The women and men—mostly women—who care for our aging and ill relatives, providing both physical and emotional support, sometimes for many years, are among a workforce that has long been underpaid, overlooked and, all-too often, looked down upon. Yet these home health aides, personal care assistants and domestic workers toil in occupations described by the U.S. Bureau of Labor Statistics as among the fastest growing in the United States.

So what does this say about us as a nation? 

“It’s an industry that links our most challenging issues”—wages, benefits, immigration, offshoring, outsourcing, neoliberal politics and more, said historian Jennifer Klein. Klein and Eileen Boris, authors of Caring for America: Home Health Workers in the Shadow of the Welfare State, led a discussion on justice, dignity and health care policy Wednesday at the Kalmanovitz Initiative for Labor and the Working Poor in Washington, D.C.

AFL-CIO General Counsel Craig Becker and Sonya Michel, American history professor at the University of Maryland, joined Klein, an American history professor at Yale University, and Boris, a professor of feminist studies at the University of California, Santa Barbara.

In discussing how those laboring in home health care came to account for 1.8 million low-paid workers today, Klein and Boris began by documenting these workers’ exclusion from the 1938 Fair Labor Standards Act, which provided a federal minimum wage for nearly everyone except domestic workers and agricultural workers, as well as their exclusion from other New Deal initiatives like the National Labor Relations Act, which gave most private-sector workers the ability to form unions. The ensuing decades-long efforts by federal, state and local lawmakers to limit the rights of home care workers stems in large part from the association of such labor with devalued domestic work as well as the unskilled, minority status of many in these occupations, says Klein.

As Michel put it: 

Home care workers are so closely associated with the poor meant they were not valued. 

Although amendments to the FLSA in the 1970s covered nursing home workers and others at institutional worksites, those toiling in private homes were cut out of such coverage, their work constantly subject to the question of whether “it’s a labor of love or real work,” said Klein.

Home care workers’ efforts in recent decades to win a voice at work through unions and workers’ organizations have resulted in hundreds of thousands joining with AFSCME, Communications Workers of America (CWA), the Domestic Workers United and SEIU, said Boris. But these gains are now under attack, Becker noted, with efforts by states and other government entities to move toward systems that would make workers independent contractors and so unable to collectively bargain for a better life.

These new attempts to exclude this growing workforce from basic labor laws again highlights the parallels of home health care work with the nation’s economic evolution. Said Michel: 

Home care has been outsourced not to other countries, but to a poor workforce within the United States.