As more and more Americans turn to in-home health care workers to take care of elderly family members, research from a University of Iowa law professor has found nobody is taking care of the caregivers.
Peggie Smith, an expert in employment law, has found that most home health care workers are protected by few of the federal labor standards that other Americans take for granted.
"For the most part, those government agencies responsible for enforcing labor laws, like the Occupational Safety and Health Administration, have turned a blind eye to home health care workers," said Smith. "The problem the government faces is, how do you regulate the employment relationship of someone who works in a private home?"
The issue will become increasingly important in the future, as Baby Boomers will need increased healthcare services as they age and their health declines. The home health care industry is already one of the fastest growing industries in the economy and the number of home health care workers is expected to grow by 70 percent by 2014, she said.
Unfortunately, because home health care is considered low-skill work, Smith said workers are poorly paid, and receive few if any benefits. Depending on their employers, many home health care workers are also exempt from minimum wage, overtime and worker's compensation laws.
As a result, she said most home health care workers are poor women, and they are disproportionately women of color who are single mothers. In addition, many workers are illegal immigrants who work off the books and get paid under the table. The annual turnover rate is about 50 percent.
Smith said that because home health care workers work in private residences, they are often forced to work in unsafe conditions.
"We tend to think of home as a safe place. Yet the reality is that most homes are not designed to accommodate safe care practices," Smith said. "For instance, a throw rug on the floor of a client's home can pose a `trip and fall' hazard to a health care worker as she attempts to assist a client with limited mobility."
Smith observed that in terms of health and safety, the greatest hazard to workers stems from the amount of client lifting that can often lead to severe muscle injuries. "Home care work is exceedingly dangerous when measured in terms of the injury rate to workers. For example, they experience back injuries at a rate that is nearly three times the rate for nursing aides in hospital or nursing home settings."
Smith said that the high rate of injury is not surprising. "Whereas workers in institutional settings can rely on co-workers to help lift patients or can use lifting devices, home health care workers typically work alone and without the aid of patient transfer devices or equipment like adjustable beds."
Because judges and policy makers are reluctant to apply labor standards to private homes that serve as workplaces, Smith said there is little effort to think seriously about how to improve the workplace safety of home health care workers. Smith added that the current legal atmosphere cheats not just the home health care worker, but also the elderly, because they often receive sub-standard health care.
"It seems to me that we ought not fund health care for the elderly on the backs of poorly paid workers," she said. "All too often, when policymakers consider home health care work, they focus on it solely from the perspective of the consumer, and rarely consider the interests of the workers. If we are to make headway in this area, we need to appreciate the connection between treating workers with respect and improving the quality of the service that they provide."
Smith has little expectation that Congress or the legal system will change that atmosphere. Instead, she sees some hope in organized labor negotiating with state governments to improve working conditions. To date, unions have organized more than 300,000 home health care workers, and some improvements have been paid, most noticeably in terms of increased compensation and the provision of benefits. However, Smith said that limited progress has been made with respect to health and safety issues.