About

Ariel C. Avgar is the David M. Cohen Professor of Labor Relations, Law, and History at Cornell University's ILR School. His research focuses on labor relations, law, and history, with an emphasis on understanding the dynamics of work and employment. As a faculty member in the Global Labor and Work program, he contributes to the academic exploration of labor issues, workplace relations, and employment law. His work involves analyzing the legal and historical aspects of labor, aiming to inform policy and practice in the field of industrial and labor relations.

Research topics

• Medicine
• Sociology
• Economic growth
• Political Science
• Virology
• Computer Science
• Economics
• Medical emergency
• Psychology
• Engineering
• History
• Business
• Gerontology
• Family medicine
• Law
• Labour economics
• Nursing
• Internal medicine
• Environmental health
• Public relations

Selected publications

• Unionization, Ownership Status, and Direct Care Worker Turnover

  JAMA Network Open · 2026-04-02

  articleOpen access

  Importance: Direct care workers (DCWs) provide essential support for millions of older individuals in the US, but high workforce turnover-the rate at which workers leave the DCW workforce-undermines care access and quality. Structural factors associated with DCW working conditions, such as unionization and employer ownership status, may play an important role in DCW retention, but their association with DCW workforce turnover is not known. Objective: To assess the association of unionization and ownership with workforce turnover among DCWs. Design, Setting, and Participants: Data on DCW turnover for this cross-sectional study were obtained from the Outgoing Rotation Groups of the Current Population Survey, an annual survey of 60 000 US households, from January 1, 2009, to December 31, 2024. The study population included individuals aged 15 years or older who were employed as DCWs. Exposures: Unionization (whether the respondent was covered by a union through their DCW role) and employer ownership status (whether their employer was for profit, nonprofit, or publicly owned). Main Outcomes and Measures: The main outcome of interest was workforce turnover at 1 year, defined as reporting a non-DCW occupation or no occupation 1 year after the initial survey. Bivariate analyses and logistic regression were used to compare DCW turnover rates across union status and employer ownership type and test whether ownership type moderates the association between unionization and turnover. Results: The overall sample included 18 175 DCWs (mean [SD] age, 44.0 [14.7] years; 15 860 female DCWs [86.5%]). In the fully adjusted models, the estimated probability of turnover was significantly lower among unionized DCWs than nonunionized DCWs overall (37.4% vs 45.0%; odds ratio [OR], 0.72 [95% CI, 0.64-0.81]), at nonprofit organizations (33.6% vs 47.1%; OR, 0.56 [95% CI, 0.39-0.80]) and at for-profit organizations (35.2% vs 45.9%; OR, 0.63 [95% CI, 0.54-0.75]), but not at public employers (39.8% vs 41.0%; OR, 0.95 [95% CI, 0.78-1.16]). Public ownership was also directly associated with lower turnover (39.1% vs 41.8%; OR, 0.89 [95% CI, 0.80-1.00]) compared with for-profit ownership. Conclusions and Relevance: In this cross-sectional study of DCWs, employer ownership status and unionization were independently and jointly associated with DCW workforce turnover rates, suggesting that these structural factors may play an important role in DCW retention. State and federal policies that facilitate DCW unionization or public employment of DCWs may significantly improve DCW retention.

  PublisherOA PDFDOI

• Home health aides’ perspectives towards achieving cardiovascular health and life’s essential 8: a qualitative study

  BMC Public Health · 2026-03-26

  articleOpen access

  Despite frequently providing care to adults with cardiovascular (CV) disease in the home, home health aides and attendants (HHAs) have poor CV health (CVH) themselves, which is problematic for their own health and potentially their patients. We elicited the perspectives of HHAs towards achieving optimal CVH, including the American Heart Association’s (AHA’s) Life’s Essential 8 (LE8). We conducted focus groups and interviews with HHAs from January 2023 to January 2024 in partnership with the 1199SEIU Training and Employment Fund, a benefit fund of the largest healthcare union in the US. We included English-and Spanish-speaking HHAs at risk for poor CVH, defined as having: 1) hypertension, 2) obesity/overweight, and 3) ≥ 1 other CV disease risk factors (hyperlipidemia, diabetes, smoking, and physical inactivity). Twenty-two HHAs employed by 12 home care agencies participated. They had a median age of 60 years (IQR 50, 64), 21 (95%) were female, 9 (41%) were Black, and 12 (55%) were Latinx. Consistent with the Social-Ecological Model, 5 themes emerged. At the individual level, many HHAs were motivated to carry out aspects of the LE8 (diet, physical activity), but faced challenges doing so, including varied perceptions of the severity of their CVH and constraints of their job (e.g. limited time). At the interpersonal level, HHAs perceived that their relationship with their patients influenced their own CVH, as well as that of their patients’. At the organizational level, shift-work and long commutes were barriers to certain LE8 (i.e. sleep). Notably, HHAs sought community among peers to learn about CVH. Policies and structural inequities (health insurance, citizenship) were barriers to achieving CVH. HHAs’ ability to achieve CVH is likely influenced by personal, interpersonal, organizational, and policy-level factors. Findings can inform future interventions better tailored to this workforce and the context in which they provide care. Such interventions can aim to improve not only HHAs’ CVH, but potentially that of their patients.

