The Washington PostDemocracy Dies in Darkness

America’s fastest-growing profession is joining a very public fight for higher wages

Home health-care aides have joined fast food workers in a campaign for a $15 minimum wage.

Lynette Reece, a home health-care aide in Washington, D.C., makes $13.60 an hour — but says $15 would be better. (Lydia DePillis/The Washington Post)
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In a life working a string of low-wage jobs, Lynette Reece always had trouble paying the rent. A home health-care aide for the past 21 years, she has too often had to skip work to go to landlord-tenant court to try to hold on to her apartment.

“How can I go to work if I have to go to court?” says Reece, 46, a single mother of two in the District, who pays $985 for a two-bedroom place. “That’s stressful when you’re trying to concentrate at work, and you can’t because you got so much on your mind.”

Her predicament eased when the District’s 2006 living wage law for government contractors — including home health-care aides paid by Medicaid — took effect. She now receives $13.60 an hour, up from $10.50 a few years ago. “I can pay my rent with one check. One check,” she says.

Knowing what a difference higher pay can make, Reece has joined a new movement launching this week to raise wages and improve workplace protections for home health-care aides nationwide. Backed by the Service Employees International Union, the effort seeks to replicate the “Fight for 15,” a push earlier this year to raise the income of fast-food workers through high-profile strikes.

On Wednesday, Reece will rally on D.C.’s Freedom Plaza to demand the same for home health-care aides. It’s part of actions in nine states aimed at putting the concerns of the nation’s fastest-growing workforce — one that’s 91 percent female, 56 percent non-white and highly dependent on public aid — on the political agenda. About 600,000 of the country’s 2.1 million home health-care aides are members of the SEIU.

It’s election season, so the events are targeted toward specific politicians: A rally in Wisconsin against Republican Gov. Scott Walker’s general opposition to a higher minimum wage, and another in Ohio against Republican Gov. John Kasich’s opposition to organized labor. On the flip side, Rep. Jan Schakowsky (D-Ill.) will join home-care workers at an event calling for a $15 wage, and Atlanta’s home-care workers will praise Georgia Democratic Senate candidate Michelle Nunn’s support for raising the minimum wage, which her opponent, David Perdue, opposes.

Home health aides can’t entirely replicate the fast-food workers’ tactics. Unlike someone flipping burgers, they can’t just walk off the job: That would leave those they care for — the nation’s parents and grandparents — in danger. And crucially, although most low-wage workers battle big corporations, home health-care workers usually are dealing with a different beast: the state, which ultimately pays their wages.

The SEIU, along with other unions and advocates, has had some success. Washington State recently signed a contract to raise wages to more than $14 an hour, while Illinois’ contract had raised the average to $13. Montana and North Dakota also have earmarked money to raise wages over the past few years. Others, including Missouri, are considering it.

It’s a long way to $15 in most states, though, and that remains the rallying cry. For Reece, the higher wage would help her get the three-bedroom apartment with a washer and dryer. “With the $15, I’ll be able to pay my rent, and have some change left over, be able to pay my bills,” she says.

Why now?

Reece is being paid substantially more than the median wage for home health aides, which is $10.01. But she and others describe a wide range of problems in the field: Agencies don’t always pay their employees promptly, and other times they don’t keep wages on track with local laws, or local governments don’t enforce them. Reece’s agency, ASAP Services, doesn’t offer paid time off or retirement benefits, and she says the health insurance option it offers is unaffordable.

“That’s something we’re reviewing,” said Denetria Ngati, ASAP’s director of nursing, referring to the prospect of offering more benefits.

According to the Paraprofessional Healthcare Institute, a nonprofit consultancy affiliated with a worker-owned home-care co-op, 58 percent of home-care aides are either uninsured or are covered through the safety net.

Organized labor officials say it’s important that these workers get a raise, but also that they join a union, so they continue to receive protection. That’s why in the fast-food movement, protesters called for “$15 and a union.” The push made a major splash this year and may have added momentum to efforts in many cities and states to raise the minimum wage.

