“If women are devalued in the marketplace, women of color are even more devalued in the marketplace,” said Albelda, who studies women in the low-wage workforce. But it’s not just about low pay. The majority of home care workers get zero benefits. About 88 percent of domestic workers don’t get paid time off, sick time, employer-sponsored health insurance, or any other benefits. Angelica, for example, never gets a day off. “Take a day off? And miss paying a bill? I can’t really afford to take a day off,” she said. So she worked through Christmas Eve and Christmas Day, New Year’s Eve, New Year’s Day, and every holiday since. When her son is sick or her car breaks down, she can have a co-op colleague cover her shift, but Angelica won’t get paid. That means it’s even harder for her to make rent. “We don’t go out; we don’t do anything that month. It’s just ramen and eggs to survive,” she said. Yet she’s one of the lucky ones. Because Angelica is part of a co-op instead of working at a for-profit company, she gets to keep about two-thirds of the money clients pay for her services. The co-op charges clients $18.50 per hour if they need more than nine hours of care each week; Angelica gets $12.50 of that. The rest covers the co-op’s administrative costs and goes toward a pool of money that caregivers will split at the end of the year. That’s not common. About two-thirds of all home care workers are employed by businesses that take a huge cut of the earnings. For example, in New Mexico, the median pay for home health aides is $9.50 an hour, but most agencies charge clients up to $20 an hour, said Adrienne Smith, director and CEO of New Mexico Direct Caregivers Coalition, which advocates for home care workers. “It’s a really crummy job,” said Smith. “They are undervalued, underpaid, and overworked. Smith notes that the fast-food chain Wendy’s pays about the same but provides workers with health insurance. Deborah Brockington, the home care worker in North Carolina, gets $10 an hour to care for two sisters who live together, five days a week. One is 75 and the other is 86, and they have trouble with basic tasks. So Deborah dresses them, brushes their teeth, cooks, and does light housecleaning for them. Unlike Angelica, Deborah works for a home care agency that placed her with the clients. She hasn’t gotten a raise in four years. Deborah said she believes the company charges clients at least $22 or $23 per hour but doesn’t know for sure because the companies don’t tell their workers. When she recently asked for a raise, her boss said no. “[My supervisor] said that if I needed more money, I had to work more hours,” she said. Deborah is on Medicaid and qualifies for food stamps. Two months ago, her car was repossessed because she couldn’t pay the monthly lease. Now she takes a bus and walks nearly 2 miles to get to work, unless she can get a ride. “I am tired, I’m frustrated,” she said in a phone interview. “I get my paycheck and I can’t pay for some things I need to pay for.” Dombi, whose group represents the home care agencies like the ones that hire caregivers such as Deborah was one of several people Vox spoke to who placed a lot of the blame on governments for keeping wages low, in particular through state Medicaid programs. The health insurance program only pays about $12 to $15 an hour for home care work, depending on the state. So agencies pay low wages to cover payroll taxes, training, and background checks while still turning a profit. “It puts [agencies] in a terrible position,” Dombi said. “They don’t want dissatisfied workers. Turnover creates costs.” He argued that lobbying states to reimburse home care providers at a higher rate is one possible solution. Lawmakers could even include a provision ensuring that the rate increase would go entirely toward increasing pay for home care workers. Kezia Scales, director of policy research at PHI International, a national nonprofit that advocates for home care workers and their clients, agreed with Dombi. But she pointed out that agencies have many private clients who can afford to pay higher out-of-pocket rates, but that doesn’t translate into higher pay. “What we’re seeing is wages remaining low all across the sector,” Scales said. “This is where we confront a need to better finance our long-term care systems.” If nothing changes, said Cornell’s Litwin, there will be an extreme home care shortage. “This may be a crisis that can only be solved through policy,” he said. Violence on the job Another reason the job has high turnover: It’s exhausting — physically and mentally. Clients with dementia can be difficult. They get confused, disoriented, and overwhelmed, which often gets translated into aggression and depression. Mood swings are common among clients with developmental disabilities too. Amalia Rodriguez, a 54-year-old immigrant from Mexico, runs the caregivers co-op Heart Is Home in Albuquerque that Angelica is part of. She occasionally fills in when Angelica and other caregivers are sick. Before that, she worked for an 85-year-old woman who, she recalled, repeatedly made racist, derogatory comments about immigrants and Mexicans. It often happened when Amalia was driving her to doctor’s appointments. They would see someone asking for money at an intersection, and it would set her client off, regardless of whether the person was Latinx. “She would say, ‘Mexicans are lazy and they just want everything handed to them,’” Amalia recounted. In February, Amalia pointed out that a homeless person could be a veteran, and asked her client why she thought he wasn’t getting government help. “She said, ‘You don’t know anything about the law; you just make stuff up. If you don’t like America, why don’t you go back to Mexico?’” Amalia said. She quit. “Our work isn’t valued and we’re treated as inferiors,” Amalia said. “Not to mention what a hard job this is — transferring immobile, heavy [clients] all around the house.” Yet home care agencies offer little to no training on how to deal with difficult situations, said Smith, of the New Mexico Direct Caregivers Association. Amalia, for example, never learned the proper way to move immobile clients until she heard about the nonprofit and participated in its free training programs. If she’d injured herself at the job she had before the co-op, she wouldn’t have been entitled to workers’ compensation because home care workers are not considered their clients’ employees. Now Smith’s organization hosts free training sessions for home care workers. Sometimes the sessions focus on communication with clients, but they’re also about self-care and personal safety. On a recent Wednesday, Smith led a session for five women who work at a group home for people with developmental disabilities. The point of the training was to help the caregivers deal with difficult clients. “What do you think is most challenging for you, emotionally, in these settings?” she asked the group of women seated around the kitchen table. When we get hit,” answered one woman. “We tend to take a lot of physical abuse, mental abuse, you know,” said another. “We’re called every name in the book and get spit on. Stuff can get pretty physical. When a client is having a behavior, they have rights, so we can’t do anything to protect ourselves ... we have to literally just stand there and get the physical abuse. And that’s very frustrating.” She then described a recent scenario in which a client grabbed a colleague’s hair, pulled her into a corner, and spit in her face several times. “So what is it like when you’re hit and spit at?” Smith asked. “It messes with you mentally,” one caregiver said. “It makes you traumatized.” “It makes you question if this is something you want to commit to. Is this a place I want to be at?” said another, adding that it’s normal to get bruises and black eyes at work. “It’s degrading.” Caregivers Rebecca Williams (left) and Savannah Williams listen during the training. “I feel good knowing that I am helping somebody’s family member, even though it’s not mine,” one caregiver answered. “And I would hope that if I were in the same situation and it were one of my family members, I would want them to get the best care possible.”

