A labor of love - and low pay

A RECENT report in the medical journal The Lancet estimates that half the babies born in the United States this year will live to age 100. That means plenty more work for people like Evelyn Coke. Coke was a home care aide who spent more than three decades taking care of elderly shut-ins on New York’s Long Island. She bathed, dressed, and cooked for them, kept an eye on their prescriptions, and saved the health care system millions by keeping them out of nursing homes. For this the Jamaican immigrant was paid roughly $7 an hour.

Like most home care aides Coke worked for an agency on an hourly wage, and was not compensated for driving time between appointments. Nor did the job include health care or other benefits, nor overtime, sick days, or holidays.

This is all perfectly legal. In 1974, Congress amended the Depression-era Fair Labor Standards Act in order to cover domestic workers. But it explicitly exempted “home companions’’ such as babysitters or caregivers for the elderly, who were often relatives.

That might have made some sense in the early 1970s, when families stuck close together and women were not working in great numbers. But the US Department of Labor chose to include even aides hired through commercial agencies in the “home companions’’ category, and never updated the regulations. Thus workers laboring 10 or more hours a day are not covered by overtime laws or the minimum wage.

If demographics is destiny, many thousands of Evelyn Cokes will be added to a home care work force that already numbers about 1.5 million - 32,000 in Massachusetts alone. This overwhelmingly female army of workers answers to a bewildering array of titles - home health aide, personal care attendant, homemaker, custodial care giver - with different regulations in each state. In Massachusetts, for example, a homemaker is allowed to cook for her client, but not to feed her.

The one thing they have in common is low pay. A study by the Direct Care Alliance, an advocacy group, says wages for personal and home care aides - a national median of $9.22 an hour - have not kept up with inflation and are falling in value. An advocate succinctly described the system as “poor young women taking care of poor old women.’’

Many home aides love the work and some love their elderly charges. But make no mistake: it is a job, and the workers deserve a decent wage.

In 2001, Evelyn Coke was in a car accident. When a lawyer she consulted looked at her pay stubs, he discovered that she had never been paid overtime, despite working back-to-back shifts, and he urged her to sue. The case went all the way to the US Supreme Court, but in 2007 the court ruled that it was up to the Department of Labor how broadly to apply protections of the law.

Sporadic efforts to correct the injustice have so far failed. In its next-to-last day in office, the Clinton administration filed new regulations to cover home care workers in the labor laws. But the Bush administration dropped it (and argued against Coke in her Supreme Court case).

In a familiar refrain, industry groups such as the Private Care Association oppose the changes, arguing that giving workers better pay and benefits will only raise the cost of the care, making it less available to needy elders. But this is pitting poor old people against poor young people, an odious tactic.

Some 52 House and Senate members have written to Labor Secretary Hilda Solis asking her to update the home companion regulations. Solis said in June that she shared these concerns and wants to make sure all workers’ rights are protected. But little has stirred on this front since.

It’s too bad. Solis might have been able to bring long-overdue justice to home care workers with Evelyn Coke at her side. But that won’t happen now: Coke died in July of heart and kidney failure. She was 74. Her obituary said that she had neglected her health for years, until she was old enough for Medicare, because she never had health insurance. She couldn’t afford a home care aide.