Home Health Aides: The Future of Health Care and the Future of Struggle

With the recent hospital closures and cuts, many of us are wondering what is the future of health care in the U.S.?  Many are arguing that the site for care is shifting from state-funded institutions that service all of society to a two-tiered system of health care:  a top tier of private clinics and specialists who care for the rich, and bottom tier of low-paid workers who care for the poor in the home.  Since most of us are workers, we can look forward to the latter.

The Department of Labor has noticed this trend, noting that home health aides (HHAs) are expected to have the fastest job growth of any sector in through 2020.  However, just because there are more jobs in this sector does not mean those jobs will be filled, especially considering the horrendous working conditions HHAs find themselves in.

HHAs are among the most exploited health care workers.  New York’s average HHA wage is only $10.21/hr, which is hardly enough to live on.  On top of this, HHAs are expected to work long hours (10, 12, and 14 hour shifts or more!), and are not usually offered overtime or benefits.  Furthermore, given the isolated, individualistic, and “private” nature of the work, many HHAs are sexually, physically, and emotionally assaulted by their clients.

Last week, President Obama extended minimum wage and overtime protections to HHAs, though these changes will not go into effect until 2015 (an unusual move that is supposed to give clients time to prepare for the shift).  Despite when this official policy goes into effect, we know it will only be symbolic.  These “protections” will either not be enforced, or will encourage the bosses to cut hours instead of paying overtime.  When we are only getting paid $10/hr, we need to work as much as possible just to survive.

Similarly, HHAs in Connecticut have petitioned to unionize with the American Federation of Teachers – Connecticut.  While this move may provide some relief in the short term, such as job security, in the long term it will do more harm than good, since HHAs will have to deal a new layer of management.  Official union leaders historically police any rank-and-file struggles, smashing anything that the union deems “unreasonable,” “unattainable,” or as threatening the union itself.

This is why we cannot rely on Obama, the official unions, the bosses, or any other rulers or managers to better our working conditions.  This is something we must do for ourselves.  We must unite HHAs, PCAs, CNAs, RNs, case managers, and other workers who do “care” or “reproductive” work, in order to collectively demand a living wage, shorter shifts, and the ability to control and organize our working conditions ourselves.  We must confront the clients who abuse us while uniting with those who support our struggles.  Our working conditions are intimately connected to our clients’ access to services.

Florence Johnston Collective is a group that supports from-below struggles, worker- and community-led direct action, and cross-workplace solidarity.  Email or call to get involved.



  1. marybeth315

    Time to stike and march. Hha since 2007. Worn out and broke. Remember folks we are valuable. How many people really want to deal with illness, poverty, dirty depends, adult diapers, meals, their bills, their meds, dirty floors, laundry, dusting, vacuming, showeing, xishes, transportation needs, ect……….for what we get paid! M.B.

  2. Pingback: Interfaith Medical Center: A Disaster of “Titanic” Proportions | Florence Johnston Collective

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