Their answers reflected a deep empathy and willingness to put others’ needs before their own — a willingness too often taken advantage of by employers and lawmakers who won’t even give them the right to a safe workplace.

Congress created loopholes to deny labor rights to home care workers

Nearly every expert interviewed for this story pointed to historical reasons to explain why home care work is difficult: American society has always undercompensated the work of women, immigrants, and people of color.

“It’s part of America’s historical legacy that work considered unskilled and primarily done by women and people of color is not recognized as a distinct occupation,” said Scales, of PHI International.

That legacy is one reason behind the gender and racial pay gaps. Women are still earning 80 cents for every dollar a man earns, and women of color earn as little as 53 cents on the dollar.

That legacy also helps explain why Congress excluded domestic workers and farmworkers from the first federal labor protections it passed in the 1930s as part of the New Deal.

A group of farmworkers protest from the back of a truck during a strike in California in 1933.

The Fair Labor Standards Act (FLSA) of 1938, for example, excluded both groups from the right to earn the minimum wage or get overtime pay. Farmworkers and domestic workers were left out as a concession to Southern lawmakers, whose constituents were highly invested in paying low wages to personal servants and farm laborers.

At the time, that workforce was overwhelmingly black and Latinx, and excluding them from a minimum wage was intentional. Today, about a quarter of farmworkers and 67 percent of housekeepers earn less than the minimum wage. Their second-class status is directly tied to America’s legacy of slavery and racism.

Lawmakers amended the FLSA in the 1970s to cover most domestic workers, but not live-in housekeepers, nannies, and home health aides who provide “companionship services.” Because most caregivers are also companions, the amendment meant that home health aides — once again — were excluded from minimum wage and overtime rules.

Both groups were also left out of the National Labor Relations Act of 1935, which gave workers the right to form labor unions and organize for better working conditions.

When Congress passed the Civil Rights Act in 1964, some domestic workers were left out again. That’s because the law didn’t include protections for workers whose employers have fewer than 15 employees. To this day, it’s not illegal under federal law for employers to sexually harass their nannies and housekeepers, or to discriminate against them based on race, religion, gender, or national origin.

