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City Council member Christopher Marte, who represents Lower Manhattan in the municipal legislature, is sponsoring a proposed bill that would ban the widespread practice of 24-hour work shifts for live-in health attendants (primarily serving homebound elderly and disabled clients) in New York City. The No More 24 Act, which has attracted a coalition of 13 co-sponsors, would achieve this by prohibiting the agencies that hire these home-health workers from assigning shifts of more than 12 consecutive hours, and cap weekly totals at 56 hours. Mr. Marte says this would align New York City law with labor standards prevalent in the 49 states other than New York.
New York State law currently allows for live-in workers to be paid for only 13 hours out of a 24-hour shift, building into this compensation structure an unpaid eight-hour period for sleep and three hours for meals. In practice, however, home-health aides are often awakened in the middle of the the night (frequently several times each night) by the needs of the people they care for, with meal breaks similarly subject to the exigencies of frail clients.
This controversy is further stoked by that fact that the agencies supplying home-health aides often bill Medicare, Medicaid, and private insurers for 24-hour service, while paying their employees (who are primarily female immigrants or women of color, living at or below the poverty line) for only 54 percent of the time worked. This rate of compensation often yields significantly less than minimum wage.
Opponents of Mr. Marte’s bill estimate that splitting all 24-hour shifts into a pair of 12-hour segments, and paying both attendants for every hour worked, would require New York State to substantially increase its annual budget allocations for Medicare and Medicaid, which, at $96 billion, are already the highest in the nation on a per-client basis. In the current fiscal and political climate, this appears unlikely. But without more funding, opponents argue that such a reform could bankrupt the agencies that supply home-health aides, driving the clients they serve (who are mostly unable to live independently) into nursing homes, which would overwhelm a system that is already operating at full capacity.
Local 1199 of the Service Employees International Union, which represents many home-health aides, says it supports finding a way to end 24-hours shifts, but not without budgetary fixes. A spokesman argues that the union is “committed to fighting for the needs of our members and all workers, and that includes making sure they have the tools they need to work and live with dignity. We wholeheartedly believe that this dignity extends to workers being fairly compensated for the hours they work. Converting 24-hour cases to two twelve-hour shifts would cost $1 billion, which must be allocated by the Governor and State legislature.”
At a February 18 City Council hearing presided over by Mr. Marte, Zhen Li was one of a succession of home-care workers who testified. She said, “the 24-hour workday has not only seriously harmed the physical and mental health of home care workers, it has also hurt my family. Over ten years ago, I immigrated here with my son. My child was in school; my husband worked in a noodle factory. That was when my family needed me the most. But because of 24-hour shifts, I was away from home for four to five days at a time and could not take care of my family at all.”
At the conclusion of the hearing, Mr. Marte said, “today, we heard directly from the workers who hold our care system together, and their stories are heartbreaking and impossible to ignore. These are people who care for our parents and grandparents with compassion and dignity, yet they are being asked to sacrifice their own health, their sleep, and time with their families just to earn a living. No one should have to choose between caring for others and caring for themselves. The message from today’s hearing was clear: the 24-hour workday is cruel, outdated, and unsustainable.”
Matthew Fenton
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