Category Archives: Home Health Workers

SPOTLIGHT: Aging States

Source: Capitol Ideas, November/December 2016

Articles include:
Facing a wave of aging baby boomers, many states are trying to make it easier for seniors to stay in their homes—as many prefer—instead of moving into more costly nursing homes. With high stakes for state budgets, many states are undertaking long-term planning to pay for long-term care.

What is the best state for retirement? It’s a popular question among baby boomers, who increasingly seek more livable communities that will allow them to age in place. How are states responding? Drawing from an AARP scorecard on state long-term services and supports, here’s a look at top states for retirement and aging.

For many seniors, staying active in their golden years depends on staying mobile. But in many states and communities, transportation systems haven’t been developed with seniors or individuals with disabilities in mind. That’s changing as states are taking steps to improve transportation mobility for older adults.

Elder financial abuse costs older Americans $2.9 billion per year, but the harm to seniors caused by fraud often extends far beyond the checkbook. Oregon Attorney General Ellen Rosenblum shares key steps her state has taken to strengthen elder abuse prevention and response.

When state leaders discuss the fiscal challenges of an aging population, the focus is often on costs for senior services. However, as CSG Senior Fellows Katherine Barrett and Richard Greene point out, declining tax revenues are also a concern.

Client history and violence on direct care workers in the home care setting

Source: Ha Do Byon, Carla Storr, Lori Edwards and Jane Lipscomb, American Journal of Industrial Medicine, Volume 59 Issue 12, December 2016
(subscription required)

From the abstract:
Background: Health care workers providing home care are frequently unaware of their client’s history of violence or mental illness/substance abuse disorder, recognized risk factors for workplace violence. This study estimated the associations between these factors and experiencing client violence among direct care workers in the home settings (DCWHs).

Methods: Acts and threats of violence were estimated using data from an anonymous survey among DCWHs (n = 876) working at two large home care agencies. Logistic regressions were performed to produce odds ratios.

Results: Physical acts and physical or verbal threats of client violence were associated with providing homecare to clients with a violence history (adjusted ORs = 6.60 and 10.78, respectively), whereas threats of client violence (adjusted OR = 5.80) were associated with caring for clients with a mental illness/substance abuse disorder.

Conclusions: Policy and practices that support the communication of appropriate client risk information may reduce the likelihood of workplace violence among DCWHs.

Families Caring for an Aging America

Source: Richard Schulz and Jill Eden, Editors; National Academies of Sciences, Engineering, and Medicine; Committee on Family Caregiving for Older Adults; Board on Health Care Services; Health and Medicine Division, 2016

From the abstract:
At least 17.7 million individuals in the United States are providing care and support to an older parent, spouse, friend, or neighbor who needs help because of a limitation in their physical, mental, or cognitive functioning. The circumstances of individual caregivers are extremely varied. They may live with, nearby, or far away from the person receiving care. The care they provide may be episodic, daily, occasional, or of short or long duration. The caregiver may help with household tasks or self-care activities, such as getting in and out of bed, bathing, dressing, eating, or toileting, or may provide complex medical care tasks, such as managing medications and giving injections. The older adult may have dementia and require a caregiver’s constant supervision. Or, the caregiver may be responsible for all of these activities. With support from 15 sponsors, the National Academies of Sciences, Engineering, and Medicine convened an expert committee to examine what is known about the nation’s family caregivers of older adults and to recommend policies to address their needs and help to minimize the barriers they encounter in acting on behalf of an older adult. The resulting report, Families Caring for an Aging America, provides an overview of the prevalence and nature of family caregiving of older adults as well as its personal impact on caregivers’ health, economic security, and overall well-being. The report also examines the available evidence on the effectiveness of programs and interventions designed to support family caregivers. It concludes with recommendations for developing a national strategy to effectively engage and support them.
Report in Brief (PDF)
Recommendations (PDF)
Press Release (HTML)

Long-Term Care Workforce: Better Information Needed on Nursing Assistants, Home Health Aides, and Other Direct Care Workers

Source: U.S. Government Accountability Office (GAO), GAO-16-718, August 16, 2016

From the summary:
Federal data sources provide a broad picture of direct care workers—nursing assistants and home health, psychiatric, and personal care aides—who provide long-term services and supports (LTSS), but limitations and gaps affect the data’s usefulness for workforce planning. Some states have collected data in areas where federal data are limited, but these have been one-time studies. Federal data show that direct care workers who provide LTSS numbered an estimated 3.27 million in 2014, or 20.8 percent of the nation’s health workforce. Federal data show that wages for direct care workers, while differing by occupation, are generally low, averaging between approximately $10 and $13 per hour in 2015. However it is unclear to what extent these wage data include direct care workers employed directly by the individuals for whom they care. The number of these workers, often referred to as independent providers, is believed to be significant and growing. Some states, in coordination with the federal government or on their own, have conducted studies about direct care workers and collected detailed information. These studies showed that a majority of independent providers worked for a family member or someone else they knew.

