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The Future Of Home Health Care

In this Thursday, April 23, 2020 photo, Ruth Caballero, a nurse with The Visiting Nurse Service of New York, puts on personal protective equipment before entering a patient's apartment as she makes her rounds in upper Manhattan in New York. (John Minchillo/AP Photo)
In this Thursday, April 23, 2020 photo, Ruth Caballero, a nurse with The Visiting Nurse Service of New York, puts on personal protective equipment before entering a patient's apartment as she makes her rounds in upper Manhattan in New York. (John Minchillo/AP Photo)

We look at the experience of domestic and home health care workers who are among the most vulnerable during the pandemic.


Linda Walton, domestic worker in Atlanta, Georgia. Member of We Dream in Black, an organization advocating for the rights of home health care workers.

Ai-jen Poo, co-founder and executive director of the National Domestic Workers Alliance. (@aijenpoo)

Rep. Ro Khanna, he represents California’s 17th Congressional District. Co-author of the “Essential Workers Bill of Rights” proposal. (@RoKhanna)

Interview Highlights

Who falls under the “domestic worker” umbrella?

Ai-jen Poo: “Domestic workers are the nannies who take care of our children, and the cleaners who maintain sanity and order in our homes, and the home care workers who take care of our loved ones with disabilities, make sure that they can live independently, our aging parents, our loved ones with chronic illnesses. Anyone who does caregiving and cleaning services in the private home setting — and its vast majority women, more than 92 percent women and disproportionately black women and other immigrant women of color — and it’s work that has always been devalued. Linda talked about a long history of exclusion from basic rights and protections in the labor laws, dating back to the New Deal. And so there’s the legal exclusion from fairness and protection in the workplace, and then there’s a cultural devaluing. This work has always been associated with work that women do in terms of caregiving and cleaning. And as a profession, it’s always been associated with black women, women of color. And we don’t even refer to it as real work. We still refer to it as ‘help.’ And so the basic recognition that this is a profession for millions of women is something we’re still fighting for. And not only is it a profession, but it turns out it’s essential.”

On the history of domestic work’s devaluation, and its roots in slavery

Linda Walton: “The type of work that we do, domestic work, it came out of slavery and it came out of black women in the south providing domestic work for white families. And when the New Deal came along in the ‘30s, we were cut out of any type of worker type job security, benefits, things of that nature. Some of those Southern politicians — part of the New Deal was, you know, we don’t want those types of benefits for the domestic work, it wasn’t considered like a valued occupation or service, in terms of it being work. So we’re still to this day trying to make our profession valued and have these basic worker rights that all Americans have, common for us. So, it’s valued work; however, we have to make it valued in the eyes of society, because we know that the baby boomers are aging and we know that if they need our services, we also have to have basic job security.”

On the taxing, under-appreciated labor of home care work

Linda Walton: “I want people to understand that this is a calling. You have to have an empathy, a compassion, a love for a human being across the board to be a caregiverbecause you’re loving people and you’re caring for people that aren’t related to you. However you’re providing the best care — you’re a counselor, you’re a nurse, you’re a doctor. You’re all of these things rolled into one in someone else’s home. And it’s not for everyone. And you do spend a lot of your time with people who aren’t your family members, and you give your all. And I think with that, a lot of people kind of confuse it with, OK, you’re that type of person, you’re a nurturer, you’re a giver, you’re one of those people. And with that, they kind of feel like, okay, it’s free, it’s natural. It’s what you do. However, it’s our employment. This is how we provide for our families. This is us being away from our families. This is us having to work a lot of hours, because we’re not paid really great wages, to do this type of work. However, we want to be treated and we want to be compensated well for what we do, because we’re on the front line and we’re caring for your loved ones. And I want everyone to understand thatwe’re not asking for a handout. We’re not asking for people to feel sorry for us. What we want to be recognized and respected. And in doing so, we have basic rights, just like any other workers in America.”

On why home health care workers are essential

Ai-jen Poo: “Every single day in this country, 10,000 people turn 70 as the boomers age. And people are living longer than ever before because of advances in health care and medicine and technology. And sowe’ve essentially added an entire generation onto our life span, but we have none of the support and infrastructure and policy in place to really make sure that that generation can live well and with dignity and get the care that they need.And workers like Linda, workers like the home care worker who’s supporting Debbie, they are the human infrastructure that will enable a dignified quality of life for the older population in this country that is growing exponentially right now. What Debbie described in terms of that work and the texture of it, the intimacy of it — there are people like Linda who are incredible caregivers, but we lose many of them to other industries, other low-wage service industries like fast food and retail, because they cannot feed their families on the wages that they earn, literally cannot pay the bills. And sowe have got to figure out how we invest in transforming these jobs into living wage jobs with benefits and real economic security for them, and really for all of us.”

