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Caretakers

Lawmakers Grant Home Health-Care Providers a Raise, But Workers Will Still Struggle to Make Ends Meet

Frank Klein
NO SCRUBS: Audra White has been working to win a basic living wage for home health-care workers for the past two years.

By Edward Ericson Jr. | Posted 4/20/2005

Audra White is almost famous.

After being featured on National Public Radio’s Morning Edition on Monday, April 11, she called WYPR’s The Marc Steiner Show on the 12th to talk up her issue. She’s also met two different heads of the Maryland Department of Health and Mental Hygiene. And she even saw Gov. Robert Ehrlich himself, once, at a $250-per-plate fundraising dinner.

But she wasn’t exactly invited.

“Then we had to bum-rush some other meeting they had,” White says, laughing. “Some fashion show. We went down and rallied at that, too!”

Since 2003, White, a Baltimorean who has been working in home care for seven years, and more than 100 other state-contracted home-care providers have been picketing, lobbying, and generally badgering state lawmakers and bureaucrats on behalf of the people who bathe sick and disabled Marylanders, cook and clean for them, and do other chores on their behalf. Like a lot of people lobbying the state capital, mostly they’ve been asking for more money.

White’s effort paid off in the last week of the legislative session, when the General Assembly passed a bill giving White and about 3,000 other state-contracted home-care providers a hefty 10 percent raise.

In July, when it takes effect, the raise will increase White’s hourly income from $5 to about $5.50. The federal minimum wage is $5.15.

It’s the first pay increase in the home-care program’s 19-year history.

The U.S. movement for home-care assistants started in the 1980s with disability-rights groups such as American Disabled for Attendant Programs Today (ADAPT), whose slogan is still “Real Homes not Nursing Homes.” ADAPT and others argued that the elderly and disabled do better if allowed to recover or age in their own homes, and could do so if someone came in for a few hours a day to help them with daily activities like bathing, dressing, cooking, cleaning, and running errands. The idea was a win-win: clients would rather be home than in an institution, and the state could save money, because providing home care for a few dollars a day would be cheaper than institutional nursing care, which costs hundreds per day.

Maryland was among the many states who went for the plan, setting up its home-care system, funded by federal Medicaid dollars, in 1986.

But instead of hiring workers and paying them a salary or an hourly wage, Maryland, like a lot of states, hired “independent contractors.” The state set the pay limits according to a nurse’s assessment of each client’s need—$10 a visit for someone who needs minimal care, $20 for intermediate care, $50 for a person who requires 24-hour care.

“The way that people get brutally exploited is they’re treated as independent contractors and they’re not paid a wage as such,” says Ethan Rome, a national spokesman for the American Federation of State, County, and Municipal Employees (AFSCME), which has been organizing home-care workers in Maryland. “They’re paid on the basis of the services they provide generally, which seriously underestimates the amount of time they spend.”

In some states, such as California, the client can appeal an assessment, Rome says, “but as a practical matter, if you lose, the home-care worker is going to be there to meet your need no matter what.”

White says a friend told her about home-care work, and she paid $30 for a state background check before enrolling in a week-long training class.

“They teach you how to wash, bathe the client, some dos and don’ts,” White says, “Like, don’t clean the whole house or wash everyone’s clothes in the house.”

White says the training was minimal—she learned to handle clients’ dementia, AIDS/HIV, and other issues on the job. To support herself and her 11-year-old daughter, she works at least five days per week, usually earning about $280, before expenses. The raise will increase her income to nearly $300 per week. She gets no vacation pay, no sick leave, no medical insurance.

A lot of home-care workers get other jobs, including privately paid home-care jobs, White says. A lot leave the field, leaving disabled clients without care.

White has a two-hour bus commute to one client. “I gotta spend $16.50 a week for a bus pass,” she says. “I gotta keep track of all my expenses.”

The state does not reimburse her for expenses.

