These Poor Toil Unseen to Care for Poor

They are among the most poorly paid workers--thousands of “independent providers” living at or below the poverty level despite working long hours taking care of thousands of “clients” who come from society’s sick and wretched poor.

Brought together by the state-funded In Home Supportive Services, the two groups form an anonymous subclass that Fahari Jeffers, a founder of the National City-based United Domestic Workers Union, calls “the invisible poor, taking care of the invisible poor.” Working usually for minimum wage--$4.25 an hour--and without benefits, the 7,000 San Diego County providers like Maria Gonzalez, 58, act as doctor, nurse, therapist and mother, caring for people who are unable to fend for themselves or have been abandoned by their families.

Until recently, home-care workers and the people they serve were an invisible and silent group in the state. But the In Home Supportive Services program came to the forefront in January, when Gov. George Deukmejian announced that he was going to ask for a $64-million budget cut in the $575-million program for the fiscal year beginning July 1. Last month, a group of local home-care workers drove to Sacramento to lobby against the cut.

Aged, Disabled Poor

The support program was designed to help the state’s aged and disabled poor, who cannot pay for their own convalescent care but would represent an impossible expense to the state if they were institutionalized. Instead, the state Department of Social Services tries to meet their health and care needs by minimizing cost and paying Gonzalez and other providers, who are also called home-care workers, minimum wage for work time authorized by county officials.

Although the program is financed by state money, the Legislature has left its actual administration up to the counties. Union officials and advocates for both groups say that about 99% of the home-care workers are poorly educated women who come mostly from minorities.

State Department of Social Services officials say that, statewide, about 120,000 home-care workers take care of about 140,000 sick or aged persons, with some taking care of more than one person. Some are paid to take care of family members.

Gonzalez, who has no medical training, administers medication and helps bedridden Naomi, 87, with her bathroom tasks. Naomi (her real name has been changed for privacy reasons) has not spoken in two years and has taken all of her meals through a baby bottle since an operation for an ulcer in 1986.

Forty years ago, Naomi was a movie actress in Mexico City. A photograph hanging on an otherwise bare wall inside her depressing East San Diego apartment shows her in better times. Smiling and raven-haired, she is pictured with a young Ronald Reagan in a Hollywood studio. Today, the disabled woman, who has two grown, adopted children, is under the wing of the county and spends all of her time in bed. Gonzalez tends to her bedsores and bathes her twice a day. The woman never utters a word.

Gonzalez, who has taken care of Naomi for three years, also wakes up every two hours at night to turn the woman over in order to alleviate bedsores on her back. For the past three years, she has been getting paid by the state for seven hours a day of care for Naomi. But, in reality, it has been a 24-hour a day job, seven days a week.

Woefully Lacking

The state and county’s authorization for only seven hours of daily care for Naomi does not mean that social workers expect her to care for herself during the remaining 17 hours. Rather, the minimal authorized care reflects the fact that the county is woefully lacking funds to provide adequate care for severe cases like Naomi’s.

Jeffers charged that officials conveniently overlook situations where a single worker provides round-the-clock care for poor patients.

“They say that they don’t authorize it, but the bureaucrats know that it’s a mainstay of the care that some recipients receive. . . . They also don’t object because they know that these workers are in effect providing free care to people who are the government’s responsibility,” Jeffers said.

Although there are no estimates of the number of workers who actually live around-the-clock with the people they care for, Jorge Rivera, an organizer with the nonprofit Service Workers Center in San Diego and Robert Barton, chief of the state Department of Social Service’s Adult Services Bureau in Sacramento, said many are actually living with the people they care for.

“When you break it down, people like Maria Gonzalez, who are providing care to the disabled 24-hours a day, end up earning less than $2 an hour,” Rivera said.

“We only pay for the amount of service that we actually authorize,” Barton said. “We aren’t able to pay for 24-hour a day care. It would be impossible.”

William Bruner, head of the county’s home-care services program, said there are about 7,500 home-care workers taking care of about 13,000 aged or disabled residents, ranging in age from 18 upward, throughout the county. About 525 of the workers are employed by the National Homecare Systems, which has a $10.5-million, two-year contract with the county to provide services to about 2,000 clients in remote areas. Workers employed by National Homecare are represented by Jeffers’ union and earn $5 an hour plus benefits.

Few Are Unionized

Statewide, about 12% of the home-care workers are unionized and hired by companies that contract with individual counties.

But the overwhelming majority of home-care workers are recognized as independent contractors and not organized. Although they are hired through a registry administered by the counties, the courts have refused to recognize them as county employees, eligible for higher pay and benefits.

