Kassandra Gonzalez has worked in fields picking strawberries and grapes, in a fish processing plant, and as a cook. But it wasn’t until she began working as a home caregiver that she feared for her health.

One afternoon, while taking out the trash, Gonzalez felt a stab in her thigh. Looking down, she saw a needle jutting though the plastic bag she was carrying and drops of blood on her leg from the puncture. The house where Gonzalez was hired to clean and care for the ailing owner had hypodermic needles everywhere, on tables and countertops and dropped carelessly into wastebaskets.

“I want to do this work. I want to bring comfort to people who are struggling and to help those in need,” says Gonzalez.  “I am terrified of getting sick or getting an infection — I don’t have health insurance.”

Many home care workers make less than minimum wage, receive no overtime pay, and have no paid sick days, health coverage, or unemployment compensation should they be let go. “I never felt as exploited as I do as a home caregiver,” Gonzalez says.

As the baby-boomer generation ages — on average, a boomer turns 65 every eight seconds — the gap between those needing affordable care and the workers available to provide that care is projected to reach crisis proportions. By 2040, about 27 million Americans will need care. There are fewer than 3 million home care workers now, more than 1 million of whom work for near-poverty wages.

“It’s a social time bomb,” says Nick Licata, a Seattle city councilman who has found himself needing care at both ends of the family spectrum — for a parent with Parkinson’s Disease and a young adult stepson who suffered brain injury when he was hit by a bus.

Domestic workers like Gonzalez help fill a critical gap, caring for our children, spouses and grandparents without a safety net for themselves. The vast majority are women; most are immigrants. They are often vulnerable to abuse and have few other options for work.

A national movement, Caring Across Generations, hopes to change those grim realities. It proposes transforming the nation’s approach to long-term care in ways that will provide affordable, quality care for the elderly and disabled, a path to economic stability for immigrants, and stimulation for the economy.

The campaign aims to improve access to home care through Medicare and Medicaid; create two million new, living wage home care jobs; increase training opportunities and promote career-advancement, as well as create a visa category and path to citizenship for those who participate in home care training. And it calls for compensation and support — including social security credits — for family members who leave their jobs to care for a spouse, parent, or disabled child.

So far, the effort has attracted a diverse group of supporters: senior citizen groups and immigration reform advocates, labor unions and people with disabilities. The baby-boom generation is used to having its own way, and they still wield considerable influence. They are the generation that opposed the Vietnam War. They fought for civil rights, equal rights, and social justice. Now they are ready to fight for quality care for themselves — and fair working conditions for their caregivers.

“Our supporters are diverse but interdependent,” says Jodeen Olguin-Tayler, campaign director with the National Domestic Workers Alliance. "We really need each other in this movement."

Home care is strenuous and stressful. Workers face hazards like the needle that jabbed Kassandra Gonzalez, exposure to household chemicals, risks of burns, and injuries from lifting or falls.

In most states, employers have no responsibility to cover health insurance for domestic workers and caregivers. According to a December 2010 report issued by the Excluded Workers Congress, just 13 percent of domestic workers employed at least half-time, year-round, receive health coverage from their employers. The same survey found that 41 percent of workers in private homes aren’t paid minimum wage, and 90 percent of the home care workers weren’t paid overtime.

Proponents say that in-home care will reduce the pressure on Medicare and Medicaid by providing an alternative to expensive convalescent homes and other facilities for the elderly — who in many cases would rather remain in their own homes. Many are already pointing to momentum building nationally and on the state level. In December 2011, the U.S. Department of Labor proposed extending federal minimum wage and overtime protection — the basic rights given most other workers under the Fair Labor Standards Act — to home care workers. For decades, home care providers have been exempted from the federal law. The comment period has been extended until March 12.

New York state passed a domestic workers' bill of rights in 2010 that sets a 40-hour work week and requires overtime pay, a day off each week, and three days of paid time off after a year’s employment. The state law also entitles domestic workers to temporary disability benefits and unemployment insurance. A few other states and cities are working on similar legislation.

In Washington state, domestic and in-home workers are covered by minimum wage and overtime laws if they are employed regularly, even if “regularly” is just one or two days a week. They are entitled to overtime if they work more than 40 hours a week. However, in Washington state, the minimum wage law may not apply if you live or sleep at your place of employment.

Kassandra Gonzalez, who lives in Washington, says employers often ask her to do extra tasks or work longer hours, but then refuse to pay her what she is owed. Once, when she asked an employer for the additional pay, she was simply told: “It’s your word against mine.”

That’s not necessarily true, says Elizabeth Smith at the Washington State Department of Labor and Industries. “We look at everything on a case by case basis. If you are employing someone regularly in your home, then you need to act like a real employer; that includes good record-keeping and paying at least minimum wage.”

In Washington, the Department of Labor and Industries provides workers’ rights information on its website and in public presentations and "Know Your Worker Rights" advertisements in Spanish-language newspapers and radio stations around the state.

A recent Caring Across Generations event in Seattle drew 200 representatives from diverse organizations. Similar events are planned in other cities, including Miami, New York, Boston, and Chicago.

“Caregivers are among the hardest working people,” says Jeanette Wenzl of Seattle, who attended the event. Wenzl worked as a nurse for 46 years and is now retired. “They really deserve our support, and to be paid a living wage, benefits, and get better job training. And they need a pathway to citizenship."