Photo by Elise Nakhnakian, Direct Care Alliance

Direct care workers prepare for lobbying on Capitol Hill for the National Day of Action in Washington, D.C.

Home health-care workers still fighting for higher wages, better benefits

Wednesday, December 26th, 2012 

Tracy Dudzinski babysat for four years after the cheese factory where she worked closed in 1992. An offer of free training and a job at a local nursing home brought her into what has become a 16-year career changing diapers of a different kind as a certified nursing assistant.

“I figured I was already changing diapers and caring for children, so how much different could it be? Boy was I wrong,” said Dudzinski of Princeton, Wis. 

Dudzinski, 48, worked at the nursing home for the next seven years, as a nursing assistant, a cook and in an administrative capacity before moving to home health care. Today, she serves as president of the board of directors and administrative coordinator for Cooperative Care, a worker-owned home health-care agency in Waushara County, Wis.

The nation’s aging demographics and the increasing desire of baby boomers to age in place at home will increase the number of jobs for home health aides and personal care aides at a blistering pace —70 percent by 2020, according to projections made by the Bureau of Labor Statistics (BLS)  in 2010. 

The average projected increase for all occupations over the same time period is 14 percent. 

But the national median wage for these health workers was $9.70 per hour in 2010, according to the BLS. During 2009, more than one-quarter of the aides in the home health-care industry relied on public health insurance, including Dudzinski.

A different way

Cooperative Care was started with an eye toward strengthening conditions in a field where few workers receive benefits. Employees are eligible for workers’ compensation, paid time off and mileage reimbursement, among other benefits. While many workers take such benefits for granted, they are scarce in the home health-care industry. 

Cooperative Care is modeled on a similar company in the Bronx in New York City, in which all the board members are direct-care workers and any profits made in a given year are returned to workers. Pay is $1 more per hour on average than at other agencies because, as Dudzinski put it, “We don’t have an owner that is lining his own pocket.”

But Cooperative Care is not immune to cost-cutting measures. Tight state budgeting reduced Medicaid reimbursement rates paid to the agency. Cooperative Care was forced to cut a costly health insurance plan serving a small number of employees, including Dudzinski and her family.

“I’m not proud that I’m on my state’s Medicaid program,” she said.

Dudzinski is furthered worried that a provision of the Affordable Care Act may force the company to provide health insurance, complicating things even further.

“We take care of ourselves well already… We’re really nervous about it because we don’t know how we’re going to afford to provide insurance,” she said.

But the law’s implementation is a catch-22 for Dudzinski. She also hopes that subsidies offered in the law once it goes into effect in 2014 will help her purchase insurance for herself and her family. Both her disabled husband and 15-year-old daughter are insulin-dependent diabetics.

Fighting for better

Dudzinski also serves as chair of the Direct Care Alliance, which advocates for greater protections for direct-care workers. Health support professionals such as nursing assistants or orderlies, whether in an institutional setting or at home, are classified as direct-care workers. The alliance, in conjunction with other organizations, held a National Day of Action last week on Capitol Hill. About 50 direct-care workers, including Dudzinski, met with members of Congress or staffers to lobby for greater protections. Hundreds more held wrote letters or met with elected officials in their areas.

“I knew if I wanted things to change, I had to speak up. I had to be a part of the change I wanted to see,” she said.

Home care workers are exemp from federal wage and overtime protections because they were treated as elder companion caregivers when the law was amended almost 40 years ago. The Labor Department announced last December new rules requiring employers to pay minimum wage and overtime to home health-care workers but the department has yet to finalize them. A bill to essentially do the same things, was introduced in the House of Representatives and the Senate last year but is languishing in committee.

There is also a legislative effort to maintain the status quo. In a bid to preempt the Labor Department’s rulemaking, Sen. Mike Johanns, R-Neb., and 13 other Republican senators introduced a bill in June that would keep the 1975 exemption in place. The bill is still in committee, as is a similar proposal in the House.

“Providing seniors and people with disabilities care at home gives them the option of leading a more independent life,”  Johanns said in a statement in June. “This proposed change to a decades-old rule would take that opportunity away from many families by driving up costs and could force them to put loved ones in institutionalized care facilities,” he said.

Stress and showers

In 2011, the median hourly wage for a home health aide in Texas was $8.75, according to the BLS. Latasha Smith of Houston has worked as a certified nursing assistant for 15 years and often is called on to train new employees.

“People who are in this field to get a paycheck don’t need to be in this field,”  Smith said. “I don’t get paid nearly enough, but it’s a job that is necessary.”

In addition to working through a staffing agency in homes and temporary institutional work, she also works at a long-term care facility primarily serving the elderly, including patients with Alzheimer’s disease. Smith typically handles five to10 residents during a shift and makes $10.35 per hour.


Photo courtesy of Latasha Smith

Latasha Smith, Houston, Tex.

“There are combative residents. There’s a couple that resist,” said Smith. “They don’t understand, especially taking showers. Showers are sometimes very difficult for Alzheimer’s residents.”

Smith, a married mother of four, recounts the recent upending of her own family. Her husband already unemployed, Smith faced severe cutbacks at both jobs before the summer, going from full-time at the nursing home to just one or two days a week in the past month. Unable to keep up, the family was evicted last month and now lives with her in-laws, 35 miles away from her job. They have been relying on food stamps and sought housing assistance only to find a four-year wait list. Smith’s two school-age children attend classes online through the Texas Connections program to avoid enrolling them in a new school during a temporary living situation.

“My stress level is very high,” she said in a recent telephone interview.

But Smith’s young voice also belies her resolve. She attends school for a certificate program in the evenings Monday through Thursday, waking at 4 a.m. to leave by 5 and returning home after 10 p.m.. Smith wants to go on to obtain a bachelor’s degree in health management. Despite being initially suspicious of the efficacy of lobbying elected officials, she participated in the National Day of Action, meeting with staffers of the Texas Senate delegation.

“I understand that it’s important and probably more effective than doing nothing at all,”  Smith said.

As many as half of direct-care worker households reported using public assistance in 2009. Smith says higher wages for workers could be a win-win for government, which will be hit with higher costs because of aging demographics.

Only 21 states, including Wisconsin, cover home-care workers under minimum wage or overtime laws.  A 2007 Supreme Court ruling struck down a challenge from a home-care worker who sought overtime pay. Without changes from Congress or the Labor Department, no federal protection exists. 

Even though she lives in a state with a minimum wage for home-care health workers, Dudzinski says it is important for her to be involved in advocating to help others..

“I go and fight because it’s a matter of respect for our profession. If we’re not guaranteed minimum wage and overtime, it’s like saying we don’t have a real job,” she said.

When her pay is adjusted for inflation, she earns 40 percent less than she did as a machine operator at the cheese factory 20 years ago.

“Being a machine operator was pretty mindless … Now I work with people and it’s different every day. But I love what I do,” she said. 




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