Health care reform, now the source of some of the most contentious debate in recent history, has many collateral issues, one of which is the status of those who care for the elderly and disabled. This is illustrated by the case of Evelyn Coke, a home care aide, who worked for more than 20 years in New York with duties many people would find revolting: bathing patients, changing their diapers, turning them frequently to prevent bedsores, emptying bedpans, and, of course, administering medicine at the right time and in the proper dosage.  

Coke, a lifelong home care aide, was a prime example of someone overworked and underpaid. She constantly worked more than 40 hours a week, sometimes three consecutive eight-hour shifts—sleeping at patients’ homes. She was a single mother, originally from Jamaica, raising five children. Her employer, Long Island Care at Home, paid $7 an hour with no time-and-a-half for overtime and provided no health insurance. The home care agency based its practices on a ruling by the U. S. Department of Labor that the Fair Labor Standards Act (FLSA), which governs overtime and minimum wages, did not apply to home care workers.

Meanwhile, Coke was hit by a car, injuring her shoulder. She filed a suit against her employer. The Second Circuit U. S. Court of Appeals overturned the Labor Department’s interpretation. The case then went to the U.S. Supreme Court. The George W. Bush administration’s Labor Department opposed the wage benefits stating that such practices would be a financial burden on home care agencies. The high court in 2007 unanimously ruled against Coke and others in her category, stating they were not entitled to overtime and minimum wages.

The issue has a long history. The Clinton administration, in its waning days, drafted legislation to cover home care workers but the Bush administration, after taking office squashed the proposal.

One of the lawyers who represented Coke before the Supreme Court expressed hope that the presidential campaign then underway would bring an administration that would “construe the law differently.” That idea is coming to fruition as Hilda Solis, the Labor Secretary appointed by President Barack Obama, is now charged with interpreting the Fair Labor Standards Act. She is the daughter of immigrant parents both of whom were activists on their jobs for better wages and working conditions.

Last June 11, 15 senators, led by Tom Harkin (D-IA), wrote a letter to Solis and noted that the date was the second anniversary of the Supreme Court’s decision. They urged Solis to “issue new rules that cover home care workers under the FLSA to ensure that home care workers have the same protections other workers enjoy…. You indicated at the time of your confirmation a willingness to work to develop a regulation that will close this loophole for thousands of low wage workers, primarily women, who are doing difficult, dangerous, yet extremely important work.” The senators urged action on that promise.

Whatever decision is made Coke will not be around to hear it. As her case began its route through the legal system she was dealing with failed kidneys as well as the lingering effects of the injured shoulder. She had to quit work and was unable to hire a home care aide, so her son assumed that role. Coke died last month at age 74.

Coke’s case attracted the support of service employees’ unions and others. But she did not win the wide backing gained by Lilly Ledbetter, the Goodyear Tire & Rubber Co., employee who filed suit after learning male coworkers doing the same work were paid considerably more. In January President Obama signed the Lilly Ledbetter Fair Pay Act to eliminate such inequities.

The 2000 Census indicates 50 percent of home care workers are minorities and 90 percent are women. Pay averages $9 an hour and the annual turnover rate is about 50 percent. The home care workforce totals more than 1.4 million.

There are many in situations similar to Evelyn Coke’s in Memphis and every other city, caring for some of society’s most vulnerable members while living in poverty. Their hope now rests with Solis and the Department of Labor. As life expectancy increases and as more people choose to remain at home rather than enter an institution, home care will become a more crucial concern.

(George E. Hardin worked as a photographer, reporter and editor, and in public relations during a long career before he retired. His column appears every other week.)