Health Care for Saints

Now the state must find money to pay for health plans for people who care for the elderly and disabled

Richard Devylder knows firsthand the importance of home health-care workers: They feed, bathe, dress, change catheters and take people to the doctor.

All the embarrassing little details of our everyday lives which we all hope we can always handle ourselves; but which most of us -- some of us sooner, many more later -- will need help doing.

Devylder now chairs the Los Angeles County Personal Assistance Service Council. This county-appointed board administers the county system that supervises the placing of what are now 73,000 home caregivers. These are the people who give intimate assistance in the homes of close to 100,000 disabled and elderly people. As a man with neither arms nor legs, Devylder notes that he himself has spent a lot of time in the consumer‘s end of the business.

Now, he says, he’s glad to be able to be helping people in the profession that has so helped him. And they need some help, Devylder says. For one thing, they don‘t get paid much -- $6.25 is the set wage: That’s minimum wage plus a recent, state-approved 50-cent raise over the minimum wage. More to the point -- and not without irony -- few or none of the county‘s 73,000 home-care providers have any health-care plans of their own.

That’s right. As one caregiver put it last week -- she was testifying at the Tuesday Board of Supervisors meeting in favor of the health-care benefits motion of Supervisor (and newly appointed board president) Gloria Molina -- said, “I‘m a health-care worker just like all the others; but when I need to see a doctor, I don’t have a doctor to see.”

Others recounted their long hours spent, as one put it, “waiting in that line at County” for medical treatment. That wasted time in line could be better spent taking care of patients, another caregiver testified.

Yet now that the supervisors have approved the concept, the final decision goes to the Legislature, which, the board hopes, taking into account the savings that home care affords the state health system, will vote to fund the care for care providers. Molina spokesman Miguel Santana said that Assemblyman Gil Cedillo was involved in putting together the package. I called last week to ask how he was doing on this one, but he still hasn‘t got back to me on it.

To Devylder, however, the case for health benefits for home-care workers is flat-out inarguable: “Medical benefits are important -- in many ways, more important than higher wages,” he said. Devylder sees the benefits as a further vital step in the upgrade of the caregiver’s work that began with a bang last June, when the Service Employees International Union organized a home-care bargaining unit in the form of its new Local 434b. This unionization of tens of thousands of unaffluent caregivers was widely reported -- from this paper to The Wall Street Journal -- as a millennial breakthrough in the re-empowerment of organized labor. Most impressively, the SEIU‘s organizational success -- one of the largest in union history -- was accomplished with some of the lowest-salaried workers in the state.

The supervisors supported this creation of a union organization for the diffuse and underrecognized care workers. But preparing the way for the SEIU’s feat also posed challenges that it took even a friendly board majority years to surmount. For instance, with the help of Supervisor Zev Yaroslavsky, the county created an employing organization for the health-care providers -- a sort of “straw boss” public employer with which the union could negotiate. Thus Devylder‘s Personal Assistance Service Council was born. Technically, the PASC is the profession’s county employer of record.

But Devylder and his panel often seem to be advocating for the entire underpaid occupation of home care. Devylder‘s objective is to see the entire profession more stabilized, with higher standards, more developed job skills and, perhaps most importantly, a decrease in its high job turnover.

This may be partly because many of those who care for the sick or elderly do so part time, balancing their home-care jobs off against family or other employment. Molina suggested that “If health benefits were available to home-care providers, we might be [better] able to attract and retain experienced and qualified providers.”

Her motion, however, seeks health care only for those working at least 150 hours a month. That’s almost 36 hours a week, which is very nearly full-time employment.

Santana calls the gradual upgrading of the entire county home-care profession “a deliberate and incremental process.” But, once again, the final say, and the health-benefits funding allocation itself, must come from the state. Santana and Devylder share the hope that the Legislature will come around to their side. They point out that better basic home care means lower state health-care costs, because it reduces the need for the more expensive alternatives of hospitalization, nursing home and home nursing care, all of which receive state subsidies. “And home care is often preferred to hospital care,” Santana adds.