
by Dr. Arcelita Imasa
In our October 6, 2024 column, we discussed what domestic work is and who the domestic workers are.
To review, domestic workers provide care for individuals, whether children, adults, or elderly, serve as companions for those who are sick, clean houses, or perform laundry, cooking, or other domestic services.
Domestic workers are primarily found in long-term care facilities such as adult residential care homes, foster homes, and nursing homes.
There are 3 main categories of long-term care facilities:
1) Adult Residential Care Homes (ARCH) are licensed and regulated by the Hawaii State Department of Health, Office of Health Care Assurance. ARCH homes can either be regular (providing minimal assistance with activities of daily living) or expanded (providing 24-hour assistance or skilled nursing services). Only expanded ARCH homes may choose to accept Medicaid patients, but they are not required to.
2) Adult Foster Homes are licensed and regulated by the Hawaii State Department of Human Services and are formally known as the Community Care Foster Family Homes (CCFFH) program. Foster homes are designed to be a less expensive, family-home setting alternative to institutional nursing homes. Foster home residents must be at either Intermediate Care Facility (ICF) level of care or Skilled Nursing Facility (SNF) level of care, and at least one resident must be under Medicaid. All residents in a foster home must have a Case Management Agency licensed by the Department of Human Services to coordinate their healthcare requirements. Note: There are around 30 licensed home and community-based case management agencies in Oahu.
3) Full-fledged Nursing Homes are generally licensed under the Hawaii State Department of Health, Office of Health Care Assurance as ICF and/or SNF facilities. These homes can have anywhere from a few dozen to hundreds of residents, many of whom are on Medicaid, although some also pay privately. Note: There are 29 large nursing homes in Oahu alone.
As with many low-income workers, domestic workers are vulnerable to a wide range of violations of their rights, which stem from the informal, undervalued, and unregulated nature of their work.
They are generally paid low wages and face difficulties saving for retirement. Many experience violations related to minimum wage, overtime pay, workers’ compensation, and other workplace benefits, as well as federally supported employment benefits.
They are also at risk of wage theft or illegal retaliation. The nature of their work exposes them to workplace health and safety hazards due to poor working conditions, where they have little control over their environment.
Employment is often arranged without a written contract, leaving them vulnerable to working long hours without breaks and having responsibilities that prevent them from getting at least five hours of uninterrupted sleep.
Stories abound as well of domestic workers who lack legal protection or job security and are excluded from key provisions of labor and employment laws like the Occupational Health and Safety Act of 1970 and the National Labor Relations Act.
Workplace isolation and lack of health coverage also affect domestic workers.
Nationally, there has been a long history of pushback against the undervaluation of domestic work and domestic workers. The National Domestic Workers Bill of Rights was introduced in 2021.
Today, Hawaii is one of the dozen states that have passed domestic workers’ bills of rights and protections.
Domestic workers in Hawaii are also protected under the Hawaii Law Act 248, enacted in 2013, which guarantees at least the state minimum wage, overtime pay after 40 hours of work in a week, and protection from job discrimination.
Fortunately, efforts to organize domestic workers are already underway. The Hawaii ILWU Local 1000 organizes over a hundred of independent home care operators.
Many workers at the Oahu Care Facility, a kupuna assisted living home, are unionized under the Hawaii Nurses Association and had their strike in 2023 over fair wages.
UNITE HERE! Local 5 union represents hundreds of certified nurse aides and workers in the dietary, maintenance, recreation, and housekeeping departments at Hale Nani Rehabilitation & Nursing Center (owned by Avalon Company); they had a strike in 2016 to address understaffing and low wages.
The International Labor Organization calls to make domestic work “decent work,” ensuring that society values domestic workers for their contributions and protects their rights as workers.
In Hawaii, domestic workers are predominantly Filipino migrants and women.
The Hawaii Workers Center aims to be a strong advocate for domestic workers. To learn more about domestic workers’ rights, contact the Hawaii Workers Center at (503) 967-5377 or (503) WORKERS.
The Hawaii Workers Center also offers “Know Your Workers’ Rights” trainings and can help you learn about your rights and stand up for them. Contact nelson@hawaiiworkerscenter.org to request training.
DR. ARCELITA IMASAis a practicing family physician and the secretary of the Hawaii Workers Center’s Executive Committee of the Board. She grew up in the Philippines before migrating to Hawaii with her family more than a decade ago.
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