Home health aides fight for higher wages

September 20, 2008 2:49:49 PM PDT
Nearly a quarter century after Linda Bertoni began working as a home health aide, she earns $7.15 an hour, the state's minimum wage. She says she doesn't get health insurance, sick days or paid holidays."Sometimes I can't even pay my bills because I'm making $7.15," said Bertoni, 49. "If I pay my rent, I can't pay my electricity. My cell phone, I pay them little by little. I never pay all of it."

Bertoni and about 3,500 fellow home health aides are in the midst of a four-year struggle to gain union representation and are threatening to strike next week if their employers don't grant them a contract.

The labor dispute could serve as a prelude to similar fights as the demand for home health care soars.

As people live longer and more baby boomers age, home care remains one of the fastest-growing areas of the health care industry nationwide because it's less expensive than nursing homes, officials say. But low pay and lack of benefits create shortages and high turnover, compromising care, union officials said.

"If we all live long enough and we're not independently wealthy, we're all going to need the kind of assistance these workers provide in your home," said George Gresham, president of Local 1199 United Healthcare East.

The dispute in New York involves two agencies that employ the workers, Bestcare and Prestige Care. Bestcare hasn't responded to requests for interviews about the dispute. An administrator for Prestige declined to comment.

At the root of the wage issue are burdensome state and federal regulations that often increase agencies' costs, said Peter Notarstefano, director of home and community-based services at the American Association of Homes and Services for the Aging. The association represents nonprofit groups that provide housing and service to the elderly.

Such costs can include screening potential employees, training for staff, supervisory staff to manage aides, liability insurance, 24-hour on-call service, accreditation, and initiatives to improve quality of care, Notarstefano said.

"There's layers and layers of regulations that bring up the amount of money the home health agencies are dishing out," said Notarstefano, who ran an agency in upstate New York a decade ago. "It's not as simple as the agency is getting X amount and why is the aide only getting $7 an hour?"

In addition, Notarstefano said, reimbursement rates from Medicaid, Medicare, private insurance and other sources can vary.

In New York City, for example, an agency gets an average $22 an hour for a home health aide Medicare-certified case, he said. The national average for the same type of case: $38, he said.

Aides usually work for private for-profit agencies that are subcontracted by Certified Home Health Agencies and Long-Term Home Health Care Programs, which bill Medicaid and Medicare for the care.

Medicaid and Medicare are federal insurance programs, the former for low-income people and the latter for the elderly.

While the pay for home health care workers is often menial, the work is anything but, workers say.

A typical day begins with the worker arriving at a client's home, helping him or her out of bed, changing linen and sometimes bathing, grooming and dressing a sick or infirm client. Aides also cook meals (sometimes feeding the client), remind clients to take medications (they can't administer medication), as well as clean, wash clothes, shop for groceries and make trips to the pharmacy.

"I do everything for them," said Delsi Pina, 62, who has worked for Bestcare for five years. She makes $8 an hour caring for five patients. Because many aides earn the minimum wage or close to it, they often work more than 40 hours each week.

After Pina pays her $700 rent, $25 a week for an unlimited MetroCard, $100 a week for food, and her electricity bill (she just received a $377 bill for two months of service), there's not much left from her roughly $440 weekly take-home pay, she said.

"I am so tired of having to work so many hours just to pay my rent," Pina said at an 1199 rally this week.

Because Pina has no health insurance, she tries to stay fit by eating healthy foods and exercising everyday in her Bronx apartment.

Like Pina, who is from the Dominican Republic, and Bertoni, who started working in the industry shortly after immigrating from Haiti 25 years ago, the majority of home health aides are women and immigrants. The union prints all of its leaflets in Spanish, English, Chinese, Russian and Creole, Gresham said.

And then there's the emotional investment some aides make in their clients. Bertoni recalled working with an elderly woman and her husband for more than a decade. She grew to love the couple, who have since died, she said.

"She had no children," Bertoni said. "I feel sorry for her. She had only me. I was like part of her family."

Bertoni lives with her husband, who receives disability, and his two young adult children because they can't afford their own apartment, she said.

Gresham said the reimbursement system should be reformed so that agencies are required to pay workers higher wages. Or, he said, agencies could decide on their own to pay employees more from the taxpayer-funded reimbursements.

"These are the working poor," said Gresham, whose mother is a retired home health aide. "It takes an economic genius to live in New York City and take care of a family on the menial wages they get away with paying."

This is not the first time home care workers have fought for greater protections. The case of a Queens woman who spent two decades in the industry and never received overtime went all the way to the U.S. Supreme Court last year.

But the workers lost. The court unanimously upheld a 1975 Labor Department regulation exempting home care workers from the protections of the Fair Labor Standards Act.

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