Who Cares for the Care Workers?

Who Cares for the Care Workers?

Care workers in the South—disproportionately black women—face limited worker protections and difficult working conditions. But they’re organizing to challenge that legacy.

December 21, 2018

The care worker’s lot is not an easy one. A typical care worker, says Priscilla Smith, a certified nursing assistant in Durham, North Carolina, must “hop from company to company just to make ends meet,” which generally includes caring for a handful of clients. “If you [care for] someone with a general disability, you may get an hour or two hours of work [a day] at the most, so then you have to find someone else,” she says. “And nine times out of 10 that person is not located in the same part of town [as the other], so it’s hard to make 40 hours [a week].”

The absence of adequate worker protections means that care workers may also have to “deal with the disrespect of the family [or] disrespect of the patient,” Smith relates. She has scrubbed baseboards and cleaned ovens because families of patients tell her to, though it’s not in her job duties. If she refuses, however, “they’ll tell you, ‘we can replace you.’”

“Respect,” sighs Smith, “is key in this job—and it’s lacking.”

As we’re speaking, Smith is interrupted by a soft knock at the door. “It must be the baby—hold on,” she says, and steps away from the phone for a moment. I can’t help but imagine that her care work doesn’t end when she comes home.


National Domestic Workers Alliance

Activists at the inaugural national We Dream in Black retreat

SINCE ITS INCEPTION IN 2007, the National Domestic Workers Alliance (NDWA) has endeavoredto change the idea that caring for people who need their help isn’t professional, valuable work. The Alliance has organized care workers in 17 states, and persuaded a number of solidly blue states to enact Domestic Workers Bills of Rights. 

Now, it’s specifically focusing on organizing black care workers across the country through an initiative called We Dream in Black.

We Dream in Black “aims to raise worker standards and really organize around the intersections of black domestic workers’ lives,” says Celeste Faison, who helped launch the program as director of black organizing at NDWA. We Dream in Black focuses on African American women workers specifically, because they make up such a large proportion of domestic workers, especially in the South (though We Dream in Black is active in non-Southern states as well, including Massachusetts and New York).

Last year, the NDWA and the Institute for Policy Studies (IPS) conducted citywide surveys of the domestic workers involved in We Dream in Black in Durham, North Carolina and Atlanta, Georgia, documenting their experiences, struggles, concerns—and their recommendations to make the work better. A new report based on the surveys tells the stories of a wide range of such workers, from nursing assistants, home health aides, companions, and caretakers to housecleaners and cooks. The vast majority of the women surveyed in Atlanta and Durham work primarily as care professionals. But as many of the women detailed, they are not always treated as the professionals they are. 

In Atlanta, nearly three-quarters of the 49 women surveyed reported earning less than $30,000 per year; in Durham, that number was 91 of the 101 women surveyed. Most domestic workers in both cities had job-related certifications or degrees, but the majority also reported that they worked without contracts or did not earn enough to cover their living expenses. As a result, the majority (82 percent in Atlanta and 59 percent in Durham) received public assistance like food stamps or Medicaid. Fifty-nine percent of Atlanta workers thought their pay was unfair—73 percent in Durham did.

As the elderly population rises and people live longer, the care economy continues to grow. Yet the average hourly wage across the country for a care worker is between $10 and $11, and in Georgia and North Carolina, it’s even less.

“We end up losing some of our best caregivers to fast food and retail, other jobs, because people cannot take care of their families and pay the bills doing this work,” says Ai-jen Poo, executive director of NDWA. Indeed, nearly a third of respondents said that they work other, non-domestic jobs to get by. “We have to revolutionize how we invest in caregivers if we’re to actually support the growing demand for care in America,” says Poo.

Care work represents “a piece of the economy that has been totally delegitimized and disrespected,” according to Marc Bayard, one of the authors of the report and the director of the Black Worker Initiative at IPS – and has been for a very long time. Domestic work at the turn of the twentieth century “was weighted with a long history of slavery, servitude, and racial oppression,” Premilla Nadasen, a professor of history at Barnard College, writes in the report. Domestic labor was one of the only occupations available to black women in this era, and according to Nadasen, “domestic service, in many ways, became emblematic of racial inequality.”

When the New Deal enacted a federal minimum wage and created Social Security benefits for workers in the 1930s, it explicitly excluded agricultural workers (disproportionately black men) and domestic workers (almost entirely women, and disproportionately black women). 

The vestiges of these policy choices lingered in worker policy for decades, and their effects are still felt today, where black workers are even more disproportionately represented in domestic work. Domestic workers remained fully excluded from the Fair Labor Standards Act (FLSA) for nearly 40 years, until 1974. 

Emerging from the wider Civil Rights movement, groups that organized domestic workers, like Dorothy Bolden’s National Domestic Workers’ Union, agitated for basic protections for domestic workers. The movement pressured policymakers to pass an amendment that would give most domestic workers the minimum wage and hour protections in the FLSA. But many domestic workers were still not covered—live-in workers were not given overtime protections and other groups of care workers, like home care aides, were totally excluded.

