Portside

Gui Hua Song retired from home care work in 2020, but when she heard about plans for a New York City hunger strike earlier this spring organized by a coalition fighting to end home health aides’ 24-hour workday, she signed up to join.

“People asked me, ‘Why would you risk your health when it doesn’t even affect you? You are already retired,’” Song said with the help of an interpreter. But after spending years working grueling 24-hour shifts, she said she knew she had to participate. She recalled the high stress work environment and endless nights of sleeplessness while caring for an elderly couple. When she tried to report the unsafe conditions of the government housing the couple lived in, Song said she was told “she was complaining too much.”

The Ain’t I a Woman?! (AIW) coalition is leading the No More 24 movement in New York City, which is organizing to end home health attendants’ 24-hour workdays and cap the maximum number of hours worked for home attendants to 50 hours per week. The coalition’s last action in March was the highly publicized hunger strike that Song participated in, though it was just the latest effort in the yearslong battle to shorten shifts.

Most home health aides are women of color and immigrants like Song, who said she was willing to put her health on the line for the hunger strike because she doesn’t want future workers to suffer.

“My goal was to eliminate the 24-hour policy,” she said. “We really suffered; it impacts our health, our family, our children. We are using our life to bargain … for the next generation of care workers and patients.”

Harnessing the energy and popular support garnered by the hunger strike, the AIW coalition will hold a rally at New York City Hall on International Workers’ Day on May 1 to advocate for legislation that ends the 24-hour work day. The landscape of home care work politics in New York City can complicate the organizing work. There are cracks within the progressive movement where community-based organizers clash with longstanding unions, and influential insurance agencies tangle with home care workers. There’s even tension among progressive organizations, with grassroots alliances criticizing political heavyweights like the Chinese-American Planning Council (CPC).

Part of the justification for dangerous 24-hour shifts is that care workers are in high demand.

‘Massive care crisis’ 

Researchers predict that by 2025, there will be a workforce gap of 446,300 workers in the home health aide industry—a canary in the coal mine for a rapidly aging national population.

Polls show that aging adults have an overwhelming preference for long-term care at home and a need for policymaking that supports affordable home care. In New York, home health care is one of the fastest-growing industries, and while these workers are in high demand, the industry leaves much to be desired.

According to the New York Times, home care aides in New York 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,” and 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.” In practice, this is almost never the case.

The state of New York’s Home Care Program transitioned in 2012 to a long-term model, meaning that rather than being sent to nursing homes or in-patient facilities, disabled and chronically ill people can be cared for in their homes for as long as it is possible. The effort is part of a larger pattern in which the purported goals of improved services and increased efficiency often come at the cost of patient and care worker outcomes. Critics say health insurance and home health agencies that have emerged in the last decade serve as bloated intermediaries in the supply chain.

Yiran Zhang, assistant professor of employment and labor law at the Cornell University School of Industrial and Labor Relations, explained that labor and social movements, as well as the pandemic’s “massive care crisis” moved issues related to home health care into the public consciousness.

“For a long time, home care was socially invisible due to its isolated worksite of private homes and legally invisible due to various exemptions from labor regulation,” Zhang said.

The fight against the 24-hour workday in New York City is part of a larger legacy of worker organizing in Chinatown. The AIW coalition consists of sponsors and endorsers like the Chinese Staff and Workers’ Association (CSWA), the Flushing Workers Center, The National Organization for Women, the New York Young Community League, Science for the People, the National Mobilization Against Sweatshops, and student groups, among others.

Organizing efforts seek to address harm experienced by home care workers. CSWA organizer Zhishun Ning said that 24-hour shifts and other unjust labor practices are forms of “racist violence” against care workers in New York, where 90% are women, 60% are immigrants, and 18% live below the poverty line. These are women whose work doesn’t allow them to sleep for days. Many cannot have regular meals or must otherwise always be prepared to work. According to worker testimonials, it’s not uncommon to experience physical injuries on the job.

