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"She told me to get the hell out of her house," Gonzalez says of her weekend ward. "She doesn't know what she's doing. So when I try to put on her Pampers, she pulls it right back off."
Such is life in the home health care industry, or the "modern sweatshop," as labor leader Denis Rivera likes to refer to it. Despite a slight slowing in the last two years, home care is the fastest-growing sector in health care. And Rivera's union, 1199, is recruiting thousands of home care workers even as the industry is witnessing the emergence of difficult-to-organize, for-profit companies.
The biggest surge in 1199's home care membership will take place next week when, pending a division vote, 22,500 home care workers will join the 22,500 already in the city's biggest health care labor group. The imminent merger, which will make home care 1199's second largest division, is the result of the dissolution of DC 37's local 32B-32J, whose president, Gus Bevona, stepped down amid controversy over misuse of union funds. Within a year, Rivera also expects to add workers from subsidiaries of the Visiting Nurse Service (VNS), which would swell the division's ranks to roughly 60,000.
Perhaps the most significant addition to the home care division was a small group of home health attendants at Partners in Care, a company within VNS, which voted to join 1199 in July. Although the move added a mere 4000 workers to the already mammoth union, it marked the first time workers at a for-profit home care company signed on.
For-profit companies have sprung up over the last 15 years as policy changes made home care a potential moneymaker. But the trend may be unfortunate for those employed by the new agencies. "The profit comes from the salaries and wages and benefits of home care workers," says Rivera.
Although Partners in Care characterized the six-week drive to organize its own workforce as "cooperative," union representatives complain that for-profits generally pose significant obstacles to organizing. "They have the money to fight us," says Ada Garcia, executive vice president of 1199's home care division. Garcia notes that an attempt to organize Partners in Care some 10 years ago was stymied when the agency changed locations and hired "anti-union" lawyers. Such tactics, which she says a number of for-profit agencies have taken, "can keep us for years in the anti-union process."
Without the negotiating power of the union, the majority of the city's home care workforcewhich is overwhelmingly black and Latino and virtually all femalemakes around $5.50 an hour and has no health benefits. Because their jobs are in the home, workers are also exempt from some of the basic protections of labor law, such as the right to get paid for overtime.
Conditions of unionized home care workers, though better, also remain stubbornly dismal. Home attendants and home health aides in 1199 make an average of $14,000 each year for 2000 hours of work; many would like to work more hours, but are unable to get the assignments. A large proportion of workers don't have health insurance that would pay for them to get the kind of care they're providing others. And wages for the sometimes backbreaking work (tasks include turning bed-bound patients and moving them from the bed to the wheelchair to the toilet) start as low as $6.89 an hour.
1199 would love to further add to its rankshelping underappreciated workers and expanding its already significant political clout. But reaching the thousands of non-unionized home care workers scattered throughout apartments and houses across the city is a vexing problem. To make contact, union organizers have resorted to attending training sessions, tracking workers by phone, and even hanging around check-cashing places on payday.
"It's not like organizing a hospital, where you just stand outside the building," says 1199 organizer Keith Joseph. As with many unionizing efforts, concern about retribution is a main obstacle. "They're afraid of losing what little they have," says Joseph.
Beleaguered and low-paid as they are, many home care workers do have pride in their work. "My client's been with me nine years and she never gets a bedsore," one woman bragged at a recent training.
Even Gonzalez, who says she is "tired, tired, tired" of working, finds satisfaction in helping her clients. "I like to take care of them," she says. "And they like me."
For 1199's Garcia, the challenge is to broaden that appreciation. "The union would like to see these workers considered part of the health care system," says Garcia. "They're not maids, they're not invisible."