It wasn’t until 2013 that the Obama administration’s Department of Labor altered regulations to include home care workers in minimum wage and overtime protections—due chiefly to lobbying efforts from organizations like the NDWA. (Live-in domestic workers who are paid privately—that is, by their direct employer and not by a third-party caregiving company—continue to be excluded from overtime protections.)

Even now, job protections for domestic workers are limited (which has led to some states to pass their own worker protections for these workers). Benefits, obviously, are few and far between. Domestic workers do not have the right to a union and do not have protections under the Occupational Health and Safety Act. And even those laws that do provide protections are difficult to enforce, because domestic work is so isolated; many workers labor alone.

“You have a total disaggregation of the workplace,” explains Poo, “where you have millions of workplaces that are hidden … You could go into any neighborhood and apartment building and not know which homes are [also] workplaces.”

That isolation means that sometimes, “something happens”—say, a worker doesn’t receive her paycheck—“and you’re just stuck out there alone,” says Lurika Wynn, a care worker in Durham who is profiled in the report.

“There’s no HR department. There are no coworkers. There’s not a water cooler where you can go and commiserate with your colleagues,” Poo says. “You really do need to be empowered and incredibly courageous to assert your rights.”

Wynn has had back problems that began when she first started doing home care more than a decade ago. Her work since has inflamed those injuries—care workers routinely have to lift heavy patients to help them complete basic activities. She was working in a long-term care facility, but recently she was forced to leave work due to her health issues. 

Finding work “is like a shopping experience,” says Wynn. “You have to shop around for your rate of pay,” as well as for clients, she says, “[and] you’re not always going to get paid for your experience.” Wynn points out that many care workers make just the minimum wage—and sometimes, due to lack of enforcement, even less. 

The alternative to shopping around for clients is to work at a facility (for example, a nursing home), like the one where Wynn recently worked. That’s more stable, she says, as you can meet 40 hours a week—“but you have a bigger workload.”

And it can be a much bigger workload. Smith says that care workers at facilities, as opposed to those doing one-on-one home care work, may be taking care of 15 patients—all by themselves.

Ultimately, many care workers are paid through Medicaid—one reason why so many of those workers suffer from low wages. As Paul Osterman, who wrote Who Will Care For Us?, a book about the challenges facing workers like certified nursing assistants and home care aides, told PBS News Hour in August, “The financing system is a tremendous challenge. Medicaid has to compete with education and public safety for resources”—which places a limit to how much domestic workers can be paid with Medicaid funds. As such, many domestic workers are campaigning for this cap—and the amount of funds a caregiving company receives from the government—to be increased.


“THE RELEGATION OF CARE WORK TO THE MARGINS OF THE ECONOMY “WERE MISTAKES OF THE PAST,” says Bayard. “People need to understand the past to understand how to make policy changes.” 

A small number of states and cities have made such policy changes by passing “Domestic Worker Bills of Rights,” which entitle domestic workers to overtime pay, days off, breaks, sick leave, and wage protections. New York passed the first such bill of rights in 2010 after years of organizing from grassroots groups. Six other states—California, Connecticut, Hawaii, Illinois, Massachusetts, and Oregon—soon followed with their own comprehensive labor protection packages for domestic workers.

The Domestic Worker Bill of Rights in Seattle, passed in July, also created a standards board where workers, employers, and government representatives can meet to set additional workplace standards for these workers. Seattle was the first city to pass legislation protecting domestic worker rights.

In focusing now on Southern states, the NDWA is moving on to more challenging terrain. 


National Domestic Workers Alliance

Domestic workers and farmworkers lobby against sexual harassment on Capitol Hill during the Unstoppable Day of Action

THE ONGOING PLIGHT OF DOMESTIC WORKERS is due not only to the United States’ racist past (and present), but also everlasting ideas of women and labor. Domestic work, especially caring work, requires what have been thought of as feminized skills, and because so much of this is tied up with acts of care that are typically associated with love, this work is seen as priceless—that is, the work should be done for just a little more than for free. Domestic work was also excluded from the FLSA because work around the house and caring for people weren’t seen as contributing value. One economist writing in 1934 about the New Deal’s limits noted that, “domestic work … is not regarded as productive work in the current sense of the term.”

If it were regarded as real work, that would mean that all domestic labor—women’s work—could be seen as worthy of pay. Peter Brennan, Richard Nixon’s Labor Secretary, said as much when he testified before Congress in 1973 about the troublesome question of extending federal labor protections to domestic labor: “That means that you or I or we have to pay [the wife]. So we have to be very careful unless we are ready to do dishes.”

“Some people argue that care is rewarded less because women do it,” Nancy Folbre, professor emerita of economics at the University of Massachusetts at Amherst and director of its Program on Gender and Care Work, told the Prospect. She added that “while this may be part of the story, the other part is that women are socially pressured to provide care in part BECAUSE it is costly.” (Plus, it’s much more difficult to bargain with an employer when one’s job may be to explicitly care for that employer.)

