Home-Care Workers Aren’t Just ‘Companions’

In an op-ed story of NY Times today, the home care workers are depicted as not ‘just’ companions. They are denied adequate wages and deprived of overtime incomes as well. By keeping them labeled as ‘companions’, the employment companies that hire them are getting away without paying them justly, while at the same time, such informal sectors are experiencing rapid growth and stellar profit margins.

Home-Care Workers Aren’t Just ‘Companions’ By EILEEN BORIS and JENNIFER KLEIN NOT long after announcing his candidacy in 2007, Barack Obama spent a day working alongside Pauline Beck, a home health care aide in Oakland, Calif. Together, they cooked breakfast and lunch, cleaned house and did the laundry. Last December, the president mentioned his day with Ms. Beck when he proposed placing most home-care employees under the Fair Labor Standards Act, from which many of them have long been excluded.

Mr. Obama proposed revising a Labor Department rule so that it would give home attendants and aides the protections, like overtime pay, that most American workers take for granted. The department opened an extended comment period and received some 26,000 statements, two-thirds of them positive. It is now deliberating on a final rule.

With a work force of about 2.5 million, two-thirds of whom would be affected by the proposed rule, home health and personal care is the second-fastest-growing job category in the country, projected to double by 2018. As women, immigrants and service workers have become the new face of labor, what happens to home care matters for the shape of our economy, the fate of unionism and the establishment of a decent standard of living for all.

Mr. Obama’s proposal has come up against Republican opposition. On June 7, a dozen Senate Republicans, led by Mike Johanns of Nebraska, sought to pre-empt Mr. Obama’s initiative and consign home-care workers to perpetual second-class status. Senator Johanns introduced the Companionship Exemption Protection Act, which would permanently codify their exclusion by defining “companionship services” to include “meal preparation, bed making, washing of clothes, errands” and “assistance with incontinence and grooming.” In assuming that adequate care can come only from suppressing wages, these Republicans seek to pit the interests of care receivers and givers against one another.

To understand this talk about “companionship exemptions,” we have to go back to the 1970s, when domestic servants received the F.L.S.A. protections denied to them under the original law in 1938. During a debate in 1971 about extending the act, Senator Harrison A. Williams Jr., Democrat of New Jersey, compared home health care aides to baby sitters: “ ‘companion,’ as we mean it, is in the same role — to be there and to watch an older person.”

When Congress actually granted domestic workers the right to a minimum wage and overtime pay three years later, this analogy formed the basis for excluding home aides and attendants. Implementing the new amendments in 1975, the Labor Department redefined home-care workers as “elder companions,” which also had the perverse effect of removing from the law employees of nonprofit social welfare agencies and for-profit manpower firms who previously had F.L.S.A. coverage.

The existing exemption mainly serves home-care franchises, an $84 billion industry that is one of the most profitable in the United States. Congressional Republicans and industry representatives like the National Association for Home Care and Hospice invoke the debates of the 1970s to defend a rule that allows the industry to squeeze additional hours of unpaid labor from “companions.”

They offer a false history of “companionship.” From the 1930s until the 1970s, no such job as “companion” existed, though there were community volunteers who would check in with a “shut-in” or other homebound individual. New Dealers named the job “visiting housekeeper,” financing a work relief program that sent unemployed domestic servants into the homes of chronically ill or elderly adults. After World War II, family welfare agencies renamed the position “homemaker”; hospitals defined it as health aide. Aiming to develop “manpower” for the booming service sector, President Johnson’s War on Poverty trained home aides. Once Medicaid funds became available after 1965, states embraced the term “home attendant.”

The title may have changed, but the work has remained the same: a combination of basic bodily care and housekeeping. That care workers substituted for the unpaid labor of wives and mothers further confused their status. So did the home location. As one 64-year-old worker told Congress in 2007, “I would get time and a half pay for my overtime hours for performing the same tasks for Mrs. G. if she were in a nursing home facility. But because my work helps her to stay in her home, I am deprived of overtime pay.”

The “elder companion exemption” has allowed staffing agencies to avoid paying overtime. It treated women who labored to support their families as if they were teenagers picking up some spending money. Conveniently, this exemption came just as home care became a growth industry, aided by changes to Medicare, Medicaid and other government programs. Beginning with the Omnibus Budget Reconciliation Act of 1981, these programs funneled more public money to for-profit firms, generating a vast home health industry — with a tenfold increase in for-profit agencies during the first half of the 1980s alone. By the 1990s, home care was the fourth largest occupation.

This labor market growth made a mockery of the companionship classification. Bill Clinton’s administration recognized this and proposed ending the companionship exception, but delayed action until January 2001. George W. Bush’s Labor Department withdrew the Clinton proposal. Legal advocates for home-care workers subsequently went to court, but in 2007 the Supreme Court upheld the exemption by ratifying the role of executive agencies, like the Labor Department, in making such determinations.

Using the model of the temp agency, the ambiguous legal status of the home as a workplace and the distrust of care labor as “real work,” home agencies have tenaciously held onto the companionship exemption. They do so while getting plenty of public dollars. With Medicaid directing at least $15 billion annually to their provision of personal care, agencies are clearly happy to have government money; indeed, they have depended on it to fuel an impressive 9 percent average yearly leap in revenue between 2001 and 2009. Government becomes harmful, it seems, only when setting a floor under workers’ wages.

In today’s fiscal climate, the slipperiness of the companionship terminology becomes the perfect cover for states to constrict public spending and for home-care companies to protect profits. States are reducing the hours an aide can spend with a client and targeting housekeeping for elimination. They are able to do so because there is a long history of dismissing housekeeping and personal care as not real work and because both providers and consumers of home care are stigmatized as clients of the welfare state.

Mr. Obama’s proposal explicitly recognizes that housekeeping is bound up with caregiving in the home. Companionship emerges as a benefit from the human relationships essential to the job, but it isn’t the major task, as the current rule implies. Establishing the legitimacy of care as productive, necessary labor — a real job — would recognize the realities of both our aging society and our service economy. It would also begin the long-overdue work of updating labor standards for the workplaces of a new century.

Mr. Johanns and his co-sponsors probably don’t have the votes to bring their bill to the floor. But if the Labor Department delays issuing a final rule, home-care workers could remain unprotected in the shadows of the low-wage economy.

This fight isn’t simply about the ability to earn the minimum wage or slightly more for working even longer hours; that would still keep home-care workers poor. Its deeper possibility is the potential to re-establish some notion of labor standards, rights and security after decades of gutting them.

Eileen Boris, a professor of feminist studies at the University of California, Santa Barbara, and Jennifer Klein, a professor of history at Yale, are the authors of “Caring for America: Home Health Workers in the Shadow of the Welfare State.”