Homecare Hurting for Funds
Tiny Mae Rucker, 79, depends on the homecare workers who come to her house on Chicago's west side for five hours every day.
For most of her life Rucker made it on her own, raising "seven children who weren't mine" and later living solo with no family in the area, working long hours as a beautician and nurse. But several years ago she became severely ill, leaving her unable to walk and barely able to see. She needs the homecare workers to give her medication, buy her groceries and help her bathe and dress.
Meanwhile homecare worker Helen Miller, 67, depends on her physically and emotionally taxing job taking care of housebound people like Rucker to pay her own bills.
"They look for their homecare workers sometimes more than their families, because they know you'll be there," said Miller, who is also president of Service Employees International Union (SEIU) Local 880, which represents homecare workers. "I work eight hours a day with a patient who has had two brain surgeries, 12 strokes. I call her my baby in a woman's body."
In Illinois, over 68,000 senior citizens and disabled people receive government-funded homecare services from about 37,000 workers, paid for with a mix of general state funds and Medicaid funds from the federal government.
But both workers and recipients are dealing with constant uncertainty and substandard living conditions because of state and federal budget cuts.
Despite all their duties, home healthcare workers in Illinois are paid only $5.75 to $7 an hour, with few or no paid holidays, vacation days or even sick days, and 58 percent of them have no healthcare benefits. Most have little or no specific training for the job, even though it demands a mix of nursing, counseling and other skills and involves physically moving clients, which carries a high risk of back injury for the worker.
Homecare advocates point out that it is the economically efficient alternative for indigent citizens needing constant care; it costs on average three times less than a nursing home and studies have shown people fare much better physically and emotionally in their own homes as opposed to institutions. In the coming year, according to SEIU Local 880 legislative director Cindy Boland, 2,500 more disabled people are slated to be added to the program. The government will save over $65 million per year by having them in homecare rather than institutions. But despite the obvious economic sense the program makes, it is in a constant battle for funds, made worse by the Bush administration's economic policies, including cuts in Medicaid and tax cuts for the wealthy which exacerbate state budget crunches.
Last year the homecare program faced an $18 million cut in expected state funding as well as the effects of a $750 million cut in Medicaid.
The SEIU attributed the pinch directly to the effects of tax cuts, noting that the overall Illinois budget included the Medicaid cut plus cuts of $50 million in aid for the physically and mentally disabled and $400 million in public education. Meanwhile corporations got a $260 million cut in depreciation policies, a $163 million break on loss deductions and $67 million in retailers discounts, among other things, for an overall gain of $1.2 billion for the richest two percent of the state's taxpayers.
"Bush's policies have been absolutely devastating for us," said Boland. "His tax cuts essentially mean there is less money for the states to pay their bills, which means there will be less money for homecare. We need more money coming into the state, not less. We're moving in the opposite direction from what we should be doing."
Homecare worker Flora Johnson, 59, noted that without increased funding, the homecare program will find it increasingly hard to keep workers -- a situation which would actually get even more critical if the overall economy improves at all as Bush claims it will. Already, there is a 45 percent turnover rate within the first three months of hiring for homecare workers.
"People don't want to go into nursing homes, they want to stay in their communities," said Johnson, who makes $7 an hour with no benefits caring for a disabled person five hours a day. "But if they don't pay more, they won't be able to keep workers. We want to help people but we need to be able to pay our own bills too!"
The union suggests that instead of taking out the budget crunch on the back of homecare and other programs that serve the indigent, the state should institute higher casino and cigarette taxes, maintain rather than repeal the state's estate tax, and stop tax breaks to corporations. Likewise for the federal government.
SEIU Local 880 has been campaigning for almost two decades to secure raises and benefits for homecare workers, who are hired by a variety of private and government agencies and paid by the state with the federal and state funds.
The union has long represented the 13,500 homecare workers who are hired by private agencies subcontracted through the Department of Aging, and recently Illinois Gov. Rod Blagojevich signed an executive order recognizing the union as the bargaining unit for the about 20,000 workers hired by the state Department of Human Services to help the disabled.
A two percent (approximately one dollar an hour) raise for all homecare workers was passed in the FY 2002 budget, which was to have taken effect on July 1, 2002. But due to the state budget crunch, the raise was repealed (this is what the union refers to as the $18 million cut last year; about a fourth of the funding was actually restored with a 50 cent an hour raise that took effect in January).
In addition, last year the state proposed reducing service hours for recipients by 15 percent, a move the union said would be "disastrous" for clients and workers. The reduction would have brought down the annual average wages of homecare workers to only $9,350 from $11,900.
"If hours of care were cut, it would jeopardize the health of the individuals depending on this care, cause expensive and premature institutionalization of thousands of seniors and people with disabilities and would result in an additional loss of income to workers already struggling on poverty wages, without benefits, and without a raise for three years," a release from the union said.
The hours reduction was ultimately defeated for the time being, thanks largely to the union's organizing, and the union helped get bills requiring the one dollar an hour raise for both groups of workers reintroduced to the state legislature this year. The bills have actually passed the House and the Health and Human Services committee of the Senate. The union sees this legislative progress as a hopeful sign, but they are still fearful of future cuts in the program, as a result of tighter Medicaid requirements and ongoing state budget problems. Following the general trend of Bush's economic policies, social service and healthcare programs for the indigent are among the first to get the ax. In the case of homecare, low-income minorities will be the primary victims of any cuts -- both the homecare workers and recipients.
The average homecare worker is a middle-aged African-American woman who works full time making less than $7 an hour, is the single head of her family and wants more training in the health care field, according to a 2001 study by SEIU Local 880. Many of the workers get into the field through welfare reform "Welfare to Work" programs. Rucker said that all eight workers who were assigned to her in a period of two years were middle-aged African-American women with kids. She said that while she has had close bonds with all of them, their performance suffered from lack of training and personal problems such as unreliability and addiction.
"I felt like they wanted to do a good job but they couldn't," Rucker said. "Sometimes they wouldn't show up at all and they wouldn't call. Some of them are addicted to drugs -- if you spend that much time with someone, you know the signs. I had people here who couldn't even read the medicine labels to give me my medication. And I'm big, so I really needed someone with more strength to help me move better."
Boland said she doesn't know how the homecare program will keep meeting the needs of clients without increased funding.
"Will they just start putting people out on the street or what?" she asked. "There's the potential for some pretty horrific things to happen."
Kari Lydersen writes for the Washington Post and is an instructor for the Urban Youth International Journalism Program in Chicago.