Working for food stamps Like other forms of historically female care work, direct care was underpaid and undervalued from the start, seen as unskilled “women’s work.” The women who did it – predominantly women of color – were expected to live in genteel poverty, or assumed to be earning “pin money” to supplement their husbands’ earnings. Those assumptions were built into the Medicaid and Medicare reimbursement systems that fund most long-term care, tying direct care worker earnings to the fate of two programs already under intense pressure to reduce costs in these tough economic times. As a result, direct-care workers – about 90 percent of whom are women – struggle to support themselves, let alone their dependent children, on their paltry wages. Many have to take a second or even third job to make ends meet. The national average for all direct care workers is less than $10 an hour, and about a third of the home health and nursing home aides who are single parents depend on food stamps. The situation is worst in home care – which is the fastest-growing type of long-term care service, and the one most consumers prefer. Personal care and home care aides average just $8.54 an hour, and their annual raises aren’t keeping up with inflation. A recent report found their wages fell by 4 percent between 1999 and 2006, after adjusting for inflation. Erratic hours and being ineligible for federal minimum wage and overtime protection also contribute to keeping many home care workers perilously close to the poverty line. Health care workers without health care In a particularly cruel irony, direct care workers often do not get health insurance through their jobs, even though their work is crucial to maintaining the health of the people they care for. Approximately 30 percent have no health insurance. That’s about twice the uninsurance rate of the general public. A lot of factors contribute to this crisis. Some workers are hired directly by the people they assist, who cannot offer health insurance or worker’s compensation. Some work for small businesses that can’t afford to subsidize high group insurance rates. Some can’t book enough hours to qualify for the company plan, which may offer insurance only to employees who work full-time. And many simply can’t afford the premiums and copays. It’s not as if direct care workers need health care less than other people. In fact they have higher than average rates of diabetes, asthma, and other chronic conditions – conditions that become much more serious when they go untreated. They also have one of the nation’s highest rates of on-the-job injuries, mostly back and neck injuries caused by lifting people or helping them move from place to place. These injuries often cause permanent impairments and pain that require ongoing medical treatment. Fighting for the right to minimum wage and OT pay The federal Fair Labor Standards Act requires employers to comply with minimum wage and overtime laws – with a few exceptions. A so-called “companionship” exemption was created to cover unskilled, part-time workers such as babysitters who are employed by individuals to work in the home. A controversial ruling by the U.S. Department of Labor (DOL) during the Bush Administration included all home care workers, even those who are employed by agencies, in that exemption. As a result, home care aides are denied the right to minimum wage and overtime protection from the federal government. Evelyn Coke, a home care attendant who worked for many years for an agency in Long Island, New York, challenged that ruling in 2007. Coke took her employer to court, charging that she was owed thousands of dollars in back pay because she was never paid overtime for the overnight shifts she worked. In fact, she was not paid at all for many of those hours (the agency subtracted time that was assumed to be spent sleeping or eating, saying that she would have been doing the same thing if she were in her own home), bringing the average amount she was paid per hour to less than the minimum wage. Her case got all the way to the United States Supreme Court. The court ruled in favor of the agency. The controversial ruling still stands -- but the DCA and its allies have been working to change that. In September 2007, the Direct Care Alliance board passed a resolution declaring that it would work to overturn the ruling. In letters sent to President-elect Obama (PDF) in 2008 and to newly appointed U.S. Secretary of Labor Hilda Solis (PDF) in early 2009, the DCA asked the new administration to reverse the ruling. In April 2009, the DCA organized a trip to DC to ask legislators to include direct care workers in health care reform -- and to sign onto a letter from members of Congress to Secretary Solis that asked the Secretary to overturn the DOL ruling. On May 18, 2009, 37 members of Congress sent the letter to Secretary Solis. Less than a month later, 15 U.S. Senators sent Secretary Solis a letter asking for the same thing. The Senate letter was sponsored by Senator Tom Harkin (D-IA) and signed by Edward M. Kennedy (D-MA), Chuck Schumer (D-NY), Arlen Specter (D-PA), and Robert P. Casey, Jr. (D-PA), among others. The day after receiving the senators' letter, Secretary Solis told an Associated Press reporter that her department was looking into whether the exemption should be overturned. Related materials DCA policy brief on the Coke case DCA fact sheet on the Coke case
Speeches about the Coke case by graduates of the first Voices Institute National Leadership Program
Be sure to check out the speeches. These are some of the people I spent that incredible week with.
This comes from the Direct Care Alliance.
By Megan Rosati
Here in Maine, we want to remind our Senators of the human cost of our health care system. According to the consulting firm PricewaterhouseCoopers, employers' health care costs will increase by 9 percent next year. That means more American businesses struggling to compete and stay viable. And it means even higher premiums, deductibles, and co-pays for working families.
At Change that Works, we're highlighting the stories of the men and women forced to reach out to their neighbors to cover the costs of expensive medical procedures that are either not covered, or are inadequately covered by their current insurance. And thanks to 
