Organizing Home Care
After fracturing her hip in 1981, Ethel Hunter, an 80-year-old stroke
survivor, just "needed somebody to take care of [her]" so she could
remain in her Forest Hills, New York apartment. She gained that aid
through the minimum wage labor of Haitian immigrant Maryse Williams, who
was paid by the city to "help her bathe and dress, cook the broiled
chicken that she likes, clean her house and take her outside in a
wheelchair." Williams was one of what was then 28,000 New York City home
attendants providing personal care and undertaking household chores for
frail elderly and non-elderly disabled persons who qualified for
Medicaid. Such "domestic workers," as the press and public officials
called attendants like Williams, allowed people to avoid
institutionalization by substituting for absent family members. Their
"humane and vital service" also saved the government the cost of "more
expensive nursing homes"—but only because of minimum wages and lack of
benefits that kept workers poor despite state promotion of such jobs as
an alternative to welfare dependency.[1]
From the early 1990s until
2005, home care and health care jobs accounted for the most employment
growth in New York City.[2]
Personal attendants and home health aides like Maryse Williams are
America's front-line caregivers. Predominantly Latina, Black, and
immigrant women, they labor without health insurance, paid sick leave
and vacations, or worker compensation.[3]
Because of their location in
client homes and the dense network of state contracts to private
agencies, both the public nature of the job and the employment status of
the worker are obscured. With workers employed by a municipal or
proprietary agency, private charity, public hospital, or family, home
care has existed in a clouded netherworld between public and private,
employment and family labor, health care and household service.
As the population in the U.S. ages and family members are less
available to care for elders, we have come to rely on this vast
'invisible' workforce to provide long-term care. But the U.S. has never
implemented a social insurance or dedicated program for long-term care
at home. Instead, it has relied primarily on means-tested social
services available only to the poorest people. This financing of care
through the welfare system has fundamentally shaped the entire labor
market for care, whether "public" or "private." State policies have made
it difficult for even middle-class people to go out and hire someone to
look after their loved ones because it has turned home care into a
low-paid job.
Home care emerged as a modernized form of domestic work when state
policies transformed intimate labor, performed by wives and mothers,
into a social service authorized by state bureaucracies and financed by
taxpayer funds. State policy both mirrored and facilitated the
restructuring of domestic labor from an informal agreement between
mistress and maid to a formal labor market in which a third party—a
non-profit, proprietary, or government agency—functioned as the
employer, standing between worker and client. This 'modernization' was
never complete; a gray market expanded to offer attendants to those
ineligible for state services. This largely affected the vast middle
class, which otherwise has to spend down its assets to qualify for
publicly funded care. By the late twentieth century, home aide was one
of the fastest growing occupations in America; yet the occupation had no
clear-cut employer, common workplace, or recognition under the nation's
primary labor law, the Fair Labor Standards Act (FLSA).[4]
Page: 1 | 2 | 3 | 4
Next page
|
