POLICY: What about a fair shake for home care workers? by Mary Kay Henry, SEIU

SeiuMary Kay Henry is an Executive Vice President of the SEIU, the nation’s largest health care
union where she’s the head of the union’s Health Systems Division. The SEIU has been very active in health care generally, not least in their “alliance” with Wal-Mart and others on national reform. But there are other issues too that they care about. Here’s another issue that concerns her and probably given where we’re going we should all be concerned about them. What about fair share for the poorest care givers—home care aides?

Seventy-three-year-old Evelyn Coke worked for 20 years as a home care attendant for the elderly for sometimes as many as 24 hours a day, four days a week,. She occasionally even slept overnight at her clients’ homes so she could be there for them if they needed her. Unfortunately, because of the “companionship exemption” under the Fair Labor Standards Act, she rarely ever received overtime pay for the extended hours she put in. Today Evelyn stands alone as the sole plaintiff awaiting a Supreme Court decision. How the justices rule on Long Island Care at Home Ltd v. Coke might mean larger paychecks, overtime coverage, and ultimately a reduction in high turnover, which could go a long way to reducing shortages in one of the nation’s fastest growing occupations — home care workers.

As SEIU continues promoting new health care solutions, we must
remember the contributions of health care industry workers — especially
in the midst of a looming “care gap” and an aging elderly population
expected to grow 40% by 2030. This “care gap” is present in nursing
homes, assisted living facilities, and home and community-based care
across the country. As the number of elderly Americans increases
dramatically, the long-term care industry is not keeping pace. We are
barreling toward a crisis, and it is going to take some innovative
thinking and some radically different ways of doing things to avert
what could be a disaster for a generation of Baby Boomers who will all
too soon hit their “golden years.”

I’ve devoted my life to helping America’s health caregivers improve
their jobs and the quality of care they give their patients. When I
started working with SEIU more than 20 years ago, I realized that a
rational and humane health care system was necessary—but you can’t have
a good system without a stable workforce. Currently there are more than
one million workers in the United States who help sick and infirm
clients with both survival and quality of life tasks like dressing,
bathing, cooking, and cleaning. For some families, the help of a home
care assistant is a matter of life and death. Yet most of these
caregivers work for a pittance, with no health insurance, no sick time
and no vacation. Is it any wonder that it’s difficult to find and keep

That’s why SEIU Healthcare—the nation’s long-term care union—is
uniting caregivers, seniors, people with disabilities, and community
leaders to build a stable, professional long term care workforce. We
need to ensure that patients and health care consumers will receive the
quality care and support they need, now and in the future. And a key
way to do that is to respect and support workers in the health care and
long-term care industries. We must invest in professionalizing the
industry. We must compensate workers with wages and overtime benefits
that stabilize the workforce. And, most importantly, we must
re-evaluate the critical role home care workers play in our
society—before we are overcome by the “Care Crisis.”


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17 replies »

  1. We are so thankful that you have this blog. We look forward to reading it daily and wanted to let you ow great it is and thank you..
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  2. Peter,
    I lost count of how many times I’ve heard calls for more taxpayer funding of various government agencies and functions whether its border security, the FDA, FTC, SEC, Medicaid, the public schools, higher education, medical research, etc., etc. Each argument, in isolation, is at least somewhat plausible. However, resources are finite, there is a limit to what people are willing to pay in taxes, and, in the U.S. that limit is undoubtedly lower than it is in most of Europe and Canada. I wish there were a lot more emphasis on spending the resources we already provide more intelligently. That includes healthcare spending at or near the end of life, an area where, I think, we can learn plenty from our friends in Canada, Western Europe, Japan and Australia.

  3. Barry, my use of the word “sealed” was certainly an overstatement of possibility. But it can be made much better with more border personnel and technology as long as there’s a committment for funding. The funding has never been there. It’s interesting that during the Mexico free trade discussion one large argument was free trade would solve illegal immigration – just another lie. As for a personal ID maybe we could just all have passports, they seem to be pretty much tamperproof. That would also not require a whole new government agency.
    On the healthcare issue you may be right. I understand that border towns have a much bigger problem with illegals childbirth and other health issues. It’s hard to get a handle on the size of the problem because no one is counting.

  4. Peter,
    I generally agree with most of your immigration comments. Sealing a 2,000 mile border with Mexico, however, falls into the category of easy to say and very tough to do – with or without a wall. As for immigrants’ use of healthcare resources, my sense is that it is generally overstated. The most expensive resources they use relate to childbirth, and, except for a few areas where a heavy immigrant presence strains emergency room resources, they really don’t use much healthcare overall because most of them are young and healthy. Their impact on the schools is probably more significant. That all said, I would like everyone here to have a robust, tamper proof (or at least, tamper resistant) ID card with a picture, fingerprint or other biometric identifier. People who apply for government benefits should be required to prove that they are here legally and that they are who they say they are.

