According to the most recent data from the US Bureau of Labor, the median hourly wage for home health aides (HHAs) is just $11.52 an hour That rate that has hardly changed for the past decade. In general, the pay for care work is actually lower than other jobs with similar characteristics and requirements.
But why are caregivers paid so little? We have far fewer home health aides than we need, so their pay should rise until enough people take the jobs. Furthermore, the work is often complex, and physically and emotionally difficult. Normally this would increase wages.
There are various explanations for the low wages. But any analysis needs to account for the way American society has undervalued the labor of women, especially women of color. It’s now uncontroversial to say women are underpaid, but it’s still worth unpacking how gender and race came together in the case of HHAs specifically. This social history keeps caregivers underpaid to this day.
Domesticity and the Industrial Revolution
As Evelyn Glenn explains in her book, Forced to Care, caregiving has traditionally been defined as women’s work. That gender breakdown is ingrained and continues today, hence the second shift that modern working mothers put in.
Even if society kept a strict division of labor between men and women, at first the labor of both was considered valuable. Before the Industrial Revolution, the main site of economic activity was the home. People grew their own food and mended their own clothes. Community workshops were usually small and domestic. Caregiving was like any other labor then. It was as important for maintaining the family as anything else, so people looked at it like any other job.
That changed after the Industrial Revolution. Factories replaced homes as the primary sites for production. At that point, the home and the market were split into separate spheres with distinct characteristics and purposes. The world of industry was brutal, mercenary, and focused on production. The home was meant to be calm, quiet, altruistic, and focused on consumption.
Narrow ideas about what a home, and the women in it, should be like kept the new emphasis on money and profits outside the home. People thought of caring for family as motivated by affection, obligation, or responsibility. Supposedly, women did not, and should not, need wages to motivate them to do it. Offering money would taint the feelings that were supposed to inspire care work. Only paid work was considered real work, and people were paid only for work outside the home and in the market.
Domestic Work and the Census
These shifting attitudes toward domestic work were recorded in changes to how the federal census recorded occupations.
Initially, the U.S. Census only measured the number of families working in a given industry. By 1860, it included the individual occupations of the people surveyed. Still, it did not officially recognize the job of housewife.
In 1878, the Association for the Advancement of Women wrote to Congress to argue that “home-keepers” should be considered productive workers, but it did not work. By 1900, wives and daughters without paying jobs were classified as dependents. It did not matter how much unpaid work they did for their families.
Even when women did receive a wage as paid caregivers, that work was still devalued. Because certain jobs were considered appropriate for each gender, people believed that this type of work was easy or “second nature” for women. As a result, they did not need to be paid much to do it.
Domestic labor was also considered a job for young, unmarried women. People assumed these women would stop working once they started families. Although, even at the time, most working women supported families. Young women did not need to be paid much because they had no one else to support.
In fact, people assumed that young women actually benefitted from working in upper-class houses all day: they could learn vital skills for running their own homes eventually.
Together, all these ideas—that domestic labor was not productive work, that it was natural and easy for women, and that it was a job that only young women took—kept wages low.
The Compounding Effect of Race
But the devaluing of care work did not impact all women equally. Domestic service, including caregiving, became explicitly associated with women of color, driving down their wages even further.
As Evelyn Glenn also points out, following Emancipation and into the twentieth century, systemic discrimination shut Black women out of typical occupations for women like retail sales, clerical jobs, and light factory work. As a result, they turned to domestic labor. They had to work because discriminatory welfare laws denied them benefits.
Because women of color did not have many options, employers could keep wages artificially low. In effect, there was no competition from other industries for their labor.
Race and Labor Law
This history of exploiting people of color for cheap domestic labor can be found in some of the most important labor laws.
For instance, the Alien Contract Labor Law of 1885 forbid companies from bringing in immigrants for cheap contract labor to drive down wages. But, among other exceptions, employers could still bring in “domestic servants” to work under contract. This guaranteed that wealthy white citizens could still find cheap servants and caregivers.
Domestic workers were similarly excluded from President Roosevelt’s New Deal legislation in the 1930s.
The Fair Labor Standards Act (FLSA) of 1938 set the Federal Minimum Wage and mandated overtime pay for any time over 40 hours a week. But the FLSA explicitly barred farmworkers and domestic workers from these rights. That is how Evelyn Coke worked 70 hours a week without overtime, before she brought her case before the Supreme Court in 2007.
Omitting farm and domestic work was a way to exclude Black workers without explicitly mentioning race. Black workers in the South were disproportionately concentrated in those two industries. Leaving these industries out of the FLSA appeased the Southern Democrats whose support was needed to pass the bill, but without antagonizing Northern supporters.
With few changes, this exclusion lasted until President Obama finally did away with it in 2013. In the intervening decades, there was little political impetus to improve a job that was dominated by women of color and immigrants, most of whom had no political power.
The Continued Effects Today
Caregivers continue to be underpaid today in part because of who does the work. Of the approximately 2.3 million home care workers, 86 percent are women, 62 percent are people of color, and 31 percent are immigrants. Even among caregivers, men earn more, especially white men. Men of color earn $12.00 an hour, while white men earn $12.38 an hour. White women earn $11.50, and women of color, the majority of HHAs, earn the least at $11.13.
Right now, these low wages are baked right into our healthcare system, most notably the low reimbursements Medicaid provides for long-term in-home care. Because wages are tied directly to reimbursement rates, these rates are a concrete reflection of the low value society places on caregiving.
In Nickeled and Dimed, her famous book on trying to survive on low-wage work in America, Barbara Ehrenreich says that to do this work is “to be an anonymous donor, a nameless benefactor, to everyone else”. A society that depends on this labor should feel “shame—shame at our own dependency, in this case, on the underpaid labor of others.”
Ehrenreich’s point applies to caregiving even more deeply. If we want to start valuing our caregivers and home health aides properly, we need to reckon with our shared history of overlooking the labor of women, especially women of color.