Unions hope they can reprise the strategy with home health-care efforts, but there are are myriad challenges. In the District, for instance, none of the 27 home-care agencies is unionized. Reece has been working with the local SEIU to try to sign people up. But many of her fellow aides are from West Africa and speak only French. “Some of these workers don’t know they’re supposed to be making $13.60,” Reece says. “At first they brush you off, and then you talk about money and they focus. Money is the key word.”

Nationally, unions have faced similar problems. Unlike factory workers, home health-care aides rarely work in the same place, requiring unions to track them down at home. They also work for thousands of small agencies, which means that unions must negotiate contracts with each one to build membership.

And it may become harder still. The SEIU had a breakthrough in the late 1990s, when states – including California, Oregon and Washington — began to recognize home health aides as public employees, even if they were employed by private agencies contracted by Medicaid. That allowed them to negotiate large contracts on the behalf of thousands of workers.

Then, earlier this year, the Supreme Court threw up a big roadblock. In Harris v. Quinn, it ruled that “fair share fees” — which many contracts allowed SEIU to collect from all workers, whether they joined the union or not — infringed on workers’ free speech rights.

The ruling represents a substantial financial hit for unions, and made organizing that much more difficult.

“Now they have to go out there and get every single home-care worker to be a member of the union,” says Janice Fine, a professor of labor relations at Rutgers who focuses on immigrant and low-wage work.

The goal, SEIU President Mary Kay Henry says, is twofold: To make non-union and privately paid home-care workers aware of how the union is trying to help, and shift public sentiment such that politicians feel there’s support for what they want. That could help the SEIU transcend its state-by-state task.

“We understand that if we continue to do it incrementally like that, we’re not going to keep up with how fast-growing this work is,” Henry says. “So this is a shift to building a national movement and making a national demand, that we want every level of government and every employer to respond to.”

Making states pay

One of the biggest complications is that in their “fight for $15,” home health aides aren’t fighting a large corporation. About three quarters are paid through Medicaid, which means that higher wages are a blow to public budgets, not shareholders.

By and large, however, states haven’t been increasing budgets to keep pace. New York state, for example, cut its home health-care budget by hundreds of millions of dollars in 2011 and 2012. In 2013, it imposed a wage mandate for the New York metropolitan area that reached $14.09 in pay and benefits in March.

That has squeezed providers. According to Joanne Cunningham of the Home Care Association of New York State, which represents the private providers that employ health aides, agencies have been cutting other priorities — like training and administrative staff — to comply.

“No one, least of all the agencies, wants to pay their workers anything less than a living wage,” Cunningham says. “The issue is, the health-care system now is going through such change and challenge that home health-agency providers are feeling a lot of fiscal pressure, and they’re having a very hard time coping with the wage mandate.”

That became glaringly apparent last week, when the Obama administration announced a six-month delay in enforcement of a new federal requirement that home-care workers be paid the minimum wage and overtime. States complained that overtime protections in particular could cost hundreds of millions more per year, so the effective date was moved back to July 1, 2015.

“What we’ve seen is that states have been dragging their feet in terms of dealing with this rule. A handful of states have been increasing budgets, like California, but other states have basically been fighting it,” says Abby Marquand, director of policy research with the Paraprofessional Healthcare Institute. “From the advocacy side, it may be politically challenging, but you can’t balance your long-term care system on underpaying the workforce.”

The SEIU says boosting those budgets is the flip side of its campaign to raise wages legislatively.

“We believe as we raise workers’ wages in this part of the economy that we will be having a broader fight about our nation’s tax system, what we invest in,” Henry says.

But even in California, which has long applied its minimum wage to home health aides, an old notion remains that home health-care workers aren’t due full protections, because it’s just “companionship” — a job a young woman might do to help an aging relative. Last month, California Gov. Jerry Brown (D) signed a bill requiring employers to pay for sick leave, but home health aides were excluded.

That’s wrong, Reece says — lifting old people in and out of beds, keeping track of their medicine, doing their shopping and generally keeping them healthy is just as challenging as the factory jobs of days past.

“It’s not right, because these people that are getting more than us, they don’t do half the work we do, or deal with half the situations we have to deal with,” Reece says. “We have to be their mother that died, their son that died, their daughter that doesn’t come around, their niece that doesn’t come around. We’re like their whole family. So why can’t we get paid?”