  5. SBD first let me state that I am sick and tired of Washington looking the other way when it comes to illegal immigrants from Mexico. But the politicians look the other way because their business supporters want the cheap labor and consumers like the low prices. Immigrants from all countries have always been used for the crap work. Just look at the history of the meat packing industry. Mexico IS the big winner as you stated for the billions sent back there. Mexico does not need to fix their economy when they can export their problems and import cash, so the illegals are taken advantage of by Mexico and the U.S. But I don’t think they leave their families willingly and would much rather have them with them.
    I want the border sealed (not by a wall) before we discuss immigration reform. But illegals are no different than anybody else – they want something for nothing even though they work hard. In healthcare if we could tax them to pay for the services they use that would help us. But they would probably qualify for public assistance for healthcare anyway because of their low wages. So getting their wages up through the actions of a union, SEIU or not, would help them pay for healthcare. But unions don’t come free, so dues are part of what you pay to get something back. And yes unions morph into organizations that lose sight of their mission – no different than any other organization. Their members need to hold them accountable. I too would like to have Ms. Henry comment here on this discussion, if she’s even watching.

  6. It has been interesting to read the comments here by a seemingly diverse set of people. During my graduate work for my MBA in Health Services Management, we had to proffer ideas on policy reform. One of my suggestions was moving towards a national health plan that would at least cover basic services. Obviously, the cost would be extremely high to provide full benefits for all.
    Perhaps a national plan would cover a certain standard of care for all (legal citizens and/or taxpayers). This might include things such as regular office visits and most treatments that could be done by a primary care physician. Beyond that, individuals would be able to purchase additional coverage either through their employer or directly. Their premiums would be less because they would only be paying for additional coverage. Hopefully the majority of their doctor visits would be covered under the basic care benefits provided instead of those by their additional policies, thus reducing the need to inflate the premiums for those policies anywhere near the rate they have grown in the last few decades. And I realize there will be greater costs in other areas such as taxes. However, that is why we need multifaceted reform to reduce costs in other areas such as administration.
    Peter noted, “everyone will have to shoulder some pain – higher taxes, reduced reimbursements, single government payer.” If we could come close to maintaining the current costs, or even if they were slightly higher, while providing basic access to all, overall public health would improve and long-term this will lead to reduced costs as a whole. I don’t think we can expect drastic cuts in healthcare costs in the next few decades. Especially when you consider the aging population, however, would it not be a success if we could match yearly increases closer to that of inflation?

  7. Peter,
    The only way I could get health insurance was by joining some Association and paying Union Dues to a Union I know nothing about. I guess that makes me a Union supporter in the strict sense of the term.
    Also, your comment about supporting a desparate population with few options having to work for low wages and benifits for cost savings misses the mark.
    The illegal immigrants that come here to work could care less about becoming legal or benefits. They are not immigrating to this country like my parents did and maybe your as well, with the intention of staying here and becoming US Citizens. They come here to make as much money as they can so that they can send it back to their families in Mexico.
    They have no desire to have taxes deducted from their pay, nor will they want the cost of Health Insurance deducted from their checks. Thats money that they could have sent back home to their family which after all is the reason they are here.
    Granted, not all illegal immigrants come here to support there families back home, but a majority of them are here for that reason. If you need proof, just look to the Federal Reserve and their “Directo a Mexico” sponsorship.
    Directo a México Promotes FedACH Service
    “Remittances are a large and rapidly growing business. Mexicans living in the United States sent home $16.6 billion in 2004, according to the Inter-American Development Bank, which projects that figure to reach $20 billion this year and nearly $40 billion by 2010.”
    Right now SEIU and illegal immigrants are one happy family. The SEIU is promising them better wages and benefits which sound great and they are all for it. Just wait until they get their paychecks and see all of the deductions taken out. The honeymoon will be over real quick.