Caregiving Crisis Highlighted in PHI Fact Sheets

Source: Paraprofessional Healthcare Institute (PHI), September 6, 2016

From the blog post:
Two fact sheets from PHI highlight the low wages, high injury rates, and high demand that characterize nursing assistant and home care aide jobs, two occupations at the center of the U.S. caregiving crisis: – U.S. Home Care Workers: Key Facts
U.S. Nursing Assistants Employed in Nursing Homes

Key Facts Among the findings:
– 633,000 additional home care workers are needed by 2024, more new jobs than any other occupation in the U.S. economy.
– Low wages, limited work hours, and low annual earnings cause one in four home care workers to live in poverty, compared to one in ten U.S. workers.
– This high poverty rate means one in two home care workers relies on some form of public assistance, such as food stamps, Medicaid, or cash assistance.
– Nursing assistants are more than three times as likely to be injured on the job than the average U.S. worker.
– Due primarily to poor job quality, 52 percent of nursing assistants leave their jobs each year, and 50,000 nursing assistant positions nationwide cannot be filled.
The fact sheets, which provide comprehensive analyses on workforce demographics, size and composition, job quality indicators, and employment projections, will be released on an annual basis.

New Business Models Demand New Forms of Worker Organizing

Source: Ai-jen Poo, Palak Shah, New Labor Forum, Vol. 25 no. 3, September 2016
(subscription required)

We welcome the opportunity to discuss the merits of the Good Work Code (GWC) and engage with Jay Youngdahl’s critique. As we read it, Youngdahl poses three main objections to the GWC: (1) the values framework articulated is aspirational and unenforceable, (2) it “greedwashes” companies engaged in bad labor practices, and (3) it is based on the notion that “Good Capitalism” can be mobilized to solve the problem of worker exploitation. In the course of his critique, Youngdahl also targets what he calls the “Philanthropic Labor Movement,” that is, those of us with the temerity to organize workers outside the frame of traditional labor unions.

Digital technology and on-demand hiring platforms are rapidly transforming how workers engage with various sectors of the labor market and their terms and conditions of work. Domestic work is among the many occupations affected by new technology. Increasingly, workers and employers are matched online for child care and elder care jobs through companies like, and the on-demand economy has penetrated the housecleaning market through companies like Handy and TaskRabbit.

National Domestic Workers Alliance (NDWA) turned its attention to Silicon Valley not because, as Youngdahl implies, we were bedazzled by the bright, shiny objects dangled by tech companies, but because, the fact is, these models are transforming labor markets. Increasing numbers of domestic workers, and other low-wage workers, access work through these companies. This phenomenon is in its infancy, and our expectation is that it will grow. We believe these workers deserve the best wages and conditions of labor. We assume that Youngdahl agrees with us, at least on this point.

The labor movement is still in the early stages of determining how best to meet the multiple challenges posed by companies that aggregate and deploy workers through digital platforms. Mechanisms for exploiting labor are proliferating and changing far more rapidly than our capacity to organize workers and represent their interests. Tech companies are building new business models, often creating ever more precarious conditions of life and labor, lowering wage floors and job quality. …. At the same time, those who follow the gig economy know that it has been tech companies, not unions or labor advocates, driving the national conversation. By releasing a simple values framework, we have successfully inserted the demands and voices of workers into a narrative dominated by tech companies, with the intention of creating space for a conversation about what better employment practices could look like in the digital economy…..

Underpaid, unpaid, unseen, unheard and unhappy? Care work in the context of constraint

Source: Donna Baines, Sara Charlesworth, Tamara Daly, Journal of Industrial Relations (JIR), Vol. 58 no. 4, September 2016
(subscription required)

From the abstract:
Care work – in its paid and unpaid forms – spans the private, public and non-profit sectors in addition to being an essential underpinning of home and community life (Duffy et al., 2015). Due to its close association with gendered expectations of elastic, uncomplaining work undertaken by women across the continuum of home, community and residential places, care work continues to be undervalued in numerous ways (Baines, 2004; England, 2005; Folbre, 2008). Indeed, care workers often work in conditions in which they are underpaid, unpaid, unseen, unheard and unhappy (Daly and Szebehely, 2012; Palmer and Eveline, 2012). These conditions are related to government austerity models; how care work is regulated within employment relations; state, market and private roles providing and funding care; and how care work organisation is shifting in the context of austerity strategies, policies of constraint, continued high demand, decreased union density and increasing standardisation.

