Caring

San Francisco In-Home Supportive Services (IHSS) Public Authority  held an information meeting to discuss IHSS program changes.  As a result of IHSS workers’ successful fight against Governor Brown’s proposal to cap IHSS worker hours to 40 hours per week to avoid paying overtime, the State Budget included pay for IHSS overtime, travel time and wait time starting January 1, 2015.   In addition, Governor Brown’s proposed budget includes restoration of the 7% cut to IHSS hours effective July 1, 2015.  However, at this January 21 meeting, it was announced that California IHSS Program will not pay overtime, travel, or wait time due to recent U.S. District Court decisions. . . and after it printed six million new timesheets!

On September 17, 2013, the U.S. Department of Labor (DOL) announced a final rule extending the Fair Labor Standards Act (FLSA)'s minimum wage and overtime protections to most workers who provide home care assistance to elderly people and people with illnesses, injuries or disabilities.  Set to take effect January 1, 2015, DOL’s proposed changes would have extended FLSA protections to more than two million home care workers by 1) eliminating the companionship exemption for home care workers employed by third-party agencies, and 2) limiting the definition of “companionship” to providing fellowship and protection, with “care” services limited to no more than 20% of hours worked per week. 

With a Little Help From My Friends:  On a sunny Saturday morning, joined Beatles Choir led by Christie Chew of City Church San Francisco for the past five years to provide monthly musical companionship to residents at Laguna Honda Hospital and Rehabilitation Center.  We met in the lobby to introduce ourselves, receive Beatles Choir Lyrics booklets and rehearse for our tour of three “neighborhoods” (home to maximum 60 residents each who live in four 15-person “households”).

We practice choreography for Here Comes the Sun: raise hands for “sun, sun, sun, here it comes“ and then lower bodies for “I see the ice is slowly melting.”

However, two U.S. District Court rulings on December 22, 2014 and January 14, 2015 vacated DOL’s Home Care Rule, finding DOL was “trying to do through regulation what must be done through legislation.”  While home care agencies challenged DOL’s rule to maintain the affordability of home care services, DOL disagreed with the Court’s orders, stating: “We believe the Rule is legally sound and is the right policy—both for those employees, whose demanding work merits these fundamental wage guarantees, and for recipients of services, who deserve a stable and professional workforce allowing them to remain in their homes and communities.”  DOL is considering “legal options” including appeal.

With this recent setback for IHSS workers, I decided to re-visit a gerontology class paper I wrote two years ago about the campaign for Domestic Worker Bill of Rights, which California Governor Brown signed into law (though it does not cover IHSS workers) just nine days after DOL announced its Home Care Rule.  

Ob-la-di, Ob-la-da got a bird sing-ing-a-long “life goes on, brah!”

Domestic Worker Rights and Implications for Aging in Place

Most people wish to remain in their own homes (“age in place”), and view nursing home placement as a last resort option.  In the absence of informal care by family and friends, domestic workers provide formal in-home care to seniors who need assistance with activities of daily living so they can age in place. 

I Wanna Hold Your Hand (with permission):  “And when I touch you, I feel happy inside”

Government Policies Relating to Formal In-home Care

As supplements or substitutes for informal caregivers, domestic workers make possible middle-class women’s “liberation” from unpaid housework and caregiving, which are often outsourced to racial minority and immigrant women in mostly low-paying in-home care jobs.  Due to its historical roots in slavery and association with women’s unpaid labor, domestic work is undervalued and underpaid.  Further, domestic workers are marginalized by deliberate government policies, often criticized as rooted in gender and race discrimination, which exclude them from labor protections that apply to other occupations and workplaces.

Yellow Submarine:  “As we live a life of ease, Every one of us has all we need, 

Sky of blue, and sea of green, in our yellow submarine”

Since colonial times in the United States, domestic work was performed by enslaved, indentured and semi-free female laborers.  Since the 19^th century, domestic work offered opportunities for paid work by Black and new immigrant women.  “Visiting homemakers” emerged in the Great Depression as work relief for unemployed Black women who previously worked as domestic servants and as an alternative to fiscally strained public hospitals.  As such, they were ignored as an occupation: the New Deal Congress (Southern politicians seeking to maintain an inexpensive supply of Black labor) excluded domestic workers from coverage for Social Security (until 1951), collective bargaining (National Labor Relations Act of 1936), minimum wages and other labor standards.  In 1974, the Fair Labor Standards Act of 1938 was amended to include domestic workers, but exempted companionship from coverage (U.S. Supreme Court affirmed this exclusion in 2007 for workers who provided home companionship services through a third party) and live-in workers from overtime provisions.

