Inside NYC Home Care Workers’ Fight to End 24-Hour Work Shifts

Thousands of home care workers in New York City complete 24-hour shifts and suffer from chronic illness after years of overwork and sleep deprivation.

Xuandi Wang

On October 18, thousands of home care workers and allies rallied at New York's City Hall to push for the "No More 24" bill, a legislative effort to end the current 24-hour shifts in the home care industry. Photo by "Ain't I A Woman?!" campaign

Shuzhen Ruan, in her early 50s, emigrated from China to New York City with her son in 2009. With a limited command of English and a reluctance to undertake technical training due to her age, she opted for a common path embraced by many other Chinese immigrants in the city and became a home care worker in 2010, tending to elderly patients afflicted with chronic illnesses. Despite Ruan’s repeated objections, the healthcare agency, Amazing Home Care, signed her up for 24-hour shifts, warning her that if she refused, she would lose her job.

Ruan says she needed the money and didn’t have other work options, so she reluctantly agreed. But it came at an incredibly steep price, as she began 12 harrowing years of overwork and sleep deprivation.

This was the only type of work I could do for someone at my age,” Ruan says. I could barely get any sleep. When the patient got hungry at two or three a.m., I had to get them up and cook for them.”

On one occasion, Ruan’s patient, a woman in her 90s who is suffering from paralysis, slipped in the bathroom and fell on Ruan when she tried to help her up, fracturing Ruan’s arm. In order to skirt responsibility, Amazing Home Care demanded that she not report it as an occupational injury and coerced her to return back to work without any sick leave. In These Times reached out to Amazing Home Care for a comment and did not receive a response. 

Ruan retired 12 years later, in 2022, and has been left with severe insomnia after years of working 24-hour shifts — she must take sleep aids every night — and has a permanently impaired arm that does not fully extend. 

Ruan is not alone. Yukchee Shek, 59, started working as a health care provider at Americare in 2012 so that she could secure a pension for her retirement. She initially shared the 24-hour shift with another home care worker, but about three years later, Americare told her that the government was running out of money. She was then placed on a 24-hour shift, with the company justifying this move as a cost-saving measure, effectively paying her for only 13 hours of work. The company was stealing our salary like a bandit,” Shek said. By 2019, the toll of sleep deprivation and relentless overwork had taken a severe toll on her health, forcing her to cease working entirely. Since 2019, Shek has remained unemployed and has faced ongoing challenges in her pursuit of a pension.

“I could barely get any sleep. When the patient got hungry at two or three a.m., I had to get them up and cook for them.”

Determined to rectify the injustices in their former industry — and make sure no one suffers the way they did — Ruan and Shek have spent the past year organizing with hundreds of fellow home care workers in a collective effort to pressure the city of New York to adopt Intro 175, the No More 24” bill, through an organizing campaign called Ain’t I A Woman?!” intended to put a stop to the current 24-hour shifts in New York City’s home care industry.

On October 18, Ruan joined hundreds of home care workers and allies at City Hall to rally for the legislation. It was one of the campaign’s efforts to end the ongoing exploitation of immigrant labor in the home care industry, following its previous partially successful attempt to help underpaid home care workers receive their owed back pay and overtime.

If the bill passes, any 24-hour shift in the home care industry would be split into two 12-hour shifts. This would overturn the current practice upheld by a 2019 ruling from the New York State Court of Appeals, allowing healthcare providers to only compensate their workers for 13 hours of their 24-hour shifts, with three hours for meal breaks and eight hours designated to rest — five of which should be for uninterrupted sleep.”

Following former New York Gov. Andrew Cuomo’s successful campaign to privatize state Medicaid dollars in the 2010s, health insurance providers — who contracted with local home care providers and pay workers through Medicaid reimbursements — became incentivized by the 24-hour shift structure to reduce their payments to workers.

Zishun Ning, an organizer with the "Ain't I A Woman?!" Campaign, spoke during the rally. Photo by Ben Weng

However, the stark truth regarding these 24-hour shifts, as highlighted by Jumaane Williams, the Public Advocate of the City of New York, is that home care workers often do not enjoy the expected hours of uninterrupted rest. Their patients generally require continuous care, so home care workers persist in their duties without appropriate compensation for these extended hours of service, according to Williams’ testimony before the city council in 2022.

As a result of long work hours, completing physical tasks and getting little to no rest, home care workers themselves have developed chronic conditions that endanger themselves and the quality of care they can provide to their patients,” Williams said. We cannot allow home care workers to choose between working unconscionable hours just to make a living versus preserving their health and safety but risk losing income.”

The heaviest burden of the 24-hour work structure often falls on immigrant workers of color, who confront numerous obstacles in their efforts to assert their rights. New York State Assembly Member Ron Kim says that home care providers, such as the Chinese-American Planning Council (CPC), have resorted to using intimidation tactics, such as threatening their employees with allegations of Medicaid fraud should they report their true work hours. Despite years of worker grievances and legal actions, organizations like CPC have operated with impunity, shielded by the veil of forced arbitration, according to Kim. CPC touted itself as a progressive organization and received public donations during the peak of anti-Asian hate crimes. However, as Kim disclosed during a public hearing before the city council last year, CPC forged an advantageous agreement with 1199SEIU, one of the nation’s most influential healthcare labor unions, drastically reducing the compensation workers could otherwise get. 

In 2015, home care workers who believed they were unfairly compensated took their case to court. However, 1199SEIU mandated mandatory arbitration for all its members, preventing them from individually pursuing court action, according to Kathy Lu, an organizer affiliated with the Ain’t I A Woman?!” campaign.

