ILR Press

Home Care Workers and the Need for Alliances

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Home care workers are at the bottom of the health care hierarchy alongside elderly and disabled people. Home care workers assist people with crucial daily activities like bathing, eating, and keeping a clean house. Yet, they work in temporary and part-time jobs with low pay, few benefits and, too often, are disrespected. They are disproportionately immigrant women and women of color so these inequalities reflect, and reinforce longstanding racial injustices. Such worker insecurity puts elderly and disabled people and their autonomy at risk and threatens their dignity.

The coronavirus pandemic exacerbates these preexisting inequalities. Now more than ever, home care workers, elderly and disabled people, and home care systems need our attention.

Home care workers are at the bottom of the health care hierarchy alongside elderly and disabled people.

How can we change the way we think about home care workers and ensure both quality care and quality work?

In my new book, “Home Care Fault Lines: Understanding Tensions and Creating Alliances”, I compare how four government-funded programs differ in the way they organize home care. My analysis uncovers key problems with the way we deliver home care. I also chronicle some of the advocacy of workers, elderly and disabled people, and their organizations, which are generating the ideas and building blocks for change.

One key ingredient for the sweeping changes required is alliances between workers’ associations or unions, elderly and disabled people’s organizations, and allies in the broader public.

One key ingredient for the sweeping changes required is alliances between workers’ associations or unions, elderly and disabled people’s organizations, and allies in the broader public.

I argue that creating the deep and enduring alliances necessary for systemic change requires recognizing fault lines in home care systems and tensions at the personal level, and how they are connected.

Understanding tensions in context

My analysis in this book rests on over 300 interviews revealing how a variety of players shape the conditions of care and work in unique home care contexts in Los Angeles and Toronto.

I trace elderly and disabled people’s quest for flexible services to fit their varying needs. I also sketch workers’ search for security in employment contracts and respectful conditions, a journey that often starts with migration.

Tensions between flexibility and security can bubble up in the care-work relationship. So, drawing also on interviews with program officials, employers, labor and disability advocates, I excavate the dynamics that fuel everyday tensions and reinforce structural fault lines.

I join others who find that funding based on a narrow, medical definition of need and delivery of care through a market logic encourages employers to hire workers on precarious contracts and also reinforce gendered and racialized labor market inequalities.

My comparative analysis reveals how narrow funding dovetails with marketization to discourage employers from mediating tensions in the daily labor process and to make collective action difficult. For example, tensions between people’s need for flexible tasks and workers’ experiences of gendered and racialized servitude ignite in contexts where cleaning has been defunded and profit motives reign. In these settings, employers leave it up to individual workers and service users to negotiate what is done and how.

Yet, I also found systems that worked better for both workers and elderly and disabled people.

Creating alliances for flexible care and secure work

My analysis reveals not only home care fault lines but also the potential for change.

I argue that, if the goal is both flexible care and secure work, we must foster coalitions that address tensions at the labor process, labor market and government levels.

My analysis reveals not only home care fault lines but also the potential for change.

We need universal funding for home-based elder care and disability support. We also require labor market intermediaries to meet people’s varied needs for care and support and help workers find multiple jobs and make a living income.  

Finally, we need critical education to assist in challenging inequalities at the nexus of race, immigrant status, gender, age, and disability when they emerge in the labor process.

The comparative analysis in this book shows the importance of labor-community alliances that cultivate grassroots leadership of home care workers and elderly and disabled people. Such deep and democratic alliances could create the political and social will for the necessary multi-level, systemic changes.


Cynthia Cranford is Associate Professor of Sociology at the University of Toronto. Her research investigates the intersection of labor, gender, and migration through case studies and broader labor market analysis and is published in Gender & Society, Gender, Work and Organizations, Industrial Relations, Just Labour, Social Problems, Work, Employment and Society, and other journals. She is also the co-author of Self-Employed Workers Organize: Law, Policy, and Unions. Follow her on Twitter @Cranford1971.

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