Avgar, CAROW Awarded Grant to Document Home Care Worker Power

The ILR School and Weill Cornell Medicine have received a $300,000 grant from the Robert Wood Johnson Foundation to administer a worker-focused survey of home health aides across the North and the South of the United States. It will allow for a comparison of home care work in different institutional contexts, including the prevalence of labor unions in the North and limited collective representation in the South.

The principal investigators will include Senior Associate Dean for Outreach and Sponsored Research Ariel Avgar, Ph.D. ’08, ILR’s David M. Cohen ’73 Professor of Labor Relations, Dr. Madeline Sterling, A&S ’08, MD, MPH, MS, associate professor of medicine at Weill Cornell Medicine and director of ILR’s Initiative on Home Care Work, and Zoë West, senior researcher for worker rights and equity at ILR’s Worker Institute. 

“I'm extremely grateful to the Robert Wood Johnson Foundation for their support of this really important work around the working conditions and the contributions that home health care workers make to patient care,” Avgar said. “Working with the Robert Wood Johnson Foundation is unique because it’s a partnership focused on the end goal, which is advancing health for everyone, and making sure that the workers delivering health care have what they need to thrive.

“This specific study will allow us not only to understand how home care workers contribute to patient care, but we'll be able to look at some variation across northern states and southern states and get a better sense of what levers of power they can use in advancing their own needs and the needs of their patients,” said Avgar, director for the Center for Applied Research on Work (CAROW). 

Through the survey, the research team will collect, document and compare critical dimensions of home care workers' roles, working conditions and sources, or lack of occupational power and voice. 

The second objective guiding the study is the collection of high-quality empirical data assessing several core home care work dimensions. First, the survey will examine the range of tasks performed by home care workers. Second, the team will record working conditions – wages, workplace voice, training and support – and make comparisons across employer settings and regions. Finally, the survey will seek to assess the role institutional actors, such as unions, worker centers and community organizations, play in affecting both home care aides’ working conditions and the roles those institutions play in delivering patient care.

"It's pretty simple. The more we can understand about this workforce, the better off our patients will be,” Sterling said. “We know that they provide essential care in the home and are often with patients much longer than any doctor is. We also know that the conditions in which they provide care — their wages and benefits, organizational policies at their agencies, their voice on the healthcare team — are incredibly variable. 

“We believe this project will advance our understanding of these factors across the country and can help us move the needle on programs and policies to improve the workers' experience, which in turn can benefit their patients.”

The final objective of the study is to engage with community and advocacy organizations. Survey findings regarding home health aide working conditions, the role they play in delivering care, and sources of power, will then be used to inform the strategies that could be deployed by advocacy organizations, including unions. The researchers will provide the survey findings in a manner that guides concrete action, advocacy, policymaking and worker representation.

“A big part of this study will be utilizing the survey results to help us to support both advocacy groups and policymakers in making sure that the policies we have in place for home care work are effective, and that they're based on evidence,” Avgar said. “The proposed policies will be based not on what we imagine home care workers do for their patients, but on what we actually know that they do for their patients.” 

About the CAROW Initiative on Home Care Work
The CAROW Initiative on Home Care Work aims to improve the status quo for undervalued and overlooked health care workers who provide care to people at home. The multidisciplinary initiative seeks to elevate the value of home care workers while improving their working conditions and patient outcomes through rigorous research and community engagement.

About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation is a leading national philanthropy dedicated to taking bold leaps to transform health in our lifetime. Through funding, convening, advocacy, and evidence-building, they work side-by-side with communities, practitioners, and institutions to get to health equity faster and pave the way together to a future where health is no longer a privilege, but a right.