As Congress gins up its attack on women’s health services, another issue that affects the welfare of women has been getting far less attention. Caregiving in America is a female occupation. Most family caregivers are women — and they constitute 90 percent of paid workers who provide home health services.
Many people do not realize that those who provide home care are not guaranteed the same right to a 40-hour week under the Fair Labor Standards Act as most other workers. Since 1974, home-care aides have been subject to the “companionship exemption,” which deemed “companions to the elderly and infirm” to be much like teenage babysitters: casual laborers who did not need to earn a living wage to support a family.
Today, however, home care is one of America’s fastest-growing industries. Revenue reached $84 billion last year, according to census data. Nearly 2 million women, half of whom are women of color, provide support and assistance to elders with chronic illnesses and people with disabilities who wish to continue living independently. The services they provide — including bathing, dressing and assisting with toilet use — require skill and compassion. For many women, providing these services is a calling — but it is also a job. Their paychecks are essential in supporting their own families.
Efforts to narrow the companionship exemption have failed in the face of strong opposition from industry lobbyists and fears that higher wages will make some services unaffordable. Caregiving, like other forms of domestic service, has traditionally been considered less important than jobs done by white men. This was the logic that initially excluded home-care workers and many other types of workers from Social Security coverage. It is the logic behind a statement made in February by Gale Bohling, the director of government relations for the National Private Duty Association, an industry trade group. Referring to home-care aides who provide life-giving services to millions of Americans, Bohling said, “They’re kind of like superstars. For them, this really isn’t a job; it’s a lifestyle.”
The idea that domestic work is not “real work” has kept wages low for all types of “women’s work.” For home-care workers, the average wage is $9.40 an hour. Annual incomes average $16,600, the Paraprofessional Healthcare Institute has calculated, based on hourly wage data from the Bureau of Labor Statistics. Many workers are unable to find full-time employment. About 50 percent of home-care workers live in households that rely on public benefits such as food stamps and Medicaid to make ends meet. A third of these workers lack health insurance coverage.
Extending minimum wage and overtime protections to home-care workers is another step in America’s progress toward ending gender and racial discrimination. But fairness is not the only reason to make this change. Given the growth of the elderly as a share of the population, demand for home health-care workers is projected to increase rapidly in the next two decades.
Today, excessively high turnover rates plague the industry. Annual turnover of 50 to 60 percent costs the industry about $2 billion, money that could otherwise go to improving wages, training and workplace supports. Moreover, high turnover undermines quality of care, as clients try to cope with a revolving door of caregivers.
Lack of access to quality care imposes real costs on society. Research published last year by AARP shows that family caregivers suffer high levels of stress and ill health. They often lose significant income during the years they are helping elderly parents, and they use up their savings, making their own retirements uncertain. Workers with substantial caregiving responsibilities are also less productive on the job.
Recent debates in Congress over birth control and women’s health make it seem as if our representatives think that women should simply leave the workforce to care for their children and aging parents. But that isn’t going to happen. Americans are two-income families out of necessity. The country needs a national solution that helps us all meet our family responsibilities. That includes building a skilled, stable workforce by treating caregiving as real work and paying those who provide these services a living wage.