Four years later, in 2019, the 1199SEIU initiated a class-action lawsuit against 42 home care agencies on behalf of the union members, alleging that these employers had violated federal wage and hour laws by failing to adequately compensate their workers for sleep and mealtime interruptions during 24-hour shifts.

An arbitrator eventually sided with 1199SEIU and its members by concluding that all 42 employers had violated various laws. However, some activists and Kim alleged that 1199SEIU entered into a covert agreement with the insurance companies to minimize the compensation. This agreement resulted in a settlement totaling approximately $30 million — a payment of $250 for each of the 120,000 healthcare workers represented by the union who had worked between 2013 and 2021. Many former and current workers say this sum falls far short of compensating them for the years of unpaid wages and the physical and emotional toll their work took on them. Many have decried the settlement as an insult” to women of color and have joined in a protest to voice their dissent.

After 42 agencies were found to owe billions in back wages, 1199 lawyers cut an agreement on the workers behalf for pennies on the dollar,” Kim says. Nothing is being done at the state level to enforce abuse of workers or a basic wage loss. … This is the case of total [n]avigation of government duty and an example of what happens when we outsource and privatize public work. … [Are] Asian immigrants and women workers less human to you? The progressive establishment of certain groups, including DSA members … who pride themselves on workers’ rights, should be ashamed that they’ve empowered and validated nonprofits to enforce racial and gender hierarchy in our city.” 

Legal documents 1199SEIU filed in a separate but similar lost wages suit show that the union decided to pursue the tactic of mandatory arbitration because it could lead to substantially less payment for its members than successful individual lawsuits, because full reimbursement could challenge the status quo of the home care agencies. Employers would not be financially able to sustain many of these claims,” the union wrote in a statement released on Jan. 9, 2020. It filed a class action lawsuit on behalf of its entire home care membership to stave off the fragmentation and destabilization of the unionized home care sector.”

Ruan said that after the settlement, 1199SEIU requested her to sign an agreement before she received her compensation that dictated she should not sue her employer. The union did not disclose the specific amount of the compensation to her. Ruan opted not to accept the settlement, saying that the offered compensation couldn’t even cover my commute expenses.” A similar story was documented by New York Focus, in which a home care worker decided against submitting a claim when she learned the settlement would not fully reimburse her for lost wages.

Protestors accuse Speaker Adams of thwarting the bill by not putting it on to vote. Photo by Ben Weng

Following an extensive eight-hour hearing conducted at New York City Hall in September 2022, insurance companies and home care agencies initiated communications with Speaker Adrienne Adams’ office in a bid to thwart the No More 24” bill, according to Christopher Marte, a New York City Council Member who represents Lower Manhattan and introduced the legislation. Despite the bill having received endorsements from numerous council members and the chair of the Committee on Civil Service and Labor, the Speaker has not provided a substantive rationale for the delay in bringing the bill to a vote, Marte said. In October, he highlighted that if the bill is not advanced within the next three months,” workers will be compelled to restart the process in alignment with the new legislative calendar.

The Speaker’s office … is trying to not move forward [the Bill],” Marte says. A lot of these [healthcare insurance] companies donate a lot to higher elected officials. They have been a big obstacle throughout this whole process because they have such great influence, and they don’t even want this conversation [about home care workers’ rights] to start.”

While the City bill has received broad, bipartisan backing within the council—at least 29 council members supported it in 2022—a number of council members who originally endorsed the legislation have subsequently rescinded their support after talking to the union. Amanda Farías, a freshman Council member from the Bronx, had initially lent her support to the bill, but following conversations with 1199SEIU, she began to harbor reservations regarding workers’ prospects for overtime pay and concerns related to patient safety.

Jenna Jackson, a Communication Representative for 1199SEIU, said that one of the main reasons that the union is against the bill is because the issue of 24-hour shifts should be addressed at the state level. The union, however, actively helped stall a similar statewide bill that would have banned 24-hour shifts statewide. 

In a written response to In These Times, the Speaker’s office echoed the talking point and said that the 24-hour work shift needs to be addressed on a state level, pointing to another state bill introduced during the new legislative cycle. However, because the vast majority of 24-hour shifts are in New York City, activists believe it is easier to garner the support for a city-wide bill. Several State Assembly members also agreed that a bill at the city level could create more momentum and help move Albany to pass further legislation protecting home care workers. The squeaky wheel gets the grease,” New York State Assembly member Richard Gottfried said during the 2022 hearing. What needs to happen is that more of that squeaking wheel needs to be on behalf of home care.”

Marte attended the Oct. 18 rally along with other home care workers. We tried a lot of the internal workings of the government to move the bill along. Having a large protest can hopefully tip the scale to our side. The special interests want to control the narrative,” Marte says. But by having these mass actions, and protests, we can highlight the individual people who are being affected by this, and their story is so powerful, and their stories are the ones that really convince people that we have to end the 24 hour workday.”

Invigorated by the mass turnout of the Oct. 18 rally, Zishun Ning, an organizer with the campaign, says they are planning to turn the rally into a monthly event if the City Council continues to ignore their demand.

The labor union didn’t fight for us, and the media didn’t care about us,” Shek, the home care worker, said. The government call us protestors thugs. But we protest only because nobody has ever advocated on our behalf. We have to go out and protest on our own, or more of our sisters will die.”

[Clarification on Dec. 23, 2023: An email and a follow-up email intended to seek comment from 1199SEIU United Healthcare Workers East or 1199SEIU spokespersons in New York were sent to incorrect organizations. In These Times has connected with a spokesperson from 1199SEIU (Downstate NY & LI) and will update this article further if necessary.]

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Xuandi Wang is a former editorial intern with In These Times and a freelance writer. You can find more of his work at xuandi​wang​.com.

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