  PublisherDOI

• Sharing the Care: Investigating How Conversational AI Might Facilitate Coordination Among Home Care Workers and Family Caregivers

  2026-04-13 · 1 citations

  articleOpen access

  This paper presents a qualitative study with 17 participants that uses video elicitations to investigate how conversational AI agents driven by large language models might support “shared care,” or coordination of home-based care among family caregivers (FCs) and home care workers (HCWs) who care for the same care recipient (CR). Participants saw conversational AI as a promising tool that might help streamline communication, coordinate shift handovers, bridge language gaps, and support onboarding of new or substitute caregivers. That said, caregivers assumed AI agents would inevitably make mistakes and should thus be designed to signal uncertainty and make it easy to report errors. More broadly, participants discussed how AI agents designed for sensitive home care contexts will need to explicitly preserve the human essence of care, minimize extra data work that might distract from caregiving, and always complement—not replace—human judgment.

  PublisherDOI

• Echoes of Care: How Unions and Ownership Shape Resident Voice

  Journal of the American Medical Directors Association · 2026-02-18

  articleSenior author
  PublisherDOI

• Collective voices, healthier outcomes: the union effect in American Healthcare

  npj Health Systems · 2026-04-07

  articleOpen accessSenior author

  Abstract Healthcare unionization is growing amid consolidation, burnout, and policy gridlock. Emerging evidence suggests unions improve healthcare delivery by enhancing worker conditions, staffing, and safety, which in turn support patient and public health outcomes. As physician organizing expands, unions play a vital role in advancing workplace standards, amplifying collective voice, and promoting a more equitable healthcare system.

  PublisherOA PDFDOI

• Feasibility, Acceptability, and Perspectives Regarding the Use of Activity Tracking Wearable Devices Among Home Health Aides: Mixed Methods Study

  Journal of Medical Internet Research · 2026-01-26

  articleOpen access

  BACKGROUND: Home health aides and attendants (HHAs) provide in-home care to the growing population of older adults who want to age in place. Despite their vital role in patient care, HHAs are an underserved and vulnerable population of health care professionals who often experience poor health themselves. Activity tracking devices offer a promising way to improve HHAs' health-related awareness and promote health behavior change, particularly regarding physical activity and sleep quality, 2 areas in which the workforce struggles. OBJECTIVE: This study aimed to understand how feasible it is for HHAs to use activity tracking devices and assess their perceptions of such devices for improving their health. Specifically, we conducted (1) a field study to assess the use, feasibility, and acceptability of these devices among HHAs and (2) a qualitative study to understand HHAs' perspectives on and reactions to activity trackers on and off the job. METHODS: We partnered with the 1199 Service Employees International Union Training and Employment Fund to conduct a field study with home care agency-employed HHAs working in New York City, New York. Participants wore activity tracking devices for 4 weeks that collected data on physical activity and sleep. The HHAs were subsequently interviewed on their experiences with and attitudes toward the devices and asked to reflect on personalized visualizations of their data to prompt them to think aloud. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using grounded theory. RESULTS: A total of 17 HHAs participated; their mean age was 48.7 (SD 12.2) years, 15 (88%) were women, 11 (65%) identified as Black, 5 (29%) identified as Hispanic or Latinx, and they had worked as HHAs for a mean of 11.7 (SD 7.5) years. In total, 94% (n=16) of the HHAs wore their activity trackers for the full 28-day study period. Participants took a mean of 10,230 (SD 3586) daily steps during the study period and slept for a mean of 6.27 (SD 0.58) hours per night. Overall, 4 key themes emerged: (1) activity tracking devices enhanced participants' health awareness by providing empirical data for self-reflection; (2) this increased awareness led to positive behavior changes, including setting and achieving health-related goals; (3) HHAs believed that these devices could improve not only their own health but also that of their patients through positive behavior changes; and (4) despite this optimism, participants emphasized that their ability to modify sleep and activity patterns was constrained by social and occupational determinants, with sleep improvements being particularly challenging. CONCLUSIONS: Our findings suggest that appropriately designed personal tracking interventions could offer a promising approach to supporting positive health-related changes in this historically overlooked workforce, potentially improving their well-being and the quality of care they provide to their patients.

