As 450 home-care clinicians began the largest healthcare strike in Massachusetts history this morning, a proposed federal rule moved to strip wage protections from 3 million home-care workers and a July 10 deadline neared for immigrant caregivers, pricing the care workforce from three directions at once.

The 450 clinicians who walked off the job at Mass General Brigham this morning are asking for a first contract. The registered nurses, occupational and physical therapists, and social workers of MGB Home Care voted to unionize in June 2024; their seven-day strike, beginning July 8, folds into a walkout of 4,000 Brigham nurses that the Massachusetts Nurses Association calls the largest nurse and healthcare-professional strike in state history. They are striking over what home-care labor is worth.

The same week, the federal government proposed lowering that answer. A rule advanced by the administration would strip Fair Labor Standards Act minimum-wage and overtime protections from more than 3 million home-care workers, reversing the 2013 rule that first extended those basic guarantees to the industry. CMS's 2027 home-health proposal, meanwhile, would raise payments to home-health agencies by $420 million, the sector's first increase since the 2022 rule. One proposal sends more money to the agencies that bill for care; the other removes the wage floor under the aides who deliver it.

A third lever removes workers outright. PolitiFact Florida, examining whether ending Temporary Protected Status for Haitians will cause a caregiving crisis, found the exodus will land hardest where the Haitian care workforce is dense. Rep. Mike Lawler noted that roughly a third of the 350,000-plus lawful Haitian TPS holders work in healthcare, and Rep. Ayanna Pressley warned that seniors will lose their caregivers. Their work authorizations expire July 10, two days out.

So the sector reached for the workforce it never counted. Home care has treated its shortage as if the workers lived outside the homes it serves, McKnight's argues, when the daughters, husbands, and adult sons already managing medications and appointments are becoming the workforce the industry needs. Lance Slatton makes the same case: family caregivers are the hidden healthcare workforce, coordinating care in millions of homes for no wage at all.

Four moves in one week, each setting a different price on the same work. The therapist on the picket line is bidding it up. The proposed wage rule and the July 10 deadline push it down. For the millions of relatives the sector is now counting, the price is set at zero. Whoever stands at the bedside next week, the household absorbs the difference.