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Health and Safety Protection for Domestic Workers

• Jan 25, 2023

Domestic workers perform essential services in the most intimate realm of the home by providing clean, safe spaces for families to enjoy and by caring for children, seniors and those with illnesses or disabilities. Workers are often integrated into the daily rhythms and routines of households, enabling families to function and thrive since domestic work “is the work that makes all other work possible” [Poo, 2015].

In 2017, the University of California Labor Occupational Safety and Health Program (UCLA LOSH), in collaboration with the National Domestic Workers Alliance (NDWA) and the California Domestic Workers Coalition (CDWC) released a study, Hidden Work, Hidden Pain: Injury Experiences of Domestic Workers in California. The report offered insight into the various occupational injuries and illnesses experienced by the domestic workforce like housekeepers, childcare providers and caregivers. The report highlighted the need for all domestic workers to be included under California’s Occupational Safety and Health Administration (CalOSHA) protection.

Key findings from the report include that 51 percent of all survey respondents said they had experienced pressure from their employer to work in dangerous conditions and an overwhelming majority of respondents (85 percent) described injuries resulting in chronic back, shoulder, arm or leg pain. Additionally, more than half of respondents continued to work, despite their chronic pain, out of financial necessity and fear of losing their job. Additionally, the report highlighted the need for occupational safety and health protections to be extended to domestic workers.

Domestic workers in private homes encountered health and safety hazards similar to those found in other healthcare or service-sector jobs. UCAL-LOSH survey respondents indicated that their work commonly involved repetitive motions (81 percent), lifting of heavy objects (76 percent) lifting of children or care recipients (70 percent) and exposure to cleaning chemicals (62 percent) and biological hazards (79 percent). A number of respondents were also sexually harassed or assaulted (23 percent) while working. Many of these hazards are the same as those faced by workers performing similar tasks in more conventional work settings, such as nurses in hospitals or cleaners in hotels or office spaces.

The most common type of injury among domestic workers was musculoskeletal disorders. The majority (85 percent) of respondents described injuries resulting in chronic back, shoulder, arm or leg pain. Musculoskeletal injuries are not easily resolved, and over half (55 percent) reported they continued to work out of financial necessity or fear of job loss despite ongoing pain. Work-related injuries among residential housecleaners, caregivers and childcare providers resulted in substantial costs to themselves and their families. Almost half (45 percent) of respondents missed at least one unpaid workday as a result of their injuries, and 71 percent sought medical care. Over two-thirds of respondents (68 percent) reported spending their own money to pay medical bills, and the vast majority who missed work (92 percent) were not paid for lost work time.

While domestic work can be divided into three broad categories—housecleaning, in-home caregiving for seniors or people with disabilities and childcare‚—they include a wide range of tasks and work responsibilities. Housecleaning, for example, may include dusting and vacuuming, scrubbing and wiping down surfaces, washing windows, moving heavy furniture, doing laundry, folding clothes, making beds and organizing closets or other storage spaces [Waheed et al., 2016]. Caregiving services for seniors or people with disabilities typically involve assistance with daily living activities such as bathing, grooming, toileting, feeding, ambulation assistance, sanctioned medical care, patient lifting and basic companionship [Burnham & Theodore, 2012; Domestic Workers United & Datacenter, 2006; Poo, 2015]. Childcare providers carefully watch over children in the home and attend to their basic needs, such as dressing, bathing, feeding and overseeing play [Bureau of Labor Statistics (BLS), 2018; Waheed et al., 2016]. Caregiving tasks include the critical but often overlooked element of building relationships and providing emotional support. These relationships are often tied to worker job satisfaction and work-related stress [Delp et al., 2010].

As reported by the San Francisco Chronicle, the State of California just created the country’s first occupational health and safety guidelines for domestic workers. In California, some 350,000 people in 200,000 homes (nearly 16 percent of households) are employed as domestic workers. The vast majority of domestic workers in California are immigrant women of color; 95 percent are women, and 84 percent are immigrants. These figures contrast with the national statistics collected by the BLS, where only 46 percent of domestic workers are estimated to be foreign-born [Burnham and Theodore, 2012].

