Last month, 15 home health workers camped outside New York’s city hall for six days. They refused to eat, only ending their hunger strike after securing a promise that the city council would vote on a bill to end their mandatory 24-hour workday. It’s a practice workers argue is both a labor rights violation and a quiet public health crisis.

Now, a month later, a council vote for the No More 24 Act still has not materialized. Workers announced on Friday that they will go on another hunger strike.

“We are very confident that our movement is getting bigger and there will be more pressure to do the right thing,” said Zishun Ning, an organizer with the Chinese Staff and Workers Association.

Since 2015, the Ain’t I a Woman?! coalition of home care aides, youth groups and feminist organizations has been organizing against poor working conditions through hunger strikes, lawsuits and legislation. Under current New York labor law, agencies that assign workers to 24-hour live-in shifts are only required to pay them for 13 hours, with the remaining 11 hours classified as designated sleep and meal time, even though most home health aides care for their patients around the clock.

The No More 24 Act, introduced in 2022 and mired in negotiations ever since, would require agencies to split overnight home care assignments into two 12-hour shifts and cap a worker’s total weekly hours at 56. Agencies that retaliate against workers who refuse 24-hour shifts would face steep municipal fines.

“This is the only industry that allows people to work for 24 hours and only get 13 hours of pay,” said Christopher Marte, the city council member who introduced the bill. “A lot of times it’s 23 days in a row where people have to leave their homes and stay and sleep and eat where they work.”

Home care is one of the fastest-growing sectors in the American economy, driven by an ageing population. The Bureau of Labor Statistics projects the home health and personal care sector will add more than 70,000 jobs by 2033 – among the most of any occupation in the country. In New York alone, home care is a $13bn industry.

Yet the foundations of this economic engine rest on a highly vulnerable workforce consisting mainly of immigrants and women of color. In New York state alone, two-thirds of home health care workers are immigrants who rely on these jobs not only for income but also for health coverage.

“Many of these workers have been threatened by their home care agencies that they will lose their jobs,” said Marte.

Lai Yee Chan, 71, entered the home care industry after New York’s garment industry collapsed following the September 11 attacks. By 2007, she said, her agency had pushed her into mandatory 24-hour shifts.

Patients authorized for 24-hour care are, by definition, those who cannot be left unattended – people with advanced dementia, severe disabilities or terminal conditions. Throughout the night, aides must turn bed-bound patients every two hours to prevent lethal bedsores, assist them to the bathroom, administer medications and soothe them when they wake up disoriented.

“There was just no time to sleep,” Chan said through a translator.

Chan’s agency, the Chinese-American Planning Council (CPC), provided health insurance through 1199SEIU, the powerful union representing the vast majority of New York’s home care workers. If she worked less than 130 hours a month, she said her family of five would lose health insurance. Her husband gave up his own job to care for their three children at home while she worked live-in shifts.

Despite the essential nature of their labor, the field remains one of the lowest-paying in the country. The median annual wage for home health and personal care aides was $34,900 nationally as of May 2024. Workers and advocates in New York started filing wage-theft lawsuits as early as 2011, claiming they have the right to be paid for 24-hour shifts. In 2015, a Department of Labor rule extending minimum wage and overtime protections to home care workers took effect. But agencies found ways around them: workers say they are pressured to skip legally mandated breaks and some agencies pay flat daily rates regardless of total hours worked – practices workers say continued largely undetected inside the private homes where they worked.

Chan said she received a check from the CPC labeled “overtime” for $200, covering what the CPC’s accounting office told her amounted to roughly 6,000 hours worked between 2007 and 2013. She knew the math didn’t add up.

“They thought that because we can’t read English, they can fool us,” Chan said.

Chan walked into the offices of the Chinese Staff and Workers’ Association and began organizing.

Every Wednesday morning for the past two years, members of the Ain’t I a Woman?! coalition – many in their 60s and 70s, some leaning on walkers, others holding signs that read “Stop killing us” – gather on the sidewalk outside a glass tower belonging to the CPC. They want to bring attention to the agency they accuse of withholding $90m in wages – the CPC did not respond to a request for comment – and to pressure the lawmakers they believe could finally make the practice illegal.

But the No More 24 Act only has 16 co-sponsors on the city council, leaving the bill 10 short of the 26 needed to pass. It also faces serious opposition from the Legal Aid Society and the Center for Independence of the Disabled New York, which argues that splitting a 24-hour shift into two 12-hour shifts effectively doubles the number of workers required per household, and that the supply simply isn’t there.

The coalition scored a victory last month when, after their hunger strike, they announced they had secured a commitment from the city council speaker, Julie Menin, to bring the updated bill to a vote in May. Menin’s office formally denied making an absolute guarantee on the date but acknowledged the bill had been substantially updated to reflect stakeholder feedback.

“We look forward to phasing out the 24-hour workday, an outdated practice that places workers under extreme physical and emotional strain,” a council spokesperson said.

Advocates say the governor, Kathy Hochul, has also been actively pressuring Menin to block the bill, threatening to withhold Medicaid funding to the city if it passes. Hochul’s office declined to comment on the bill.

New York City’s mayor, Zohran Mamdani, campaigned explicitly on ending 24-hour shifts and co-sponsored the No More 24 Act as an assemblyman. Since taking office, however, workers say he has been absent. When home care workers staged a sit-in at city hall, his office sent a representative with a message that stung: that the mayor needed to consider those who wanted to work 24-hour shifts.

“People felt very angry,” said Ning. “It’s like they look down on the workers.”

Caixiong Liu, 69, who spent 18 years in home care and joined the movement in 2022, said this work has caused her chronic back pain from lifting and turning patients, insomnia that has never resolved, and memory loss she traces directly to years without uninterrupted sleep.

Liu and her fellow workers say they will soon strike again. The folding chairs will come back out. The signs will go back up. The fasting will resume.

“I don’t want the next generation of workers to go through what I did,” Liu said.