Home Care Aides Fight to End 24-Hour Shifts: ‘This Work Is Killing Them’

Home health care, among the fastest growing industries in New York and nationwide, is also one of the lowest paying, with often grueling hours.

This article was originally published in The New York Times. Read it here.

For eight years, Lai Yee Chen worked 24-hour shifts, up to five days a week, as a home care aide for bed-bound seniors in New York City. She cooked, cleaned, changed diapers and turned her patients at least every two hours to prevent bedsores.

Ms. Chen, 69, has since retired, but she still jolts awake at night, as if she’s still on call.

“The 24-hour workday is inhumane. It’s violence against workers,” she said in Cantonese.

Ms. Chen has now joined a push among New York City home care workers to ban 24-hour work shifts through a bill being introduced in the City Council this week.

New York’s population of older adults is surging. The number of home aides who care for them has more than doubled in the last decade, surpassing half a million statewide as of 2022, with most of the growth in New York City. And the field is expected to keep growing. Nationally, there are more new jobs expected in home care over the next decade than in any other occupation, said Kezia Scales, the vice president of research and evaluation at PHI, a national research and advocacy group for direct-care workers.

Making the job more humane is critical to keeping up with the increased need: It will help attract people to the job and make it sustainable, workers and advocates say.

“We have a massive aging population, but we’re decreasing the number of people who want to take care of them,” said Christopher Marte, a councilman representing Lower Manhattan who is expected on Thursday to introduce the bill to end the 24-hour shifts. “This work is killing them.”

Home care aides are allowed to work 24-hour shifts because of a longstanding interpretation of state law that assumes they should only be paid for up to 13 hours of the day. Industry regulations are premised on the idea that workers get three hours of meal time and eight hours of sleep, including five hours of uninterrupted rest.

But that is rarely, if ever, the case in practice, because of the all-hours nature of the job, workers and labor groups said.

“How can they sleep eight hours?” asked Vincent Cao, an organizer at the Chinese Staff and Workers’ Association, which supports banning 24-hour shifts. “Are they going to leave the patient to die?”

Opponents of the bill say that banning the all-day shifts is misguided. The cost to provide round-the-clock care for a patient would balloon under such a ban, said Al Cardillo, the president and chief executive of the Home Care Association of New York State, which represents health care agencies and insurance companies. And it could force home care agencies, which are supported by state and federal funding, to spend more per patient, potentially creating gaps in coverage for the neediest residents.

Replacing 24-hour shifts with two 12-hour shifts — effectively doubling the total number of hours paid — could cost an additional $645 million a year in New York City, according to an analysis by 1199SEIU, a large union representing health care workers.

But groups in support of the ban say the burden shouldn’t be borne by low-wage workers, many of whom are also aging and could need similar care.

No other industry since the pandemic has added more jobs to New York City’s economy than home health care. It also remains one of the lowest paying fields in the city, with an average salary of about $32,000, or close to minimum wage, according to James Parrott, the director of economic and fiscal policy at the Center for New York City Affairs at the New School.

Demographic shifts and a preference for in-home services are fueling the industry’s growth. Between 2021 and 2040, while New York State’s overall population is expected to grow 3 percent, the number of people 65 and older is projected to grow 25 percent, and the 85-and-older population could jump nearly 75 percent, according to a City University of New York study.

In New York City, nearly 90 percent of home care workers are women. They are often immigrants, and tend to skew older, with more than half over 45 years old, Dr. Scales said. Almost 10 percent are 65 or older.

While it is unclear how many home care aides work 24-hour shifts, there were 17,780 New York City residents who received Medicaid-funded, live-in care in 2019, according to 1199SEIU.

After two years of unsuccessful lobbying, a group of health workers say they will go on a hunger strike in mid-March to pressure the city to abolish the practice.

“They don’t want others to live the lives they lived,” Mr. Marte said.

A version of the City Council bill that sought to prohibit 24-hour shifts for home care aides and limit the number of hours they can work per week was introduced in 2022, but was never brought to a vote.

Rendy Desamours, a spokesman for the City Council, said the effort was misdirected, because home health care is funded primarily through Medicaid, which is managed at the state level.

“It has been counterproductive and harmful to mislead people into believing that this can be resolved at the city level,” he said in a statement, adding that Adrienne Adams, the council speaker, planned to introduce a bill to urge the state legislature to improve working conditions for home care workers.

Still, there are other proposals to help home care workers, said Carmela Huang, a senior lawyer at the National Center for Law and Economic Justice, a nonprofit legal advocacy group.

A bill introduced late last year in the state legislature, the Home Care Savings & Reinvestment Act, would cut out private insurance companies that manage the payment of Medicaid-funded services. That could save the state more than $1 billion a year, proponents say — money that could fund wage increases for workers. Critics say the savings are overstated.

Valeria Guerrero, 63, a former home care aide from Honduras who worked 24-hour shifts for over 20 years, said she averaged three to four hours of sleep a night. She blames her worsening diabetes on her poor sleep schedule.

At her last assignment in 2022, in a two-story house in the Bronx, she spent four days a week caring for an older woman with limited mobility who used an oxygen tank. When she wasn’t preparing meals, taking the patient to the bathroom or adjusting medical equipment, Ms. Guerrero said, she would sleep on a sofa.

Feeling drowsy one morning, she fell down a flight of stairs and hurt her back and left ankle, she said. Unable to work after the injury and left with little savings, she now lives with her niece in the Bronx. She said she was paid $15 an hour for 12 hours of the day, despite regularly working more.

Now she is seeking payment for thousands of unlogged hours, according to NMASS, a worker organizing group that is helping with her claim. Based on a complaint she submitted to the State Department of Labor, she could be entitled to over $177,000 in unpaid wages and damages.

Ms. Guerrero hopes that a ban on 24-hour shifts could help other home health workers.

“I spent most of my birthdays at work,” she said in Spanish. “You don’t get to have a life.”