Home care aides fight to end 24-hour shifts: ‘This work is killing them’

For eight years, Lai Yee Chen worked 24-hour shifts, up to five days a week, as a home care aide for bedridden 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 now retired, but she still wakes up at night, as if she is still on duty.

“The 24-hour working day is inhumane. It is violence against workers,” she said in Cantonese.

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

The number of older adults in New York is increasing. The number of home health aides caring for them has more than doubled over the past decade and will surpass half a million statewide by 2022, with most of the growth in New York City. And the expectation is that the field will continue to grow. Nationally, more new jobs are expected in home care than in any other profession over the next decade, says Kezia Scales, vice president of research and evaluation at PHI, a national research and advocacy organization for direct care workers.

Humanizing the job is critical to meeting the increased need: It will help attract people to the job and make it sustainable, workers and advocates say.

“We have a huge aging population, but we are reducing the number of people who want to care for them,” said Christopher Marte, a council member representing Lower Manhattan who is expected to introduce the bill Thursday to end the 24 -hour law. shifts. “This work is killing them.”

Home care aides are allowed to work 24 hours a day because of a long-standing interpretation of state law that requires them to be paid only for a maximum of 13 hours a day. Industry regulations are based on the idea that workers get three hours of food and eight hours of sleep, including five hours of uninterrupted rest.

But that is rarely, if ever, the case in practice because of the hour-long nature of the work, workers and union groups said.

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

Opponents of the bill say banning day shifts is misleading. The cost of providing 24-hour care to a patient would skyrocket under such a ban, said Al Cardillo, the president and CEO of the Home Care Association of New York State, which represents health care facilities and insurance companies. And it could force home health 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 paid hours — could cost an additional $645 million a year in New York City, according to an analysis by 1199SEIU, a major union that represents health care workers.

But groups supporting the ban say the burden should not fall on low-wage workers, many of whom are also aging and could need similar care.

No other industry has added more jobs to New York City’s economy since the pandemic 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 nearly minimum wage, according to James Parrott, director of economic and fiscal policy at the New York Times Center for New York City Affairs. School.

Demographic shifts and a preference for home services are fueling the sector’s growth. While the total population of New York State is expected to grow by 3 percent between 2021 and 2040, the number of people aged 65 and older is expected to grow by 25 percent, and the population aged 85 and older is expected to grow by nearly 75 percent can increase. This is evident from a study by the City University of New York.

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

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

After two years of failed 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 life they lived,” Mr. Marte said.

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

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

“It has been counterproductive and harmful to lead people to believe this can be solved at the city level,” he said in a statement, adding that Council President Adrienne Adams planned to introduce a bill to repeal the legislative power of the state to improve the situation. employment conditions for home care workers.

A bill introduced in the state legislature late last year, the Home Care Savings & Reinvestment Act, also aims to help home care workers. It would eliminate private insurance companies that manage payment for Medicaid-funded services. That could save the state more than $1 billion a year, advocates say — money that could fund pay raises for workers. Critics say the savings are exaggerated.

Valeria Guerrero, 63, a former home care worker from Honduras who worked 24-hour shifts for more than two decades, 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 home in the Bronx, she cared for an elderly woman with limited mobility who used an oxygen tank four days a week. When she wasn’t preparing meals, taking the patient to the bathroom or adjusting medical equipment, she slept on a couch, Ms. Guerrero said.

One morning, feeling sleepy, 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 a day, despite regularly working more hours.

Now she is seeking payment for thousands of unaccounted hours, according to NMASS, an employee organization helping her with her claim. Based on a complaint she filed with the state Department of Labor, she could be entitled to more than $177,000 in unpaid wages and damages.

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

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

Talmon Joseph Smith reporting contributed.