NPR featured a story tonight about how poorly compensated home health care work is. Currently, they are not entitled either to the minimum wage nor to overtime pay. Most make between $8-10/hr., while the company that employs them pockets the $18/hr. payment from Medicare. Spokespersons for the home health-care industry were permitted to whinge and whine about the terrible hardship that a minimum wage and overtime requirements would put on their businesses.
The tone of the story tilted towards compassion for the workers and their clients, but they story’s historical perspective looked back only 40 years when I think a critical component of this story is the longue durée of this kind of low wage work, work that now (as in the past going back at least 500 years) is performed overwhelmingly by working-class women, and in the Americas for the most part, by black and brown-skinned working-class women.
Intimate body care has never been a well-compensated occupation. Perhaps one reason for this is that a great deal of nursing of the young, the sick, and the elderly was done by volunteer caregivers who went by the names mother, sister, and/or daughter. Families who could afford it in North America, from the colonial period to the present, hired help from among working-class women. Working-class women (including indentured servants and enslaved women) were after all the experts in early modern and modern intimate body care, from prostitution to wet-nursing to early child care, sick nursing, and elder care. It’s important to see all of these occupations on a continuum, as the modern West (and perhaps other cultures in other places and times) has either expected this kind of intimate labor either to come for free (from women intimates) or to be offered at very cheap rates.
It seems like the closer you have to work with other people’s bodies, the lower your pay and occupational status. These hierarchies are visible not only between occupations (home health aids versus car mechanics, for example) but even within industries. For example, consider the relative status differences among L.P.N.s, R.N.s, and M.D.s. Yes, your physician touches your body during examinations, but a great deal of diagnoses are made on the basis of high-tech tests and lab values that are performed by other people below the M.D. In general, people lower down on the medical work hierarchy have to touch you a lot more often, and they have to clean up any messes you make.
Readers of this blog should also consider how bodily intimacy in our work environment decreases as the relative prestige among teachers and professors rises: early childhood caregivers and elementary school teachers are at the bottom–they not only deal with the youngest students, but are much more intimate with them either in showing affection or even cleaning up their snot, vomit, or urine. Then we have secondary school teachers, and then college and university proffies (with a similar hierarchy ordering those who work with younger undergraduates and/or older graduate and professional students). Administrators always make more money than the people who are in direct contact with students. In fact, even among professors, the fewer students you teach, the higher your prestige and pay: we too expect that the higher our teaching loads and “student contact hours,” the lower the pay and prestige of the job.
Clearly, this is a cultural or societal issue that can’t be addressed by changing a few laws or increasing Medicare reimbursement for home health care. I would welcome your thoughts and expertise on this issue.
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