On treating domestic care jobs as essential public infrastructure

Ai-jen Poo: “I think that care is a public good, and we should be investing in it as a public good. And that we should really think about care as infrastructure for the 21st century. If we think about infrastructure as that which enables commerce and everything else in our lives to happen — roadways, transportation. And what could be more fundamental to our society and our economy functioning than care. If you think about home care jobs alone, investing in home care jobs and making them living-wage jobs with benefits — if our goal coming out of the pandemic is to get America back to work again, making care jobs, living wage jobs with benefits not only benefits those workers and their families, butthese are job-enabling jobs. They make it possible for Debbie to go to work and for so many other Americans to get back to work.So if we were to invest public dollars anywhere — if we can make 500 billion dollars in corporate giveaways happen — we can make home care jobs good jobs with benefits. And I think we should invest in that as a public good.”

On why political leadership is needed to bolster and protect domestic workers’ rights

Ai-jen Poo: “I think that domestic workers have been really at the forefront of what has been an epidemic of low-wage work that has been spreading over the last decades.And, you know, it’s always been a low-wage and insecure job: There’s no safety net, no paid time off for domestic workers. And increasingly, when you look around, more and more American jobs are just as insecure without job security, without access to a safety net, without pay time off and very low wages. Millions of people are working incredibly hard and still can’t make ends meet. And we have been in denial about that, or something. We haven’t had political leadership on transforming low-wage work. Andit really did take a pandemic to help us start to see how many of those low wage jobs that have been invisible to us are actually essential. They have been keeping us safe. And they’ve been keeping this country moving forward in the midst of crisis.”

On what legislation protecting domestic workers’ rights could look like

Rep. Ro Khanna: “Simply put, it’s about the dignity of people who are doing vital work. We now know in the COVID crisis who is most essential. It’s not the lawyers. It’s not bankers. It’s not members of Congress. It’s people who are bringing us or groceries, picking up the trash, making sure we have electricity. Well, those workers deserve fair pay. They’re taking risks with their lives. They deserve hazard pay. They deserve PPE protections. When I go to vote in Congress, I get a mask. I get gloves that are provided to me. Why can’t every worker have that basic protection? They deserve to be consulted about what workplace safety looks like. There should be a standard about airborne pathogens. I mean, partly, government does have a standard requiring businesses to regulate airborne pathogens. And these workers should be able to have bargaining rights and organizing rights. That, in a nutshell, is what theEssential Worker Bill of Rightsdoes…

“[Domestic workers] absolutely would be included in that. Of course, they are essential, too. I mean, they are taking care of people’s kids. They’re taking care of people who are sick. They’re taking care of the elderly. They deserve fair pay. They deserve to have child care. I mean, many of these individuals are raising two families. They’re raising their own families, and then they’re raising the families of people who they’re helping. They should have childcare and they all should have health care. I mean, how you can have a pandemic and not provide people with health care is unconscionable. I think there is an opportunity. Our society is awake to the fact that these workers are critical. There’s 60 million Americans who are doing physical labor in a digital age. And for so long, we’ve ignored those workers. We’ve taken them for granted. Now we realize their value, and we need to deliver on what they deserve.”

From The Reading List

New York Times: “Opinion: The Future of Work Isn’t What People Think It Is” — “The stories we used to tell about work went something like this: The protagonist, a white man wearing a hard hat, has a stable job in manufacturing or construction that allows him to buy a home and work toward a comfortable retirement.”

Business Times: “Covid-19 has opened a new chapter for America’s workforce” — “The stories we used to tell about work went something like this: The protagonist, a white man wearing a hard hat, has a stable job in manufacturing or construction that allows him to buy a home and work towards a comfortable retirement.”

New York Review Of Books: “Who Cares? Now, All of Us Must” — “I came to realize in a series of waves the enormous impact this pandemic would have on the domestic workforce.”

WHYY: “Is the future of elder care at home?” — “John Stagliano never was much of a hospital guy.”

CNBC: “Home health-care workers in US at tipping point amid coronavirus outbreak” — “The nation’s 3.3 million home health-care workers are the other front-line heroes in the war against the coronavirus.”

Washington Post: “A new economic austerity could be ‘as life-threatening as the virus itself,’ says head of the National Domestic Workers Alliance” — “… The number of people who are recognizing caregivers and grocery workers for the first time is a transformative shift in our culture.”

Fast Company: “How COVID-19 has given the labor movement new urgency” — “We work with the workforce that provides caregiving and cleaning services in the home—so the nannies, the house cleaners, the home care workers who are caring for the aging or supporting people with disabilities, and a lot of people with chronic illnesses, too, who are staying at home.”

This article was originally published on WBUR.org.

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