These conditions and the women who work within them and around them are the focus of this Special Issue: Care Work in the Context of Constraint. The Special Issue draws together international researchers and scholars in a close investigation of the complexity of care work in the era of austerity policies.
Government bodies that fund care work have been under increasing pressure to cut costs, expand accountability and contribute to austerity agendas (Brennan et al., 2012; Cunningham et al., 2014; Grimshaw and Rubery, 2012). This impacts at the level of care organisations in the form of decreased financial resources and increased obligations to provide documentary and statistical evidence of the care provided to service users…..

The community dimensions of union renewal: racialized and caring relations in personal support services

Source: Louise Birdsell Bauer, Cynthia Cranford, Work Employment & Society, Published online before print July 20, 2016
(subscription required)

From the abstract:
Union renewal research calls for moving beyond broad terms, like community unionism, to specify how social relations of work shape renewal for different workers, sectors and contexts. Analysis of interviews with union officials and union members in publicly funded, in-home personal support reveal two community dimensions: both caring and racialized relations between workers and service recipients. Scholarship on care workers emphasizes empathy and coalition with service recipients as a key aspect of union renewal, yet says little about racialized tensions. Studies of domestic workers emphasize organizing in response to racialization, but provide little insight into caring social relations at work. This article develops arguments that both positive and negative worker–recipient relations shape union organizing and representation in the service sector by specifying the ways in which racialization contributes to this dynamic. It suggests that anti-racist organizing at work, alongside coalition building and collective bargaining, are important renewal strategies for this sector.

Disability Rights and Labor: Is This Conflict Really Necessary?

Source: Samuel R. Bagenstos, University of Michigan Law School, Public Law Research Paper No. 509, June 15, 2016

From the abstract:
The relationship between the American labor movement and identity-based social movements has long been a complicated one. Organized labor has often been an ally of civil rights struggles, and major civil rights leaders have often supported the claims and campaigns of organized labor. Recall the reason Dr. Martin Luther King was in Memphis on the day he was assassinated — to lend his support to a strike by unionized sanitation workers. But unions and civil rights groups have found themselves on the opposite sides of intense battles as well. The relationship between the labor movement and the disability rights movement is just as complicated. Organized labor has often been an ally of disability rights efforts. But in some of the highest stakes battles for workers and individuals with disabilities, many unions and disability rights groups have opposed each other. Although many commentators have written about the tensions and collaborations between labor unions and civil rights groups promoting race or sex equality, the very similar dynamics of the relationship between unions and disability rights groups have largely escaped comment.

In the past several years, though, the tensions in the labor-disability relationship have become especially acute. As unions (particularly the Service Employees International Union) have pushed for increased wages and benefits for direct-care workers who provide home and community-based services, and state Medicaid cuts have placed pressure on the budgets available to pay those workers, many disability rights activists have worried that labor’s agenda will lead to the (re-)institutionalization of people with disabilities. This tension stood in the background of the litigation in Harris v. Quinn, in which the Supreme Court addressed the collective bargaining system some states had set up for personal-assistance workers. And the dispute between unions and (some) disability rights activists broke out in a particularly sharp and nasty way in response to the Department of Labor’s recent rules expanding Fair Labor Standards Act protections for home care workers. Although some disability rights groups supported the new rules, which had been a major priority of organized labor, particularly vocal and influential activist groups opposed them. These tensions are nothing new. Disability rights activists have long challenged the paternalism of those assigned to “help” or “care” for them, and the unions that represent those workers are thus a natural target for suspicion if not antagonism. And many (though not all) elements of the American labor movement have strongly opposed the deinstitutionalization of people with mental disabilities. The current labor-disability tensions cannot be understood outside of the context of that history.

This essay, which was presented as the Stewart Lecture on Labor and Employment Law at the Indiana University Maurer School of Law in April 2016, attempts to do two things. First, it puts the current labor-disability controversy into that broader context. Second, and perhaps more important, it takes a position on how disability rights advocates should approach both the current controversy and labor-disability tensions more broadly. As to the narrow dispute over wage-and-hour protections for personal-assistance workers, this essay argues both that those workers have a compelling normative claim to full FLSA protection — a claim that disability rights advocates should recognize — and that supporting the claim of those workers is pragmatically in the best interests of the disability rights movement. As to the broader tensions, the essay argues that disability rights advocates go wrong, both normatively and pragmatically, in treating the interests of individuals with disabilities as inevitably superordinate to those of individuals who do the work of providing community-based services and supports. Although this wrong turn is completely understandable in light of the history of paternalist subordination of people with disabilities at the hands of the helping professions, today’s situation calls for an accommodation of the legitimate claims of each side.