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Unfinished Business: Providing Labor Protections to Home Health Care Workers

Evelyn Coke was a Jamaican-born, single mother of five who worked for decades providing care for sick and frail people in their homes. She came to the United States in her thirties and ultimately brought her children to live with her in New York City. Her work consumed very long hours, sometimes up to 70 hours a week with occasional consecutive 24-hour shifts. But no matter how much time Evelyn put in, she earned only about $7 an hour and received no extra pay – because home care workers were not guaranteed overtime wages in the United States. 
In 2001, at age 66, Ms. Coke was hit by a car and suffered injuries that left her unable to do her job. She consulted a lawyer, who invited her to bring a test legal case after examining her pay stubs and realizing that Evelyn had never received overtime for her long hours. Ms. Coke had no health insurance during her working years, and it was not until she was eligible for Medicare that she learned her kidneys were failing. Her health deteriorated rapidly and she was too poor to afford the home care she needed to prevent bed sores that ultimately contributed to her deteriorating condition – a sadly ironic situation given her own life’s work helping others with bed sores. At age 74, Evelyn Coke died of heart failure – in 2009, just two years before Hilda Solis, the Secretary of Labor in the first Obama administration, proposed new rules that could, if carried through, right the wrong that had left her without work protections.
How Home Care Workers were Left Out of New Deal Labor Protections 
The 1938 Fair Labor Standards Act provided wage and overtime protections to many American workers, although the jobs women traditionally filled were excluded. A quarter of a century later, in 1974, Congress expanded protections to include domestic workers such as cooks and maids, but still exempted individuals who provided “companionship services.” Charged with writing regulations to implement the new rules, the Department of Labor interpreted the companionship exemption quite broadly. Legislators had wanted to exempt the babysitter or neighbor who provided occasional support, but the Department chose to also exempt professional home care aides employed by third-party agencies. This has become a huge loophole, because services provided by home care aides are essential to growing numbers of Americans, and the need grows as the U.S. population ages. Those projected to need care services are expected to double from 13 million individuals in 2000 to 27 million by 2050. 
Sandra Butler is Professor of Social Work and Master of Social Work Coordinator at School of Social Work, University of Maine.