Care workers often say that they are intrinsically motivated in their work—“You’re not there for the title and you’re definitely not there for the money,” Smith asserts. But that intrinsic motivation, however much it may mean that workers will provide quality work, muddies the monetaryvalue of the labor, at least in terms of the market. 

In arguing that “workers’ rights cannot be premised on the notion of care alone,” Nadasen, writing in Dissent, contends that care workers’ “love of their labor should have no bearing on their rights as a worker … Their work needs to be valued, not because they care about the customer, but because they are individuals who are trying to earn a living and getting the job done.”

It is common for domestic workers and their advocates to remind the public that this work “enables all other work.” You may encounter a care worker who must pay more than she can afford for her own child care in order to earn the minimum wage (or less) caring for some office worker’s children. 

And the complex and inconsistent handling of care work can even be exacerbated by policy, which is often discordant across state lines. Smith’s daughter is chronically ill, but in North Carolina, family members are expressly prohibited from caring for patients for pay. The policy depends on the state: if Smith and her family lived in South Carolina, Smith, as a CNA, could take on her daughter as a patient and receive pay. Yet, the state of North Carolina still expects family members to take care of patients. Smith described to the Prospecthow her daughter “could not walk from the kitchen to the living room,” without assistance, but because she can bend her legs, Smith said, the state ruled that her daughter did not qualify for a professional aide. 

So Smith took care of her daughter without pay, doing the same work she otherwise did for a paying client


TWO YEARS AGO, dealing with low pay, torn ligaments, and sexual harassment on the job, Wynn was waiting for a bus in Durham. At the bus terminal, an NDWA organizer approached her with a flyer about a group for black women domestic workers organizing for better working conditions. Wynn then sat in on one of the organization’s meetings. That was the first time she learned about We Dream in Black. 

“I’ve learned a lot from this organization,” Wynn says. “It really opened my eyes to a unity—a sisterhood.”

The goal for many of the workers is to win policies like the domestic worker bill of rights. In North Carolina, Faison says that We Dream in Black is campaigning for the state legislature to adopt a “wage pass-through” as a part of Medicaid, which would increase state Medicaid reimbursement to providers, with the purpose of raising care worker compensation. In Atlanta, the groups is also working to raise the standard for wages, but in a different manner: care workers are trying to convince the agencies that employ them to sign contracts with them—and if most agencies in a given community provide contracts with higher wages, others will be pressured to do the same. 

AP Photo/Richard Drew

Ai-Jen Poo, center, executive director of the National Domestic Workers Alliance, rallies with activists on the steps of New York's City Hall. 

As care workers are still not covered under the National Labor Relations Act and thus cannot bargain collectively, the NDWA focuses on getting commitments from employers (the Atlanta model) or getting legislation passed (as in North Carolina). The NDWA also provides its members with benefits, like vision and prescription discounts, as well as life insurance, to its members.

But We Dream in Black is also about the “sisterhood” that Wynn experienced. By providing solidarity and support, the organization is helping workers even though legislatures in the South are less likely to take workers’ demands seriously. We Dream in Black, says Smith, is “a platform to help other women not be afraid to share their stories.” She adds that We Dream in Black cuts through the isolating nature of the work, as “sharing your story can heal somebody else, because you never know when someone is going through the exact same thing as you.”

Most of the organizing work for We Dream in Black involves “being outside most of the day and finding black workers—because this work is invisiblized,” says Faison. Organizers approach women at bus stops, like the one where Wynn first learned about We Dream in Black, or may wait outside their workplaces. There are other ways to reach workers, too: Faison laughs as she tells me how one We Dream in Black organizer “was sneaking into nursing homes” to speak with care workers.

There are other ways We Dream in Black organizes, too. For instance—the joint report with IPS.

“We designed [the report] to be an organizing tool,” says Faison. We Dream in Black hosted storytelling workshops for the women who would be interviewed to help them learn how to best share their stories. The report, then, was also “a tool for leadership development,” Faison adds, since the organization is continually involved in developing new activist leaders.

This leadership was on display before the recent midterm elections. Care workers involved with the NDWA in Georgia “had one of the largest voter registration ground games,” in the state, Faison points out. They even provided child care at polling sites.

In the report, care workers provided a list of the changes they said their industry needed, in addition to the labor protections found in a Domestic Worker Bill of Rights. They cited expanding government investment in the public programs that fund home care services, which could enable them to earn higher pay. They also sought better enforcement of the labor standards already provided, the right to a union—and the respect that other caring professions receive. 

What does that respect look like? Many workers who serve the public good—like teachers and police officers—get assistance with housing, education and training, or even simply discounts at private companies. Care workers, the original caring profession, do not.

The request for respect has resonated widely. We Dream in Black is growing, now even outside of major cities. New chapters have sprung up across Georgia, in Macon, Savannah, and Douglassville.

Besides undoing the harm from generations of misguided policies and empowering domestic workers, the rising influence of We Dream in Black is also a signal, says Faison, to professionalize “an industry that has always deemed its workers as less-than.” 

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