No More 24: Making Care Work Visible and Valued

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Every day in New York City, home care workers are pushed to the limits of human endurance. Many — overwhelmingly immigrant women of color, including older workers — are expected to remain with patients for 24 hours at a time, sometimes for multiple consecutive days. This model exhausts workers, damages their health, separates them from their families, and compromises the care patients are supposed to receive.

Shadowbanned spoke with some organizers from the Ain’t I A Woman campaign to learn more about the fight to end the 24 hour work day.

The price of working 24 hours

Luz Estrella has worked as a home care worker for roughly two decades. Twelve of those years were spent working 24-hour shifts. She described caring for elderly patients with dementia —helping them use the bathroom, bathing them, changing them, feeding them, cleaning, repositioning them in bed, and performing the physical labor required to move patients who could not move themselves. Estrella described the physical consequences of years of this work: serious pain, surgeries, high blood pressure, and heart problems that now require monitoring. But this also take a toll on worker’s personal life. At one point, while she was working a 24-hour case, Estrella faced a serious emergency involving her son. She called the agency and asked for a replacement worker so she could be with her family, but they denied her request.

For Estrella, the experience remains painful to recount. Speaking about those years brought her to tears. She compared the experience to being chained and described the treatment of home care workers as a form of modern-day slavery.

Dividing the Shift, Restoring the Care

There is an important distinction between being at work for 24 hours and providing 24 hours of care. Under the existing framework, agencies can treat portions of a 24-hour shift as unpaid if a worker is supposedly able to receive uninterrupted sleep and meal breaks. Organizers argue that this bears little resemblance to what actually happens on many cases.

Consider the reality of caring for someone living with dementia. You cannot flip a switch and turn off your responsibilities for an eight-hour block. If the patient wakes up disoriented, tries to wander, needs to use the bathroom, requires physical repositioning, or faces a sudden midnight emergency, the worker has to be right there, on duty, and responding.

Making workers peform under these conditions also hurts the patients. If a worker cannot provide the attentive care a patient deserves, due to exhaustion then the patient suffers as well. The campaign’s argument to replace the single 24-hour marathon with two 12-hour shifts is not only for the workers, but also for the patients.

Who Pays for the Exhaustion?

The economic structure behind the system is at the heart of the workers’ critique. Organizers argue that agencies and the private insurance companies that administer Medicaid have an incentive to minimize what they spend on labor. Keeping a single worker attached to a 24-hour case can be cheaper than paying two workers to cover separate shifts. The savings, organizers argue, come directly out of workers’ time, wages, and health.

The arrangement also affects worker’s overtime and benefits. If a worker is paid for only 13 hours of a 24-hour shift, the unpaid hours disappear from the wage calculation even though the worker has remained at the job for the entire 24-hour period. As one organizer explained, a worker who is scheduled for four 24-hour shifts in a week could officially be credited with 52 hours of work — 13 paid hours per shift — while actually being required to remain at the workplace for 96 hours. Under that calculation, the worker would receive overtime on only the hours recognized as paid time, rather than on the full amount of time spent on the case.

Organizers argue that this structure can produce enormous amounts of stolen wages, particularly through unpaid overtime. Union 1199 — largest healthcare workers’ union in the United States — successfully sued to recover unpaid wages. In an arbitration case that concluded on February 27, 2022, 42 home-care agencies were deemed liable for $30 million in back pay to their (mostly immigrant women) workers. Still, the Ain’t I A Woman campaign told LaborPress at the time that this sum was still likely undercounted. By the campaign’s estimate, one of agencies, the Chinese-American Planning Council (CPC), could’ve committed $90 million in wage theft for the time period outlined in the arbitration case. On the individual level, the Ain’t I A Woman campaign found one of CPC’s employees, Lai Yee Chan, may be due nearly a quarter million dollars in back pay.

In addition to eating into their paychecks. Organizers also argue that the way hours are counted can affect eligibility for union health benefits. Some workers must reach a monthly threshold of hours to qualify for health insurance. If only the paid portion of a 24-hour shift is credited toward that threshold, workers can be required to remain on 24-hour cases simply to accumulate enough credited hours to maintain their benefits. As organizers describe it, agencies can effectively present workers with a choice between accepting the 24-hour arrangement or risking losing access to health coverage.

Opponents of No More 24 have argued that eliminating 24-hour shifts could leave patients without care or force them into institutions. Workers and their allies say this as a false choice. They point out that many parts of New York State already operate with split shifts rather than the same 24-hour arrangements found in New York City.
They also point to agencies in New York City that have begun splitting shifts as a result of worker organizing, and any resistance to do so is a result of companies wanting to keep wide margins.

The Immigrant Women Keeping New York Running

This exploitation also has to be understood in the context of who performs this work. New York City calls itself a sanctuary city for immigrants, but sanctuary from immigration enforcement (which is not guaranteed anymore) does not necessarily mean sanctuary from exploitation.

The workforce at the center of No More 24 is overwhelmingly made up of immigrant women and women of color. Kiran Choudhury, a retired New York City public school teacher, explains, “Many of the home care workers in New York City were garment workers. When the garment industry went south, to the southern states, and the global south, workers turned to the home care industry.” Because of their immigrant status they are least likely to “rock the boat” and employers utilize their vulnerable positioning to maximize profits.

The political rhetoric surrounding immigration frequently portrays immigrants as a burden on public resources. The home care workforce reveals the opposite. Immigrant workers are providing the labor that sustains one of the city’s most essential social systems.

The fact that so much of this work is performed by immigrant women adds another layer to this exploitation. Care work has historically been dismissed as “women’s work” — something supposedly natural to women, something performed out of love, compassion, or devotion rather than skilled labor. This mindset allows institutions to demand extraordinary sacrifices from the workers performing it. Choudhury, put it, people repeatedly told her she was “devoted.” Reducing the sacrfices she to a personal choice rather than a systemic failure.

Four Years of Political Obstacles

According to organizers, the No More 24 Act has faced years of political delay, including a four-year period during which former City Council Speaker Adrienne Adams blocked the bill. Workers responded with increasingly militant organizing: hearings, demonstrations, sit-ins, and hunger strikes. They held a five-week sit-in outside City Hall and an eight-day hunger strike.

Although some agencies have started splitting shifts due to increased pressure, workers want more than individual agencies changing their practices. They want the 24-hour shift system ended through legislation, so that workers’ rights do not depend on which agency they happen to work for.

If you are in New York, there are several ways to support the Ain’t I A Woman campaign. You can join workers at their October 3rd picket at City Hall at 12:00 p.m., contact your state legislators and ask them to support legislation ending 24-hour shifts, share information about the campaign with your networks, and listen to and amplify the voices of home care workers organizing around the issue. You can also support worker-led organizations and efforts fighting for fair wages, humane working conditions, and the recognition of care work as real work.

To take action visit https://nomore24.org/no-more-24/

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