By MICHAEL LAWSON, Investigative Reporting Workshop
WASHINGTON, D.C. ― Rolanda Wade works as restorative aide and certified nursing assistant. To her patients, she is everything.
“A lot of them can’t get dressed by themselves. They can’t wash themselves,” said Wade, who has been on the job 17 years. “Some of them can’t even feed themselves. We have to brush their teeth, do their hair, pick out their clothes for the day.”
The pay is low and injuries are common, but nursing care is a rare bright spot in the gloomy economic landscape, adding jobs at a steady clip. As the field has grown, so, too, have efforts to unionize.
Those unionization campaigns are being fought on a shifting battleground, from massive chains to private homes. With boomers moving into retirement, the tensions aren’t likely to abate any time soon.
Workforce shifts with care industry
An aging population is increasing its demand for home health and nursing care. Relatively low training requirements mean the job is accessible to a broad range of workers. The Bureau of Labor Statistics (BLS) says the ranks of home health aides on the job ― about 1 million today ― will increase by more than 50 percent in seven years.
By 2018, there will be more direct-care workers, as they are known, than teachers or public-safety workers, BLS data show. But mean wages for these careers still hover near the poverty line, and incidences of injury among these workers are second only to police officers, according to the Occupational Safety and Health Administration.
Bill Cruice, the executive director of the Pennsylvania Association of Staff Nurses and Allied Professionals, a labor union representing 6,000 nurses and health professionals, said he has seen many changes in the industry.
Nursing homes have historically been owned and operated mostly by companies focused on health or elder care. But during the last 20 years, ownership has shifted to big investors, who are snapping up and consolidating homes. Private equity firms have gotten involved in the industry as well, with the Carlyle Group acquiring the nation’s largest nursing home chain, HCR ManorCare, in 2007.
The shift has raised red flags. In 2007, Congress held hearings on how changes in the industry are affecting care and accountability.
The image of the small, family-owned nursing home is an antiquated one, Cruice said. Private investment firms purchased close to 1,900 homes from 1998 to 2008, according to a 2010 Government Accountability Office report. Only 10 private investment firms accounted for 89 percent of these acquisitions.
Labor costs, the single greatest expense for nursing home owners, Cruice said, will likely be the source of increased conflicts with owners because of what he calls a “disconnect between decision makers and workers.”
Efforts to unionize health and eldercare workers are underway nationwide. Even at nonprofit long-term care providers, health care workers are swimming against the de-unionization tide. Although overall union membership has been cut in half since 1979, to 12 percent, unionized health workers, who earned 14 percent more than nonunion workers, have increased since 2001.
Employees at the nonprofit, church-affiliated Broomall Presbyterian Village in Broomall, Pa., are hoping to join the ranks of union-represented workers. They voted nearly two years ago to join Service Employees International Union (SEIU) Healthcare Pennsylvania. They are still working without a contract, after months of negotiations. Employees said the sticking issues involve the company’s demand that employees contribute more to pension and health care without guaranteed raises.
Broomall is the only facility pursuing a union contract out of 28 facilities owned by Presby’s Inspired Life, according to Dan Magee of Presby’s. He said, “Our goal is to pursue a fair and equitable contract,” but he declined to discuss details.
Since the union vote, Regina Robinson, who has worked at Presby’s for 18 years, has not received a raise, and she’s seen her department whittled from four workers to one.
Another bone of contention is that nationwide a quarter of direct-care workers lack health insurance coverage.
“Your copay is expensive; the specialist is expensive,” said Robinson, who makes $14 an hour. “You’re paying a lot of money out of your pocket, plus what you pay here a month.”
Even for nurses with a contract, the grueling work doesn’t necessarily translate to high salaries. Wade and her co-workers at Delaire Nursing Home in Linden, N.J., a for-profit home, are represented by 1199SEIU, the largest health-care union in the United States.
Wade makes a little more than $16 an hour, she said, and supports herself and her college-age daughter. But she is still living paycheck to paycheck, she said, and recent contract negotiations have been the most difficult she has seen.
One proposal included an end to health benefits for Delaire workers. “If we don’t have health insurance, it’s going to come between me paying for health insurance or me feeding my family. That’s just the bottom line,” she said.
Home as a battleground
As the boomers age, the battleground in the eldercare fight is shifting from facilities to the home. A recent AARP study revealed that nine in 10 boomers would prefer to stay at homes indefinitely.
Home health care workers often have lower wages and fewer protections than their institutional counterparts. They’re excluded from the Fair Labor Standards Act, which ensures minimum wage and pay for overtime. The Obama Administration recently proposed extending these protections to home care and domestic workers for the first time.
In announcing the proposal, Labor Secretary Hilda Solis cited the staggering demand for home aides and said the field needs greater job security to attract qualified professionals.
The 2008 Institute of Medicine study, Retooling for an Aging America, recommended a minimum of 120 hours of training to prepare workers for the increase in the aging population.
Federal training requirements for direct-care workers have not been updated in 20 years. While 31 states and the District of Columbia have adopted stronger standards for training, home health training lags behind that of their institutional counterparts — although the two positions often involve the same work.
“If you’re a nursing aide, you’re not going to quit a $14- or $15-an-hour job to go work for a home-care agency where you’re going to earn less than 10 bucks. It doesn’t make any sense,” said Dorie Seavey, policy director of the Paraprofessional Health Institute (PHI National), which advocates for direct-care workers.
PHI National research determined that pay is so low that half of such workers receive some form of public assistance in addition to their pay. A survey by the U.S. Department of Health and Human Services found nearly 40 percent of certified nurse assistants at nursing homes and 30 percent of home health aides reported forgoing employer-provided health insurance because they were unable to afford the copayments and deductibles. Many rely on Medicaid or other government health programs.
Poor pay also contributes to a high turnover rate ― 66 percent in 2008 in nursing facilities, according to the American Health Care Association, the trade group of for-profit nursing facilities.
A little more than half of the direct-care workforce is full-time and is disproportionately made up of people of color. Almost half (46 percent) were African-Americans or Latino in 2010, and nine in 10 were women.
“Men don’t have that many incentives to go into those jobs because you can still earn more as a landscape worker or as a laborer,” said Ariane Hegewisch, of the Institute for Women’s Policy Research.
Hard work with a purpose
Margaret Boyce has two full-time jobs. She works from 3 to 11 p.m., at one home in long-term care, dealing with permanent residents, and follows that with restorative care from 11 p.m. to 7 a.m. at another. She makes a little more than $12 an hour at each home.
“You have to account for everything — every little scratch, every single thing that goes wrong with that patient. . . . If they don’t eat, if you don’t record anything, your license is at stake,” said Boyce. “It’s like you have 16 kids.”
Boyce once dislocated her shoulder while lifting a patient and couldn’t work for a month. “Sometimes in this job you really want to turn around and go home,” she said.
Despite frustration with pay and benefits, 80 percent of the workers in a government survey also reported job satisfaction, with most citing the good feeling they have from caring for others.
Wade noted, “The elderly took care of this country for years, and they’re so easily forgotten. I feel honored that I can help someone who built a country for me to live in.”
This article is adapted from a feature by the Investigative Reporting Workshop, a project of the American University School of Communications in Washington, D.C.