The Occupational Safety and Health Act specifically excludes domestic workers.  Other federal laws exclude most domestic workers on a de facto basis, because they only apply to employers with multiple employees:

• Title VII of Civil Rights Act of 1964 and Americans with Disabilities Act: at least 15 employees
• Age Discrimination in Employment Act: at least 20 employees
• Family and Medical Leave Act: at least 50 employees

Policymakers have been reluctant to extend labor protections to domestic workers for performing care work, based on the presumption that women would always be willing to provide care and companionship for loved ones.  Caregivers may develop emotional attachment to those they care for, which reduces their bargaining power, as the lack of boundaries leads to working around the clock beyond paid hours.

Hey Jude:  “Take a sad song and make it better!”

“Care Crisis”:  Growing Demand for yet Shortage of Domestic Workers

         

Demand for home care is expected to rise faster than institution-based care.  The unprecedented increase in our older population, as the baby boom generation ages with chronic conditions and prefers to age in place, has translated into an increased demand for domestic workers.  Long-term care policies focused primarily on protecting the consumer, but paying little attention on protecting domestic workers, have not helped the recruitment and retention of these workers. 

All You Need is Love is affirming: “There's nothing you can do that can't be done”

Instead, the low pay, poor working conditions and challenges of caring for clients, who are increasingly more sick and disabled, have contributed to a “care crisis” due to high turnover and vacancy rates among domestic workers.  Men, in particular, are not attracted to domestic work because of the low wages paid and cultural stereotypes of women’s work.  About 25% of home aides make less than the federal minimum wage, and about 40% rely on public assistance, such as Medicaid and food stamps. 

         

A survey of domestic workers in the San Francisco Bay Area 

revealed the following work conditions: the majority work to provide support for their families, yet their wages are not sufficient to meet family living expenses; 90% of workers did not receive overtime pay when they worked overtime; over 80% did not receive paid rest and meal breaks; and the majority are exposed to health and safety hazards (exposure to toxic cleaning chemicals, risk of injury).

As the demand for in-home care rises in response to our growing older population that wishes to age in place, policy change is needed to improve the recruitment and retention of domestic workers.  The wages and working conditions of domestic workers are directly related to the quality and availability of care.  Problems with attracting and retaining domestic workers may translate to disruptions in continuity of care, and overworked and frustrated workers may be more likely to physically or emotionally abuse home care clients or become victims of abuse from underserved clients.   

Art with Elders, a program of Elder Givers Connecting the Generations: 

Do you hear me, me, me, me painting

  

Proposed Solutions

Advocates propose interventions to address power imbalances and discriminatory policies.  One model is California’s consumer-directed home care services.  Created in 1973, In-Home Supportive Services (IHSS) developed out of previous attendant and homemaker programs that often employed those on welfare to care for others on public assistance.  A coalition of labor, seniors and disability advocates got state legislation authorizing counties to create public authorities to run the state’s IHSS program as employers of record for homecare workers, while consumers retained power to hire, fire and supervise them.  Next, they passed local ordinances to set up public authorities in each county that paved the way for union recognition and collective bargaining.  In 1995, the San Francisco Public Authority was created, and IHSS workers unionized (Service Employees International Union) to get better pay and working conditions, which helped get better qualified and more reliable caregivers devoted to the elderly and persons with disabilities who share similar low-income class, and often the same gender and race as many hire their own relatives.

Yet, working conditions for domestic workers cannot be improved by merely shifting their location from the private market to the public sector, but we need to challenge policies that sustain low wages and poor working conditions.  Assemblyman Tom Ammiano advocated for a California Domestic Worker Bill of Rights to address discriminatory policies that have sustained low wages and poor working conditions for domestic workers.