There’s also the issue of pay. Chinese-American Planning Council home health aide Lai Yee Chan told New York Focus that she received only a fraction of the pay she was entitled to during 24-hour shifts and that she was consistently expected to work overnight due to the patient’s medical needs. Chan wants to ban 24-hour shifts, but like many home health aides, she finds herself in a bizarre situation: her union, 1199SEIU United Healthcare Workers East is opposed to the ban.  

Workers, worker advocates, and union representatives are divided on efforts to improve conditions for home health aides. In 2019, 1199SEIU—the largest healthcare union in the nation—filed a class action grievance representing more than 100,000 members against 42 home health aide agencies that violated federal wage and hour laws related to 24-hour shifts. The AIW coalition characterized the $30 million settlement the union obtained as “insulting.” In 2020, Chan and other workers signed onto a letter to 1199SEIU’s president George Gresham demanding that the union arbitrate their grievances individually rather than lumping them into a large class action lawsuit.

Pay and home health aide pay grievances are sources of mounting tension in the New York labor organizing world.

‘The runner dog for the boss’ 

The Chinese-American Planning Council is a social services organization that promotes the social and economic empowerment of Chinese American, immigrant, and low-income communities. Considered a “progressive heavy weight” in New York, many were shocked when an elected official accused the organization of wage theft.

An explosive 103-page report released in 2021, written by New York State Assemblymember Ron Kim’s legislative director David Lee, alleged CPC’s Home Attendant Program that employs 4,500 home health aides in New York City engaged in rampant wage theft. The report also alleged that CPC works with 1199SEIU to block workers’ access to courts, diminishing their chances of winning back wages.

CSWA organizer Zhishun Ning agrees with Kim’s efforts to hold CPC and the union accountable.

“We saw the union that was supposed to represent the workers became the runner dog for the boss,” Ning said, noting that the union has long been aware of 24-hour work days and failed to address the issue. “If we allow the 24-hour workday to exist in one industry, it can spread to other industries … it normalizes it and hurts all workers.”

The CPC disputes Kim’s report. The organization released a statement saying, in part, that CPC has “long called for the State to replace 24-hour home care cases with two 12-hour split shifts, which would be best for both workers and patients. This requires changes to State labor law and Medicaid funding rates.”

The CPC, Assemblymember Kim’s office, and SEIU1099 did not respond to Prism’s request for comment.

Care workers in New York continue to rally behind the No More 24 Act and despite bipartisan support, the bill has stalled in the city council, with many workers claiming that Speaker of the City Council Adrienne Adams is blocking the bill by not bringing it to a vote. In recent weeks, workers protested outside of Adams’ office.

In an interview with Prism, Rendy Desamours, policy strategist and spokesperson for New York City Council, underscored the CPC’s point that ending the 24-hour workday requires state labor law changes.

“Home care will be regulated by the state, and regulated by Medicaid and the department of labor … If we’re operating in that reality, why do these folks continue to target the city council? I think it’s unfortunate that they continue to mislead workers,” Desamours said.

The council spokesperson t pointed to the New York Caring Majority as an example of “more legitimate ways” to advocate for improved conditions for home health care workers. The coalition of state groups goes back a decade and has been credited with the inclusion of long-term care in the New York Health Act and the establishment of the Home Care Jobs Innovation Fund, which provides support that enables older adults and disabled people to remain in their homes.

Cornell assistant professor Yiran Zhang told Prism that the large labor movement around the 24-hour workday has found a home in New York because a majority of the state’s home care workers are located in the New York City metropolitan area, making the issue “highly relevant” to the region. The political composition of the area also makes pro-worker regulation “more likely to occur at the city level.”

“On the other hand, most regulations and public funding rules for home care are at the level of New York State,” Zhang said. “This tension makes it impossible for the city to reach a well-implemented pro-worker rule without some coordination and engagement with the state rulemaking process.”

Workers say they will continue to push for the No More 24 Act and call for city council members to vote against Adams as the speaker of the City Council. 

In the meantime, workers are focused on their next big rally on May Day. Despite the many challenges of organizing to ban the 24-hour workday, CSWA organizer Zhishun Ning encapsulated the reason workers continue to fight. 

 “We’re reclaiming the right to control our lives and our time,” he said.