The State of Care
By Eileen Boris | April 26, 2021
Eileen Boris is a professor of feminist studies at the University of California, Santa Barbara.
A central insight of feminist theory has gone viral: that care is not only work, but the work that makes all other work possible. Since the pandemic shut down schools, brought white collar jobs into the home, and turned long-term care facilities into death traps, media outlets from the New York Times to Jezebel have underscored the burdens faced by those who have had to juggle making a living and tending to families in the same space.
Numerous studies have documented the declining labor force participation of mothers in heterosexual households, the drop in journal submissions of women scientists and other academics, and the lower productivity and fewer promotions of women professionals compared to their male counterparts. The pandemic has made clear that the fate of unpaid and paid care workers is intertwined.
The Feminist Care Network: #CareCantWait
This growing crisis in care, long a reality for working-class women, has generated a movement represented by the hashtag #CareCantWait. A coalition of 14 organizations—led by the National Domestic Workers Alliance, the Service Employees International Union (SEIU), and Caring Across the Generations—is pushing legislative action on child care, paid family and medical leave, and home and community care. Coalitional support for the Biden-Harris campaign, especially from advocates accountable to women of color, has seemed to pay off. From a seat at the table during the transition to appointments in the administration, what we might name a feminist care network has seen its policies translated into major pieces of legislation.
From a seat at the table during the transition to appointments in the administration, what we might name a feminist care network has seen its policies translated into major pieces of legislation.
First the American Rescue Plan jumped the child tax credit from $2,000 to $3,000 for those 17 and under and to $3,600 for children under 6. Then, by making the benefit refundable, it covered low-income families who generally do not qualify for tax credits. While the initial change will only last one year, this measure is a major step toward a more fulsome recognition of the economic cost and contribution of unpaid family care. A future American Families Plan will address child care, paid family leave, universal pre-kindergarten, and tuition-free community college.
Now the American Jobs Plan proposes to improve paid care by spending $400 billion on home and community care. According to the administration’s fact sheet, it would “solidify the infrastructure of our care economy by creating jobs and raising wages and benefits for essential home care workers.” It would fund expansion of such services under Medicaid, encouraging unionization, training, and higher wages. With a dearth of workers to meet the needs of aging Baby Boomers, the cost of home and community care has become prohibitive—and yet, most people prefer to remain at home as long as they can. Raising wages and improving conditions of the home care workforce can help meet the gap between supply and demand.
Racial & Gender Bias Have Shaped Care Work as We Know It
Why is all this necessary? Why are home care jobs bad jobs? Certainly they suffer from the perception that has haunted women during the pandemic: caring for family is just what women do. It is the obligation of wives, mothers, and daughters to assist young, old, and dependent kin. So when labors of love or necessity become jobs, we don’t have to pay them much because any woman can perform them. This framing overlooks the skill required to help others undertake the activities of daily life, while maintaining the dignity and respecting the personhood of those requiring care.
But household labor is not only women’s work in the U.S. It is predominantly women of color’s work—over 60% of those employed by home care agencies are Black, Latinx, or Asian/Pacific Islander. Indeed, Black women represent one-third of home care workers.
Over 60% of those employed by home care agencies are Black, Latinx, or Asian/Pacific Islander. Indeed, Black women represent one-third of home care workers.
The lingering legacy of slavery and Jim Crow, the connections with general domestic work, shaped home care as we know it today.
But so did public policy.
From the New Deal to the Supreme Court
Home care developed as a cheap solution to the crisis of care and unemployment during the Great Depression. To remove frail elders and people with disabilities from cash-strapped public hospitals, the New Deal initiated a visiting housekeeper service that would also aid unemployed domestic workers, disproportionately Black women. For the rest of the 20th century, work programs (like those under the War on Poverty) trained welfare recipients as home attendants and aides, placing them in minimum wage jobs.
During the 1970s, amid exposés over the poor quality of nursing homes, the general public and lawmakers alike embraced home and community care—but without proper funding. In 1974 the Department of Labor redefined the home care worker as an elder companion no longer subject to Fair Labor Standards Act provisions for minimum wage or overtime.
In 1974 the Department of Labor redefined the home care worker as an elder companion no longer subject to Fair Labor Standards Act provisions for minimum wage or overtime.
During the Reagan years, the home health care industry prospered from a low wage, part-time, and temporary labor force. The poor could receive Medicaid funded home care, while middle income families were faced with institutionalizing kin who were no longer able to fend for themselves or hiring immigrant workers off the books for a little as possible.
To improve home care, trade unions and consumer allies, including senior and disability rights activists, struggled to change public policy. SEIU, AFSCME, and other unions waged innovative community-based organizing drives but found their greatest success in winning state-level legislation (such as in New York, California, Illinois, and Oregon) that created a political avenue for redress. Such legislation allowed for home care organizing, with the state acting as the employer for collective bargaining purposes, stipulating payments to private agencies, or creating stakeholder boards. The Obama administration proposed ending the companionship classification late in 2011, although it took until 2015 for a new rule to come into effect.
Right-wing legal think tanks went to court. In Harris v. Quinn, the Supreme Court in 2014 declared that home care workers were not public employees; thus, requiring those who did not want to join a union to pay an agency fee impeded free speech. This ruling hampered the collection of dues but encouraged unions to more actively recruit members. Republican capture of state houses since 2010, however, led to abnegation of home care agreements signed by Democratic governors that had allowed for collective bargaining.
It’s Time to Remake Our System of Care
The history of home care reminds us that what the state gives, it can take away, especially when we rely on executive orders and agency rulemaking. Even legislation can be overturned. To build back better demands building institutional structures that will reward the work of care no matter who controls the reins of government. It means empowering care workers and their organizations through the PRO Act and related measures.
It is about time to dismantle an inequitable system created by government policies in the first place and make home care a good job, as proposed by the Biden-Harris administration and advocated by the feminist care network.
Eileen Boris is the Hull Professor of Feminist Studies at the University of California, Santa Barbara. She’s the author with Jennifer Klein of Caring for America: Home Health Workers in the Shadow of the Welfare State and a PI for a UCSB Feminist Futures Project, “Care Across the Generations.”