COVID-19 is changing the world of work – especially for women
June 17, 2020
Health Care Workers and Covid-19
June 18, 2020

It’s Time to Recognize the Value of Home Care Work

By Cynthia Cranford


Home care has long been at the bottom of the health care hierarchy. Home care workers help elderly, ill and disabled people live meaningful lives at home, freeing up hospital beds and long term care spaces for people who really need them. Yet, this crucial, underlying support receives insufficient resources and attention, with real implications for health and inequality.

The coronavirus pandemic has both exacerbated, and made more visible, the precarity and devaluation of home care workers. In Canada and the U.S., these temporary, part-time jobs are inadequately covered by labor protections resulting in few benefits, low and unstable earnings, and unsafe work. Now, finally, major newspapers across North America are reporting on such insecurities.

One reason for home care workers’ invisibility and precarity is the contracting out system. Governments contract home care services to agencies, many of them for-profit, who become responsible for protecting and paying the workers. Peter Jamison reports in the Washington Post how home care employers need government support for sufficient PPE as well as initiatives like telehealth conferencing. Yet, too many agencies download risks to individual workers. Indeed, Mario J. Pentón reports in the Miami Herald on a worker who was fired after posting about the lack of face masks.

The downloading of health and safety hazards to individual workers has dangerous spillover effects. Home care workers face brutal decisions – whether to put their family at risk or pay the rent. And elderly, ill and disabled clients are also put in danger by the precarity of workers, so aptly explained by Sociologist Elaine Acosta. As temporary and part-time workers, they sign up with multiple agencies in an effort to obtain sufficient clients to make a living, multiplying their own, families’ and clients’ exposure.

Since home care workers are disproportionately immigrant women and women of colour, these insecurities reflect, and reinforce, gendered and racialized inequalities. One long standing tension is between people’s needs for help with housework and workers’ need for recognition as care workers. Indeed, clients and the agencies that employ them too often see home care workers as cleaning ladies, reflecting histories of racialized servitude, as home care worker Marlén Veliz recounted in the Miami Herald. And during the coronavirus pandemic East Asian aides have experienced targeted, explicit racism, reports the New York Times. Many home care workers have nursing or other health care backgrounds, yet credentials from their countries are not recognized in Toronto or other cities in Canada and the U.S. This is another reason immigrant women are funnelled into the most precarious corners of the long term care system.

Now, more than ever, we need to make systemic changes to the way we organize home care. We must adequately fund home care, including both caring and cleaning. We must limit for-profit interests in the contracting system. We need to expand occupational health and safety legislation to cover all workers. We also need to challenge inequalities of gender and race and how they intersect with age, disability and health to marginalize so many.

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