  PublisherDOI

• "Who is running it?" Towards Equitable AI Deployment in Home Care Work

  2025-04-24 · 4 citations

  articleOpen access

  We present a qualitative study that investigates the implications of current and near-future AI deployment for home care workers (HCWs), an overlooked group of frontline healthcare workers. Through interviews with 22 HCWs, care agency staff, and worker advocates, we find that HCWs do not understand how AI works, how their data can be used, or why AI systems might retain their information. HCWs are unaware that AI is already being utilized in their work, primarily via algorithmic shift-matching systems adopted by agencies. Participants detail the risks AI poses in sensitive care settings for HCWs, patients, and agencies, including threats to workers' autonomy and livelihoods, and express concerns that workers will be held accountable for AI mistakes, with the burden of proving AI's decisions incorrect falling on them. Considering these risks, participants advocate for new regulations and democratic governance structures that protect workers and control AI deployment in home care work.

  PublisherOA PDFDOI

• What Do Unions Do for Direct Care Workers? Assessing Employment and Economic Outcomes

  Journal of the American Medical Directors Association · 2025-02-08 · 5 citations

  articleOpen access
  PublisherOA PDFDOI

• The cooperative difference: perceived drivers of higher care quality at home care cooperatives

  Health Affairs Scholar · 2025-06-01

  articleOpen access

  Introduction: The quality of care provided by home care workers (HCWs), on whom millions of Americans rely, is undermined by practices, structures, and policies that marginalize this workforce. Home care cooperatives-agencies co-owned and controlled by HCWs-represent a promising model for reducing HCW marginalization and improving care, but the specific ways in which the cooperative model may facilitate higher care quality are not well understood. Methods: We conducted 32 semistructured interviews with HCWs and other staff across 5 home care cooperatives to identify perceived drivers of improved care quality at cooperatives. Results: Respondents identified 4 main drivers of improved care quality at cooperatives: (1) increased HCW input into patient care decisions; (2) additional motivation derived from being co-owners; (3) preferential selection of high-performing, mission-driven HCWs; and (4) access to high-quality, hands-on training. Conclusions: Increasing the prevalence of these perceived quality drivers through the expansion of home care cooperatives, the adoption of cooperatives' practices by traditional agencies, and the implementation of industry-wide policies that facilitate them may significantly improve care quality across the home care sector. However, additional research is needed to determine the role each perceived driver plays in home care quality.

  PublisherOA PDFDOI

• Abstract 4360859: Feasibility, Acceptability, and Perspectives Towards Wearable Devices to Assess Life’s Essential 8 Among Home Health Aides

  Circulation · 2025-11-03

  article

  Background: Home health aides (HHAs) provide essential care to the growing population of older adults with cardiovascular (CV) disease who want to age in place. Despite their vital role in patient care, HHAs are a vulnerable population of healthcare professionals who often experience poor CV health. Activity tracking devices offer a promising way to improve HHAs’ CV health awareness and promote health behavior change, particularly with respect to physical activity (PA) and sleep quality, two areas of the AHA’s Life’s Essential 8. Objective: This study aimed to understand how feasible it is for HHAs to use activity tracking devices and assess their perceptions toward such devices with respect to improving their CV health. Methods: We partnered with the labor and management fund of the largest healthcare union in the US to conduct a field study with HHAs working in New York, NY. Participants wore activity tracking devices for four weeks. HHAs were subsequently interviewed on their experiences and attitudes towards the devices and asked to reflect on personalized visualizations of their data. Results: A total of 17 HHAs participated; they had a mean age of 48.7 (SD 12.2) years, 15 were female (88%), 11 identified as Black (65%), 5 identified as Hispanic or Latinx, and they worked as HHAs for a mean of 11.7 years (SD 7.5). Sixteen out of 17 HHAs (94%) wore their activity trackers for the full 28-day study period. Participants took a mean of 10,230 (SD 3,586) steps and slept for a mean of 6.27 (SD 0.58) hours per night. Overall, 4 key themes emerged: (1) Activity tracking devices enhanced participants' health awareness by providing empirical data for self-reflection; (2) This increased awareness led to positive behavioral changes, including setting and achieving health-related goals; (3) HHAs believed these devices could potentially improve not only their own health but also that of their patients ; and (4) Despite this optimism, participants emphasized that their ability to modify sleep and activity patterns was constrained by social and occupational determinants, with sleep improvements being particularly challenging. Conclusions: Our findings suggest that appropriately designed personal tracking interventions could offer a promising approach to supporting positive health-related changes in this historically overlooked workforce, potentially improving both their wellbeing and, by extension, the quality of care they provide to their patients.

  PublisherDOI

Frequent coauthors

• Madeline R. Sterling

  Cornell University

  47 shared

• Joanna Bryan Ringel

  Weill Cornell Medicine

  21 shared

• R Fielding

  20 shared

• Paul B. Jacobsen

  University of South Florida

  20 shared

• R. Bollina

  20 shared

• Wwt Lam

  Hong Kong Jockey Club

  20 shared

• V. C. C. Afonso

  20 shared

• Kristin A. Skinner

  University of Rochester Medical Center

  20 shared

Awards & honors

• 2008 Best Dissertation Award from the Labor and Employment R…
• 2013 John T. Dunlop Scholar Award from the Labor and Employm…
• 2012 Best Paper: New Directions Award from the Academy of Ma…