Bloomberg Businessweek

WHO WILL CARE FOR YOU WHEN YOU’RE OLD?

BY 2050, ABOUT 80 MILLION AMERICANS WILL BE SENIOR CITIZENS; NEARLY ALL WILL WANT TO LIVE AT HOME. THE COUNTRY’S 3 MILLION AIDES ARE ALREADY OVERWORKED AND UNDERFUNDED—SOME ARE EVEN WORKING FOR FREE
In Greenlawn, N.Y., home health aide Natalia Hubbard helps her client, Noriko Morimoto, who is 82 years old, has Parkinson’s, and lives with her son

AT 6 A.M. ON A WINTER MORNING IN RIDGEWOOD, N.Y., A woman I’ll call Valia leaned on her kitchen counter, drinking black tea and packing a giant purse. She wore her blond-gray hair in a bun and pulled on an ankle-length brown puffer coat. “OK, I’m taking my medication, I’m taking my telephone, my tablet,” she said, going down her checklist. She whispered goodbye to her cat and her 26-year-old son, who was still asleep, and lit a cigarette to smoke on her way out.

Valia took the L train to the end of the line in Brooklyn, then switched to a crowded bus. Her fellow commuters looked as tired as she did, some dozing upright in their scrubs or steel-toed boots or polo shirts embroidered with fast-food logos. I was following Valia, a Ukrainian immigrant, on her hourlong trip to the apartment of an elderly, low-income woman with advanced Alzheimer’s disease. Valia had been assigned the case, the latest in her long career as a home health aide, a few months earlier. The woman depended on her for virtually everything. “Showering, washing her hair, feeding her,” Valia said. “She’s bedridden, she’s not walking, so I have to transfer her from the bed to a chair. She’s using Pampers.”

Her shift would begin at 8 a.m. and end at 8 a.m. two days later—a schedule that had recently compelled Valia to sue her employer, a private home health agency. Forty-eight hours stuck in a cramped bedroom with someone in constant distress, who yelled or babbled strings of Russian words, who was incontinent and unable to sleep, who was lost in her own timeless world. “I can’t fall asleep knowing she will break a bone,” Valia said. “I sleep next to her and watch her all the time.” Over two days she would work more than most full-time employees do in a week. Yet her pay stub would account for only 26 of the 48 hours, at $10 per hour. (She now earns $11.) This was arguably legal, because the law—and her employer—assumed that she slept and ate the rest of the time.

“I’m never sleeping,” Valia said. “They didn’t even tell us they weren’t going to pay us nights. When I saw that on my paychecks, they said it’s a very specific kind of case and that at some time in the night I’m allowed to stop working and put my client to bed. But in reality, most of the clients

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