them everyday.

Last month’s decision will be remembered for years to come. It is a huge victory. Here’s hoping we use this moment of decency to honor, and begin to offer support for, the people who care for us during our most vulnerable stages of life.