The same thing happened when Congress passed the Occupational Safety and Health Act in 1970. The landmark labor law, which established a worker’s right to a safe and healthy

work environment, didn’t extend that right to domestic workers and farmworkers.

This is not a tiny part of the workforce: About 2 million people in the US do domestic work, according to the National Domestic Workers Alliance.

Activists march toward the German Consulate in New York during a 2017 rally to support two Filipina domestic workers in their lawsuit against a German diplomat.

In 2015, the Obama administration closed some of the FLSA loopholes. The Labor Department finalized a rule that year clarifying that caregivers who spend most of their shift helping clients dress, bathe, eat, or clean are not excluded from federal labor laws as mere “companions.” But that still left some space for employers to argue that their caregivers aren’t covered by the FLSA if they don’t spend most of their shift doing chores or helping their clients bathe and dress.

Domestic workers are no longer accepting the status quo, though.

Caregivers are fighting back

The fact that home care workers and nannies can’t unionize has made it hard for them to fight congressional efforts to exclude them from labor protections. So instead, they began organizing without a union at the national level in 2007, launching the National Domestic Workers Alliance, the nonprofit group that advocates for housekeepers across the country and has pushed change at the state level.

So far, nine states have passed laws extending labor protections to domestic workers: Oregon, California, Connecticut, Illinois, New York, Massachusetts, Hawaii, Nevada, and New Mexico. In July 2018, the city of Seattle did too.

The group has since taken its campaign to Capitol Hill. Hundreds of domestic workers have been traveling to Washington, DC, in the past year to talk to lawmakers about their need for federal labor protections. In April, a group of them met with Sens. Kamala Harris (D-CA) and Elizabeth Warren (D-MA), Rep. Pramila Jayapal (D-WA), and other women they believe will support their cause. In July, Harris and Jayapal introduced the National Domestic Workers Bill of Rights.

Sen. Kamala Harris (D-CA) meets with domestic workers and farmworkers seeking federal protection in Washington, DC, in 2018.

The legislation would essentially amend federal labor laws to include domestic workers. But it would also extend new benefits to them, such as guaranteed paid time off, privacy protection, and a written employment contract.

Republicans have long resisted laws extending labor rights to workers, so the bill has little chance of passing the GOP-controlled Senate, but domestic workers have momentum on their side with successes at the state level.

New Mexico became the ninth state to pass a domestic workers bill of rights law earlier this year, requiring employers to pay all caregivers the minimum wage and overtime. The law also protects workers like Angelica against sexual harassment and discrimination.

During my visit, Angelica told me she planned to file an official report about the masturbation incident with her last client. Now she is entitled to overtime pay too.

Despite all the drawbacks, Angelica is surprisingly happy doing her job. (She even remained cheerful after her shift, when her car broke down for good.) She says it’s the best job she’s ever had because she loves talking to people, and she feels particularly invested in it as part-owner of the co-op.

Angelica waits with her car after it breaks down outside Albuquerque. “It’s a struggle,” she says. “But when is it not? Life’s always a struggle if you’re a single mom.”

The low pay is hard, she explained as she defrosted hamburger meat to prepare for her client, but other things can upset her more. Like saying goodbye.

One of the women she took care of recently died, and it was tough on Angelica.

“They didn’t even invite me to her funeral,” she said.

Angelica will soon say goodbye again. Her client, the widow, is moving back to New Jersey in August to live with her son. She spent the morning on the phone scheduling time for the movers to come. Angelica has been helping her pack.

“I’m really going to miss you,” Angelica told her.

Her client sat silently, staring at her address book. She didn’t even look up. Smith moved on.

“What was it that brought you to this field?” she asked the group.

They all said the same thing: caring for people, and the deep human connection it can create Smith moved on.

AND NOW YOU WANT THEM TO BUY A SMART PHONE AND BE TRACKED EVERY DAY OF THEIR LIFE TO DO A $9.40 AN HOUR JOB...  WITH NO BENIFITS ... WHERE YOU CONSTANTLY CUT THEIR PAY BECAUSE THE PROGRAM MESSED UP.. OR SOME SOCIAL WORKER MAKING 50K A YEAR DIDNT DO HER JOB...  THANK YOU DMAS FOR KILLING CONSUMER DIRECTED CARE