Visited Laguna Honda’s farm animals after completing Free Memory Screening based on Brief Alzheimer Screen Test, which included naming as many animals in 30 seconds time:  pig, turkey, duck, goat, sheep, goat, rabbit, etc.

California Domestic Worker Bill of Rights

In 2012, California Governor Jerry Brown vetoed California Domestic Worker Bill of Rights (Assembly Bill 889), based on paternalistic concerns that requiring overtime and rest/meal breaks to domestic workers might result in 1) increased costs beyond the financial capacity of the elderly and disabled to the point of “forcing people out of their homes and into licensed institutions,” and 2) fewer jobs, less hours and flexibility for domestic workers. 

In 2013, Assemblyman Tom Ammiano introduced a revised California Domestic Worker Bill of Rights (Assembly Bill 241), with the following six provisions for improving work conditions to promote the welfare of both domestic workers (except IHSS workers) and those under their care:  1) overtime pay, 2) meal and rest breaks, 3) workers compensation, 4) uninterrupted sleep provisions (live-in), 5) use of kitchen facilities, and 6) paid days of rest.  On September 26, 2013, Governor Brown signed this Bill into law, which became effective January 1, 2014.

Gerald Heffernon’s sculpture, Rabbinoid on Cell Phone, at Laguna Honda

Ethical Principles

Magnificent Magnolias bloom inside 75-year-old San Francisco Botanical Garden, 

which has the most significant collection of magnolias outside of China

The ethical principles driving Domestic Worker Bill of Rights are beneficence, nonmaleficence and justice.  Beneficence comes into play because the bill attempts to do what is good for domestic workers and care recipients.  San Francisco Department of Public Health conducted a Health Impact Assessment of AB 889, finding that both domestic workers and care recipients would benefit from giving 24-hour or live-in caregivers the right to protected time to rest and recover.  Sufficient sleep would reduce risk of premature death, chronic disease and depression for caregivers, and ensure that caregivers are more alert and attentive to their client’s needs.  

Without this protection, sleep-deprived workers may be more prone to mistakes and accidents, potentially jeopardizing themselves and those under their care as well.  In addition, overtime pay provides a disincentive to employers scheduling workers for more than 8 hours a day or 40 hours a week, because long work hours are associated with increased stress, depression, high blood pressure and cardiovascular disease.  Thus, a related principle is nonmaleficence.  Justice also comes into play because it seems only fair to extend labor law protections already enjoyed by other California workers to cover over 200,000 domestic workers in California, who are 93% female, majority are women of color, 40% are immigrants and 22% are undocumented, earning just over the minimum wage and averaging less than $20,000 per year. 

 

Quality of care is affected when domestic workers do not reflect most of their older clients who are white.  One study noted that beneficial close relationships, akin to nurturing familial relationships, between domestic workers and older adults in their care are possible when they are the same gender and race, and relationships have continued for at least one year.  As status and power differentials are reduced, clients are satisfied with work performed, and workers feel valued as persons.

Power dynamics in domestic worker-older client relationships that resemble master-servant roles make workers less able to negotiate work conditions in private homes, where they are often isolated and invisible to the public, and thus vulnerable to exploitation in an unregulated industry.  When underpaid and overworked, they suffer burnout and lose commitment to remain in their jobs to the detriment of their older clients who need continuity of quality care.

Conclusion: Call to Action

To attract and retain a more stable and diverse group of domestic workers to provide continuity of care and gender/race preferences for our growing older population, we need policy change to recognize domestic workers worthy of labor protections enjoyed by other workers.  To date, only three states have adopted Domestic Worker Bill of Rights: New York (2010), Hawaii (2013) and California (2014). 

Domestic workers are the front-line caregivers who ensure that our growing elderly population with chronic conditions can continue to age in place at home.  Thus, there is an urgent need to address how we value both our elderly population and domestic workers. 

Ai-Jen Poo, lead organizer in New York’s Domestic Worker Bill of Rights campaign, co-director of Caring Across Generations and author of The Age of Dignity: Preparing for the Elder Boom in a Changing America, said, “It’s about respect and dignity, not for one group or another but for all of us as humans.” 

 Docent Joe Barbaccia holds magnolia sprengeri & stands in front of white zen magnolia