From the summary:
….But home care workers’ hard-won victories could be undermined by a fundamental weakness in the structure of the home care industry: the industry’s pervasive outsourcing of employer responsibility for home care workers, combined with a lack of tools to hold employers accountable.
Few home care workers have a traditional employment relationship with one employer whom they can hold accountable for job standards. Instead, the key industry players that call the shots on worker pay have sought to distance themselves from their workforce. While the federal and state governments fund the vast majority of home care services through the Medicaid and Medicare programs, they largely rely on a host of poorly regulated private companies to hire and pay workers. And many private companies have attempted to evade responsibility by calling workers “independent contractors,” subcontracting out home care work, and using franchising schemes. As a result, home care workers may relate to multiple parties as they carry out their jobs, but can find no one to ultimately be responsible for raising wage standards or complying with workplace laws.
To turn these fastest-growing low-wage jobs into a stable profession, we must change course now and hold home care industry players responsible for both compliance with workplace laws and the quality of home care jobs. Given its power in the marketplace, the public sector must lead by attaching strong labor standards to public funding to ensure that additional money actually goes to the workers, and that publicly funded private employers comply with the law. And no matter what structure workers are employed in, they should be covered by basic labor standards and protected by enforcement that looks beyond employers’ superficial labels to hold the companies calling the shots accountable for the conditions they create.
This report offers a number of policy and action recommendations to begin to address the chronic problems facing this workforce and industry. These recommendations are aimed at achieving five main objectives:
• Ensuring basic labor protections for which home care employers can be held accountable;
• Stopping lawbreaking within publicly funded home care programs;
• Prioritizing smart and strategic enforcement of basic labor standards;
• Leveraging and increasing public investment in home care to create quality jobs; and
• Strengthening workers’ ability to organize and bargain for greater accountability.
Strengthening accountability now will not only help historic labor reforms deliver real benefits to a growing workforce; they will also improve quality of care and services, and set the industry on a path to a more sustainable future. While a significant influx of funding is desperately needed to fully meet our nation’s growing needs and provide living wages for all workers, the proposals we offer to improve accountability point the way toward transforming low-wage home care jobs into the quality family-sustaining profession our nation so sorely needs….