Rivera said about 7,000 workers in the county are independent providers like Gonzalez. In 1987, the center was founded to “train and educate low-income workers to become advocates of their own rights,” Rivera said. Although the center operates out of the Service Employees International Union, Local 102 office, Rivera said he is not organizing home-care workers into a labor union.

“There’s a high turnover on this job. It doesn’t pay enough to pay the bills, rent and buy groceries. These people perform a service that saves the county and state a lot of money, but they aren’t paid enough for what they do. Our goal is to make them aware of their rights as workers and let them become their own advocates,” Rivera said.

San Diego County receives $47 million a year from the state to pay for the local program. Bruner said he is not sure how much the county stands to lose if the governor’s proposed cut is enacted.

However, Bruner said any cut would hurt, because the existing money is not nearly enough to meet the community’s needs; despite the fact that it has been increased every year. Five years ago the state spent $272 million for home care; last year funding reached more than half a billion dollars.

“This has always been an under-funded program. It has never from the day it was designed been adequately funded. . . . A reduction in funding would affect both providers and clients, because we would probably have to trim the number of care hours authorized for the clients and limit their number,” Bruner said.

Angela Lomeli, 56, has taken care of an 89-year-old Chula Vista woman who suffers from Alzheimer’s Disease for almost a year. The woman, who will be called Alicia for privacy reasons, believes that Lomeli is her mother. During a recent interview with Lomeli in her client’s apartment, Alicia suddenly rose from living room chair and hugged Lomeli. Placing her head gently on Lomeli’s chest, Alicia said in Spanish, “I love you, mother.”

Lomeli’s situation is not much different from Gonzalez’s. But, while Gonzalez lives with Naomi seven-days a week, Lomeli only spends Monday through Friday with Alicia. She spends the weekend with her family in Tijuana, and the state pays another woman to watch Alicia on Saturday and Sunday.

“It’s a trying condition, to be sure,” Lomeli said. “Sometimes she’s lucid for a while, and she’ll start crying, telling me that she wants to die. She’ll cry for up to an hour. I hug her and try to comfort her. . . . I’m so concerned for her. What’s going to happen if the county can no longer pay for her care? Will they put her in a convalescent home where she will die of loneliness? That happened to another of my clients. I don’t want it to happen to her.”

Rosa Perez, 62, has an easier time with Hector Bertull, 93. Bertull, a spunky man who enjoys conversing with people and dancing polkas, has bad eyesight. Perez has been taking care of Bertull in his San Ysidro apartment for 16 years. She now tends to his needs seven hours a day, then goes home to her family.

“I’ve grown so attached to him that I sometimes take him home with me. My daughters love him like a grandfather. . . . I’m a nurse, barber and everything to him. I bathe and shave him in the mornings and even cut his toenails. I cook his meals, mindful that he can’t eat a lot of salt because of his blood pressure,” Perez said.

Three years ago, Perez and her daughter drove the old man to Parlier, near Fresno, so he could attend his granddaughter’s wedding. “I love Rosa very much. I love her like I loved my own mother,” Bertull said.

Jeffers, of the United Domestic Workers Union, argues that home care workers like Perez, Lomeli and Gonzalez are no better off than indentured servants and deserve better treatment.

“The qualities they bring to their job are incredible. The live by a higher credo and have devoted themselves to help the aged and disabled live more comfortable lives. . . . They have the qualities of a Florence Nightingale, Gandhi and Martin Luther King. . . . Unfortunately, the system is designed to take advantage of them,” Jeffers said.

Gonzalez’s income has increased only $1.95 an hour in 16 years. Jeffers cited that and other factors in arguing for better wages and benefits for home-care workers.

“Today’s home-care workers are going to be tomorrow’s recipients,” Jeffers said. When is the government going to realize that it is cheaper to pay them a decent wage and provide them with medical plans today?”

Bruner said he is sympathetic, but added that he also has to work with limited funding.

“We do ask a lot of our individual providers. I think that it’s very clear that the skills, commitment, enthusiasm and caring they bring is certainly worth more than $4.25 an hour . . . . But, when you’re running an under-funded program, which is a low priority within the state, you have to try to utilize your resources as best as you can,” Bruner said.

“I have a lot of respect for these people,” he added. “The most unique skill they bring is caring. You don’t enter this job to make money . . . it’s a maintenance program. The vast majority of our clients do not get well. Another thing that I admire in our individual providers is how they are able to cope with a client’s deterioration.”

Despite the program’s chronic shortage of funds and the looming budget cut, Bruner said he wants to see the local home-care program broadened.

“Our projected growth rate is 3% annually. The county is clearly demonstrating a greater need. . . . Simultaneously, I want to make people aware of the program and encourage them to apply. But, at the same time, if we were to market this program extensively . . . I know we would be overwhelmed with numbers. But there is a definite need out there among our poorer residents. They deserve the care,” Bruner said.