Invisible Work and Technology for Home Health Aides

Technology could increase invisible work for home health aides, but accounting for invisible work in technology design could improve working conditions

Original illustration by Joy Ming symbolizing care work, technology, and visibility.

For more on the invisible work home health aides perform and how it is intertwined with technology design, please read our full paper: “I Go Beyond and Beyond”: Examining the Invisible Work of Home Health Aides.

Rosa* has been a home health aide in New York City for almost a decade. Like the 3.6 million other aides in the United States, she helps older adults and people with disabilities with daily activities and clinical monitoring in their own homes. She prides herself on going “beyond and beyond” for her clients. One of her clients, Dorothy*, would feel anxiety coming on at the end of the day and Rosa would stay an extra half hour a few times a month, unpaid, on what she calls “Rosa time.” Her long-term dedication once saved Dorothy’s life — Rosa was able to catch a dangerous drop in blood pressure because she took the initiative to check Dorothy’s vitals, even though this was not part of her official responsibilities.

Home health aides perform essential but often invisible work

Even though aides like Rosa serve as essential eyes and ears of the care team, they are often not acknowledged for their crucial contributions. Much of their emotional and organizing contributions that are not part of their assigned tasks and are rendered invisible. Rosa noted that she felt that she was being taken advantage of for her dedication to her clients because even though she had to take on so many responsibilities, she was not recognized or paid for all of them:

“You need a big heart. You need to be able to be a psychiatrist, their secretary, their grocery store. That’s what you got to be. You got to be more than a home health aide. So that’s what I’m saying. That we need more money. We need more incentive. We need more.”

Beyond wishing her agency would offer even a simple “thank you, we appreciate you” to her for her hard work, the invisibility of her contributions had material consequences. There were times when she was lacking support from her agency when she had to act outside of her job scope during emergencies. Moreover, Rosa has to take on private duty assignments in addition to her part-time agency job to make ends meet, like the other one in six aides who lives in a household below the federal poverty level.

Our interviews with 12 other NYC-based aides like Rosa showed that they were all doing work that was “unacknowledged, unvalued, or unregulated” such as:

• Handling their own and others’ emotions by managing agitated clients with dementia and regulating their own reactions to racist incidents.
• Doing unpaid favors to take care of for the clients they cared about or help other aides they felt camaraderie with.
• Coordinating and negotiating boundaries while soliciting help from the clients’ families but also asserting and reasserting the scope of their assigned tasks.
• Learning more information to make decisions on-the-fly, using Google or YouTube to fill in gaps of knowledge left by a perceived lack of support from their agencies.

But what does invisible work have to do with technology and design? Our research finds that technology could further reinforce invisibility but also has the potential to challenge it.

Accounting for invisible work could lead to better technology design

Our research found that current technology design upholds unequal power dynamics, leading to more additional work. Firstly, the apps and tools required by aides’ employers focused on the compliance of a list of tasks associated with care, rendering additional emotional or organizing work invisible. Secondly, aides had to perform more invisible work to figure out how to use the technology or handle technical and interpersonal issues. Finally, the use of aides’ personal devices meant their clients could contact them for help even if they were off-the-clock and that their employers could ask aides to take responsibility for their own training and support.

Our paper discusses how we can design technology that not only accounts for invisible work, but also makes work more visible. However, it is not as simple as adding checkboxes to the existing task-tracking systems to also include for the invisible aspects of the aides’ work. Our recommendations to technology developers, employers, and advocates include:

• Investigate invisible work before building technology. Understanding the full picture of what workers do can help avoid inappropriate or inequitable technological systems that overlook important processes, displace the burden to other workers, or restrict worker autonomy.
• Understand potential additional invisible work. It is important to mitigate the technological system’s introduction of interpersonal conflict (e.g., communicating to the clients the importance of the app) or operational burden (e.g., hosting training and giving support to older aides trying to use a new app).
• Consider how visibility could affect power dynamics. Making this work and processes visible through investigation could lead to not only more legitimacy of the work but also surveillance and scrutiny of the work — we must understand what other stakeholders like employers are able and likely to do with the information and how workers feel about sharing it.

* Names changed to protect the identity of our participants