Mecca Abney, another AFSCME organizer, says people like White save the state about $40,000 per year in nursing-home costs for every client they see.

As the home-care workers celebrated their first victory, two unions took credit: AFSCME and the Service Employees International Union (SEIU). The two unions both have organized home-care workers across the country—some 300,000 by SEIU and at least 30,000 by AFSCME. In Maryland the two unions are facing off.

“We set all this up, then we saw a lobbyist for SEIU come in behind us and claim to be the ‘union for home care in the state of Maryland,’” says Justin Molito, an AFSCME organizer. Of SEIU, Molito says, “they weren’t even working on this at all. We’re not in a cooperative mode with them, sadly.”

SEIU spokesman Dan O’Sullivan says his union was active on this issue in 2002 and 2003.

Part of the local acrimony seems to stem from a national dispute between Andrew Stern, president of SEIU, and the rest of the AFL-CIO, an umbrella labor organization of which both SEIU and AFSCME are members. Stern contends that American unions need to increase their organizing among workers tremendously. He’s threatened to take SEIU out of the AFL-CIO unless the organization agrees to a series of union mergers and to increase the organizing budget.

AFSCME has been among the more aggressive unions, developing organizing campaigns similar to Stern’s strategy at SEIU.

“Unfortunately there is competition sometimes between unions organizing,” Rome says. “We represent state workers in Maryland. And we represent workers in institutions. That’s one reason we’re organizing home-care workers.”

Rome says AFSCME has been organizing home-care workers in 20 states: “Both SEIU and AFSCME have an interest. We think we’re the best and most appropriate union.”

All agree there is plenty more organizing and agitating to be done.

White has been volunteering with AFSCME to get the word out. She’s glad for the 10 percent raise. But the workers still don’t have medical insurance, retirement, or even direct deposit—and that spells trouble for folks like White.

“I have to drop off the invoices every week at 210 Guilford,” she says of her regular visits to the Baltimore City Health Department. “It leaves there and goes to 201 Preston Street [the state health department], and from there it goes to Annapolis, and the check comes in the mail—and don’t let it be a holiday!”

White says holidays and other mail delays add up to financial hardship, a contention that Phyllis Brooks, another home care provider, seconds.

“I was evicted,” says Brooks, who says she’s been a home-care worker for 24 years. “My lights were turned off in the past, because we’re paid through the mail, and most of the time the mail is late.

“I have to pay $35 late charge for my rent,” she continues. “That’s another reason I took extra jobs. That was before I was diagnosed with glaucoma.”

Brooks says she woke up blind one day last July. She’s been to a doctor since, and much of her eyesight has returned, but without medical insurance she’s had difficulty keeping up with her medical treatment.

Brooks, who raised four children and is grandmother to two, says support from her family has helped her make ends meet financially. “I want to be independent,” she says.

White says the same. When she went for a loan on a used car from a dealership, the dealer told her she could not get a loan without a co-signer. White refused.

White recently moved from an apartment near Gwynns Falls in West Baltimore. She moved, she says, “because they were smoking marijuana in the hallways,” and because there was mold, and her daughter has asthma.

The new place rents for a little more than her old apartment. White’s rent is subsidized, though; she pays a bit more than one-third of her income for rent and the rest of the $775 is covered by a Section 8 voucher from the U.S. Department of Housing and Urban Development. To move she had to find $1,000 in cash—for security and other expenses.

Along with the raise, the law passed last week shifts responsibility for the program from the Maryland Department of Health to the Department of Disabilities, a much smaller branch of state government that will presumably be better able to keep track of the program. The new law also establishes an “advisory committee”—AFSCME officials hope an actual home-care worker will be named to it—to keep an eye on the program.

Union organizers say they’ll keep pushing for more pay and benefits for home-care workers. The ultimate goal, Rome says, is to make them state employees.

The poverty of home-care workers “affects both families,” White says. “If I as a provider get sick, the client has no one to take care of them.”

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