By Ella Spitz

This article was originally published by Truthout

As the movement evolves, activists are pushing to ensure it helps workers and the people they care for.

When Cai Qiong Liu applied for a visa to come to the U.S., she told officials she was in search of a better life.

As soon as she arrived in 2005, Liu’s friend got her a job as a home health aide, which she kept for 18 years. For half of those years, Liu worked four to five consecutive 24-hour shifts a week, providing demanding live-in care for a patient who had suffered a stroke: helping her shower, go to the bathroom, and eat.

Liu said she had almost no time to sleep herself, and when she did, it was on an old couch next to her patient’s bed, where she’d have to wake up every two hours to turn the patient over to prevent bedsores.

Despite being on call for the 24 hours she worked, Liu was only paid for 13 hours, since New York Labor Law accounts for eight hours of sleep and three hours of meal time — a norm upheld in 2019 by the New York Court of Appeals.

“You talk about a better life, but you got to have good health to enjoy a better life,” Liu told Truthout in Cantonese through a translator. “I didn’t expect that in the United States, in such an advanced country, they would treat us like this with 24-hour workdays and end up destroying our health.”

Out of the 38 countries that are members of the Organization for Economic Co-Operation and Development, the U.S. is one of only four countries that does not have a statutory limit on hours worked per week.

Now, at 69, Liu is retired, but she still suffers from chronic back pain and headaches, and she says she believes the chronic sleep deprivation that she experienced during her years as a home care worker have caused permanent damage to her memory.

Liu is one of many home care workers who have been protesting near City Hall this spring, fighting for the New York City Council to pass the No More 24 Act, or Int 303, which would prohibit 24-hour home care shifts, as well as a workweek that exceeds 56 hours. Some home care workers have been advocating for the end of 24-hour shifts for over a decade.

The No More 24 bill was originally introduced by City Councilmember Christopher Marte in 2022. It stalled in the City Council under former Speaker Adrienne Adams, but the movement got renewed hope when Speaker Julie Menin promised to bring the bill to a vote in April of this year.

However, Menin failed to follow through on her pledge, and since then, around a dozen workers have started and ended two hunger strikes, lasting eight days each.

Immigrant Women of Color Face Exploitation Within the Home Care Industry

Sarah Ahn, an advocate with the Ain’t I A Woman Campaign, a coalition organizing the No More 24 movement, told Truthout she believes 24-hour home care shifts have been normalized in the U.S. due to this country historically devaluing care work and domestic work, while also pinning that hard labor onto immigrant women of color.

The movement “exposes that we haven’t made the progress that we say we have,” Ahn said.

A 2023 report from the NYC Comptroller’s Office found that 89 percent of care workers in the city were women and 87 percent were people of color.

Another 2025 study by the Center for Migration Studies of New York found that 73 percent of home health and personal care aides in the city were immigrants, reporting median hourly earnings of $16 — the lowest of all health care occupations.

“The attitude is that this is what women do anyway,” Ahn said, adding that since a whopping majority of home health aides are women, they leave work and go home to do even more domestic labor like cooking, cleaning, laundry, and child care.

At the same time, Liu said that her working five 24-hour shifts a week negatively affected her family, forcing her three children to learn how to take care of themselves.

“I had to show that I could do 24-hour workdays, otherwise [the agency] would not give me any work,” Liu said. “We had no choice. We had to survive and pay the bills.”

The UN Calls 24-Hour Shifts “Inhumane”

In addition to fighting the physical burden of the 24-hour workday, home health aides have also fought for compensation for their 11 hours of unpaid labor (in every 24-hour shift, three hours are set aside for meals, and eight for sleep). They sued the state’s Department of Labor in 2023 for dismissing their wage theft cases and won their case in January of this year.

Zishun Ning, another organizer for the movement, told Truthout that in July, during the second hunger strike, workers were informed that their wage theft cases would be reopened and investigated.

Toward the end of the second hunger strike, in early August, the United Nations Working Group on Discrimination against Women and Girls forwarded a letter originally sent to the federal government to Menin, Governor Kathy Hochul, and Mayor Zohran Mamdani that condemned 24-hour shifts, likening them to “inhumane, exploitative work which may amount to forced labour.”

There has been no direct public response to the letter from Menin, but a City Council spokesperson said Menin “remains focused on phasing out the 24-hour workday” and “encourages all stakeholders to come to the table to help identify a viable and sustainable path forward.”

The bill, which was amended in May, has stalled and lost support from five City Councilmembers since April due to pushback from some coalitions of disability advocates and labor unions like District Council 37 and 1199SEIU, as well as the Legal Aid Society (entities that have also represented home health aides in certain contexts).

Opposition to the Bill

Jose Hernandez, a disability advocate who has received 24-hour live-in care himself due to quadriplegia, told Truthout that the bill as it is written provides no protections for disabled and elderly patients currently receiving 24-hour live-in care, and could force those patients into nursing homes.

Splitting each 24-hour shift into two 12-hour shifts would require more Medicaid funding to cover the 11 hours that had previously gone unpaid, Hernandez said, a cost that 1199SEIU estimates to be $460 million for the 13,000 patients who currently rely on 24-hour live-in care in New York City.

Belkys Garcia, a staff attorney in the Legal Aid Society’s Civil Law Reform Unit, also said the bill does not address issues in authorization of care under Medicaid.

Garcia told Truthout that 24-hour live-in care and 12-hour split shifts fall under two separate authorizations and levels of care, as detailed in the state code. The switch in authorization is not automatic and requires a three-step appeals process, Garcia said, which could take months, a year, or longer.

According to Garcia, if the bill is passed as is, home care agencies could deny the care of the patients who had been authorized for 24-hour live-in care, as it would then be illegal to give in the city.

Rather than end 24-hour shifts, the Legal Aid Society and Hernandez have advocated for reforms that ensure home care workers can report the hours they worked during 24-hour shifts and refuse 24-hour shifts without retaliation. Or, Garcia said, if the bill were written so the city covers the cost of the additional hours, patients would have more protection.

“I just hope that we can find a way to work together and finally find a solution that helps everyone,” Hernandez said.

Raine Reilly, a disabled person who has come out in support of No More 24, told Truthout that, although the threat of institutionalization is credible, “the bill isn’t doing anything to harm disabled people, it’s the other programs taking advantage of us.”

Hernandez also said that many patients are wrongly assessed by insurance companies for 24-hour live-in care as a “cost-saving measure,” as 11 hours of the care would go unpaid.

“The more that these companies can prove that we actually don’t need this money, the more they can pocket,” Reilly said.

Reilly said the bill should be passed with defenses against the loopholes that could harm disabled people, in order to push back on the way the disability community has been pitted against the majority immigrant women doing their care work. 

“[The companies] don’t care if either of us lives,” Reilly said.

The bill is currently still in limbo, but home care workers are planning a big protest in October in front of City Hall.

“If these 24-hour workdays continue, then it shows this society is not civilized,” Liu said. “It’s really shameful for New York City, the most well-known city in the world, to have this torture against us.”

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