Methods. In 2015, a City Council-appointed Wage Review Committee heard testimony about hospital wages and employment conditions. Hospital service workers (N=156) from the two major local health systems testified. The Committee’s full report is available online.
We used thematic analysis to code workers’ testimonies. Preliminary codes were suggested by the literature. Four coders examined the first 20 transcripts to assess the adequacy of the literature-generated codes and to identify new codes. Coders discussed how codes were applied, new codes were suggested, the coding scheme was revised, and emerging themes were identified. We repeated this process during the review of the remaining transcripts.
Results: According to the workers, living on low wages entailed continual worry, vigilance, and trade-offs. They reported struggling each month to get by, experiencing a variety of hardships and employing different strategies to make ends meet.
Hardships fell into three broad categories: meeting basic material needs, obtaining healthcare, and caring for one’s family and self. Workers testified to their fears of running out of food each month, being evicted, having their utilities shutoff, and being without transportation. They acknowledged the sad irony of worrying about affording healthcare while working for the region’s two largest healthcare systems, and reported delaying treatment, not taking medications as prescribed, and being in debt to their employers for their medical care. They talked about the toll living on low wages took on their families and themselves and spoke with particular poignancy about repeatedly having to say no to their children/grandchildren.
Workers used a variety of strategies to survive, including assistance from families and friends, working overtime or taking second jobs, making use of government or private programs, and juggling which bills to pay each month. Families and friends were important sources of encouragement and support, at times providing loans and housing. To make ends meet, some workers increased their work hours well beyond their full-time schedules. Government programs, especially SNAP, CHIP, and Section 8 Housing, were critical to allowing workers to survive (or just about survive), as were community food banks. Many described their exquisitely delicate monthly calculus of deciding which bills to pay, which to delay, and how much to pay on each.
Conclusion and Implications: Surviving on low-wages involves work and requires resourcefulness and fortitude. The hospital service workers’ testimonies shed light on these realities. Understanding them will help social workers to contribute to improving the lives of low-wage workers through our advocacy, research, and policy practice.