Union Pushes for Overhaul of County Home-Care System

For two years, Los Angeles County has paid Michelle Gilbert to feed, bathe and otherwise take care of her 88-year-old mother in the rented home they share here.

Gilbert’s salary: minimum wage, $4.25 an hour.

But even though Gilbert’s mother has Alzheimer’s disease and requires nearly constant attention, the county only pays for 3 1/2 hours of care each day.

Gilbert, who quit a good-paying job selling eyeglasses to assist her mother, said the county’s meager payments have placed her in a dangerous financial Catch-22.

Since the county pays so little for such limited hours, she can’t hire someone else to care for her mother. As a result, Gilbert--who is separated from her husband--can’t go out and get another job. And with her savings gone, she is fast sinking into poverty.

“I’m angry,” said Gilbert, 51. “She took care of me as a baby. Why can’t I take care of her? Why don’t I have the funds?”

The plight of Gilbert and others like her has led to several attempts to overhaul the county’s $329.5-million-a-year home care system, which pays for cooking, housecleaning and personal-hygiene services to 77,000 elderly and disabled residents.

The influential Service Employees International Union is trying to organize the county’s 73,000 home care workers and raise their pay, which averages $3,753 a year.

Meanwhile, a recent county-funded survey concluded that low wages make it difficult for home care recipients to find good aides and for attendants to make a decent living. Despite the problems, however, the survey concluded that “most recipients were satisfied with the system.”

County officials insist that the program--intended as a low-cost alternative to putting the sick and elderly into hospitals or nursing homes--does not need major changes and, in any event, there is no money for higher salaries.

“The system works, and it works fairly well,” said Kitty Cooper, who oversees the program for the county Department of Public Social Services.

Union officials and some home care clients contend the system is plagued with problems. They cite theft, physical and psychological abuse of recipients and an absence of training for workers who routinely deal with medical problems.

Sandra Rosenstein of Van Nuys, a former nurse who is housebound with severe lupus, arthritis and diabetes, said she has gone through 12 aides in two or three years.

One attendant arrived drunk and punched her in the face, she said, and another stole a cashier’s check for $250. She said yet another yelled at her and refused to bathe her, saying she smelled bad.

None of the workers were trained to prepare the special diabetic meals she eats or to attach an oxygen mask she sometimes must use, she said.

When one worker abruptly quit, she said, she was left alone in her apartment for three days.

“At that point, I even needed help brushing my teeth, my hands are so bad,” Rosenstein said. “I couldn’t have a bath. My next-door neighbor helped me fix some rice. Other than that, I didn’t have any meals.”

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Union officials want the county to create a registry that would match aides with clients who need them. Such a system, they say, would help prevent the problem of clients being left to fend for themselves when aides suddenly quit or get sick. To qualify for the program, clients generally need to be eligible for the federal Supplemental Security Income program, which provides subsidies to aged, blind and disabled people.

“Imagine your mother or grandmother lying in bed unable to get up and vacate her bowels without the help of someone else,” said David Rolf, who heads the union’s effort to organize local home care workers.

“If that someone gets sick, someone else may not get breakfast or lunch or dinner that day.”

Rolf said attendants also should be trained to care for homebound recipients. Besides bathing, cooking and cleaning chores, workers often perform medical procedures, including intravenous injections for AIDS patients or cleaning surgical breathing holes in clients’ throats, he said.

With thousands of home care aides receiving minimum wage, no sick or vacation time and no health benefits, union leaders angrily criticize the county for running Los Angeles’ “largest nonunion sweatshop.”

They say clients often reach into their own meager pockets to supplement aides’ salaries so they won’t look for better jobs. And because nearly 40% of workers are related to the people they serve, low pay often drags down an entire family’s income.

Many union complaints are echoed in a recent county-financed survey of clients and aides conducted by RTZ Associates, an Albany, Calif.-based consulting firm.

It found that only one in 10 aides had any home care training and that 15% reported being injured on the job, which often requires lifting clients in and out of beds and wheelchairs.

The survey also said that nearly half of recipients complain that the county does not allot them enough hours of service and that the vast majority of recipients don’t know they have the right to appeal for additional hours.

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Seven percent of clients reported they had to go to an emergency room or a doctor because they were not getting enough help at home. Six percent said they had been placed in danger by aides who left them home alone.

Rolf charged that the report’s authors were pressured by county officials to gloss over problems in the program. But Rick Zawadski, senior partner with RTZ, said there was no such pressure.

However, Zawadski said the survey may have overstated clients’ degree of contentment with the system. When they said they were satisfied with it, he said, they didn’t mean they found the program problem-free but that they liked being able to stay in their homes instead of being put in nursing homes or hospitals.

In fact, many recipients cited numerous problems that they feel reduce the effectiveness of the program, especially low pay, he said.

Zawadski said he believes that aides are “tremendously exploited” and that their salaries should be increased. But, he said, the county’s financial troubles make it unlikely that officials will spring for more money.

One possible solution, said Zawadski, is for the county to participate in a state-sponsored pilot project under which counties will consolidate all health care funds from various sources.

By putting all the money in one pot, county officials would probably be able to identify efficiencies that could release more funds for some programs, such as home care.

But the union, with backing from groups representing the disabled and senior citizens, is pushing for the creation of a county agency that would oversee the home care program. Union leaders said such an entity could train and monitor aides, as well as create an aide-client matching system.

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A county home care authority would also open the door to collective bargaining between the union and the county over wages. Under the current system, the county determines eligibility and sets service hours, but sends checks to recipients, who in turn hire and pay workers.

Union officials complain that this arrangement takes the county off the hook as the employer of record, meaning the union cannot negotiate salaries with it.

Cooper, of the county Department of Public Social Services, insisted that “raising wages at this point is not doable.” She also said there is no money to fund a home care agency.

But some clients and aides said the county must find a way to bolster the system by raising workers’ pay and eliminating its other flaws.

“I’d really like to do things for myself,” said Rosenstein, the ex-nurse hobbled by lupus, arthritis and diabetes.

“But I don’t know what to do. This whole thing is horrible.”