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The United States is experiencing unprecedented growth in its elderly population. As Americans live longer and cope with chronic health conditions, the need for long term services and support (LTSS) has increased. The vast majority of elderly persons need assistance with activities of daily living (ADL) and instrumental activities of daily living (IADL) due to physical and mental impairments. LTSS are provided in a continuum of care from the individual’s home to institutional settings. There is a range of options from highly regulated skilled nursing facilities, also called nursing homes to residential care facilities for the elderly (RCFE), also called assisted living facilities or board and care homes.

This report explores how the structural and exploitative nature of working conditions in RCFEs contributes to poor quality of care and life outcomes for residents. Working conditions are an integral and essential component to residents’ well-being. A sustainable and fair work environment for caregivers in RCFEs, thus, is a health care necessity


The Coalition For a Fair and Equitable Caregiving Industry is made up of legal service providers, worker centers, unions, community-based nonprofit organizations and consumer advocates who are invested in reforming the caregiving industry to ensure that workers and consumers of care receive fair and equitable treatment. The Coalition includes the following organizations: Asian Americans Advancing Justice – Asian Law Caucus, Consumer Advocates for RCFE Reform, Filipino Advocates for Justice, Filipino Community Center, Katharine and George Alexander Community Law Center, Legal Aid at Work, Pilipino Association of Workers and Immigrants, Pilipino Workers Center, Santa Clara County Wage Theft Coalition, SEIU Local 2015, and Women’s Employment Rights Clinic of Golden Gate University School of Law.

This report was written by Hina Shah, Associate Professor of Law and Director, Women’s Employment Rights Clinic, Golden Gate University School of Law. Over a course of a year and a half, the report was meticulously researched and public records data analyzed by students in the Women’s Employment Rights Clinic.

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Elder Law Commons