There are many true stories being told about the working conditions of domestic workers. For example, a homeowner hired Irma to clean the house. When she first started, the employer was very nice to her. But when the employer had to let the dog walker go, Irma was told that she would have to walk the dogs twice a day. One dog was very aggressive, so Irma was hesitant but knew that she could not object without jeopardizing her job. One day during their walk, the dog tried to attack a woman. Irma tried to pull the dog back, but he chased the woman and dragged Irma by the leash for several yards. The neighbors called the emergency hotline when they saw that Irma was injured. She suffered a dislocated sternum, four lumbar hernias, and a broken mandible.

In this case, Antonia was hired by a family to take care of two children, clean their house, and run all of the family’s errands. She worked for the family for over four years before she started feeling pain throughout her body. She waited for two months before she told her employer about her pain since the children were on summer vacation and she did not want her employer to be burdened with having to find another childcare provider. Antonia told her employer about her pain and asked if she could go to the chiropractor. Her employer agreed and paid for three chiropractor visits. After these visits, Antonia’s pain did not subside, so she asked her employer to reduce her hours to eight hours per day. Her employer said she needed someone for longer hours and fired Antonia. Eventually, Antonia sought medical attention and was diagnosed with a dislocated pelvis, an injury to her sciatic nerve, and a lower-waist injury due to repetitive work.

Lupe was working as a caregiver through an employment agency for over five years. One day in 2014, Lupe experienced intense pain in her lower back when she lifted her client’s upper body. After the incident, Lupe had difficulty sitting down or standing for long periods of time. A year later, she had a similar case of acute back pain when she was kneeling to put socks on a patient. Since these incidents, she has continued to suffer from chronic back pain. At one point, the pain was so bad that she had to take two weeks off work. Her pain interfered with day-to-day activities such as putting on her own clothes, sitting down, and lying down to sleep. Lupe believed that having proper ergonomic equipment, such as a full-body or stand-assist patient lift, would have prevented this type of injury and allowed her to heal. She believed that her employment agency should provide the mechanical assist device along with free ergonomics training to help her do her job.

Martha loves her work as a nanny but sometimes it is physically challenging. She was among eighteen people—workers, employers, advocates and health and safety experts—who helped draft the rules for members of the California Employment Safety Standards Advisory Committee on Household Domestic Services, under Senate Bill 321 (SB 321). Employers and workers would open communication and collaboration between employers and workers in order for the program to succeed. When both parties work together, they can raise concerns, make suggestions about working conditions and work practices, report an injury and identify hazards and possible solutions to jointly resolve any problems that may arise without retaliation. They are entitled to minimum wage, breaks, overtime, and sick time. The work environment must be free of sexual harassment or harassment based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, disability, age (age 40 or older) or genetic information. Employers must carry workers’ compensation insurance, and workers have a right to coverage if they work at least 52 hours for the same person in the last 90 days and earned at least $100 for their work.

It is important to promote a culture where health and safety are prioritized and workers feel comfortable reporting problems and sharing concerns by providing information and resources in the language workers best understand. The guidelines would be organized into two categories—planning for prevention—before work begins including steps to think about in advance so that both the employer and worker are ready when work begins, identifying the most common hazards domestic workers and day laborers face and describing the control measures to keep these workers healthy and safe.

“These guidelines are voluntary but they are significant,” said Kim Alvarenga, executive director of the California Domestic Workers Coalition. “Domestic workers deserve the same protections in the home (as workers in other) workplaces.” The guidelines’ overarching message is that people who employ household help should consider their homes as workplaces and seek to safeguard the welfare of workers. They contain recommendations on proactively deciding on both tasks and hours; identifying and controlling hazards in daily tasks; providing personal protective equipment, reducing repetitive motion injuries and working under conditions of extreme temperature extremes and wildfire smoke.

Next, Alvarenga hopes for California state legislation to bring the occupational health and safety of domestic workers under the protection of CalOSHA. In fact, when California state lawmakers originally passed this idea back in 2020 with SB 1257, the Health and Safety for All Workers Act, California Governor Gavin Newsom vetoed it. The governor said that he didn’t want to regulate people’s homes as traditional workplaces. Now the thinking is the home can be the workplace and domestic workers and day laborers should be protected by law.