  8. Eric, your proposal shifts costs in your favor it does not reduce them. But as you did not answer my origiinal statement on your post I will re-state it – you can now opt-out of the insurance game without waiting for any legislation. What’s stopping you?
    I agree with tranparent pricing (one price for all) and cutting out the private insurers in a single pay government run system, but everyone will have to shoulder some pain – higher taxes, reduced reimbursments, single government payer. However, docs and hospitals will be guaranteed payment with no collections problems, no matter who walks in the door.
    “Perhaps if Ms. Henry and her union were interested in helping to bring about a more sensible approach to healthcare utilization at the end of life such as insuring the everyone has a living will or advance medical directive.”
    Barry, I think the only living will/advance directive utilization that will come from this approaching healthcare cost issue is – “When I run out of money, kill me.” In the issue of elder healthcare that’s the result of the option you’re proposing.
    It’s hard to guess if SBD supports illegal immigration to bust unions or just hates unions. I guess he supports a desparate population with few options having to work for low wages and benifits for his cost savings. That would be the free market approach.

  9. Dear Mary Kay Henry,
    Please stop the SEIU we care bit and just tell everyone the real reason behind your interest in the so called “Care Crisis”, the Immigration Bill.
    The only thing the SEIU cares about is increasing their membership at any cost. The long standing principle of the Labor Movement has always seen illegal immigration as a threat, not an opportunity. Unions were formed to protect the wages of their membership from those willing to work for far less than the wages they were paid.
    At the forefront in abadoning this long held principle is the SEIU who sees illegal immigration as their only hope for continued recruiting and collection of their Union dues. The issue is not the “Care Crisis”, it’s the “Greed Crisis”.
    “There’s no question we are going to have to organize and bring immigrants into our ranks,” said Medina, vice president of the SEIU. “If we don’t, we are going to become irrelevant because we are not going to be representing the work force.”
    The SEIU counts Hispanic immigrants as at least 25 percent of its membership. In California, and more than likely around the entire country, illegal immigrants fill the void in the SEIU so called “Care Crisis”.
    The reason is quite simple, people who need to care for their loved ones want to save a buck, so they pay cash to the undocumented caregiver which suits the undocumented caregiver just fine because they can’t legally work in this country.
    So the SEIU which has organized those massive illegal immigrant rallies and spent untold amounts of money to lobby congress is setting themselves up to cash in on their investment. Once their Immigration Bill gets passed, they will be ready to swoop down on the illegal caregivers with their premptive PR and by pushing their “Baby Boomer” angle on the story.
    Everything the SEIU does is calculated and manipulative. I have seen it first hand myself with their recent “Justice for Janitors” campaign.
    The SEIU posted a fake company Memorandum that supposedly was written by the Janitorial employer. The memo instructed employees that costs were too high and that they had to cut their use of cleaning product to the point where the cleaning product would contain more water than cleaning agent.
    Within a few days after the posting of the fake Memorandum, the SEIU initiated a PR blitz accusing Janitorial companies at shopping malls across the country of causing a health risk to shoppers who ate in their food court by diluting their cleaning products.
    That is how these people work. That smile on Mary Kay Henry’s face in the picture above is not a smile, it is a smirk.

  10. I’ve been a male caregiver but yes more are women. Most people would rather be taken care of at home then a nursing home. Yes, nursing homes will see a decline in income but patients that need the care will receive it at home from a well paid, trained and competent home health care worker.
    As the article states, the crisis is coming but good people, willing to work togther, can and will need to find solutions. Better pay and benefits along with training will allow us to shift costs from nursing care to home care which is already occuring.
    Lastly, the 500 billion spent in Iraq would fund many raises for home care workers. What a waste of our tax payer dollars and our children’s lives.

  11. According to the AARP, the average nationwide annual cost of nursing home care is approximately $74,000. In NYC, Long Island, Westchester, Southern Connecticut and Northern NJ, it can easily top $100,000. Nursing home care already consumes a large chunk of the Medicaid budget for the poorest of the elderly and disabled. Long term care insurance is very expensive, and many people can’t buy it an any price because of poor health or disability. Many of those who start off paying out-of-pocket drain their life savings within a couple of years.
    Custodial care for people who can no longer perform some or all of the normal daily living activities by themselves is a labor intensive business whether it’s provided in a nursing home, assisted living facility, local day care center or the patient’s own home. With healthcare costs already consuming 16% of GDP and rising much faster than general inflation, I’m hard pressed to understand where Ms. Henry thinks the money will come from to pay her union members substantially more. I also wonder how much similar workers are paid in other countries and what the staffing ratios are in nursing homes and assisted living facilities elsewhere compared to here.
    Perhaps if Ms. Henry and her union were interested in helping to bring about a more sensible approach to healthcare utilization at the end of life such as insuring the everyone has a living will or advance medical directive or redefining what constitutes sound medical practice or reforming the malpractice system, we could free up significant resources and her argument might earn a more sympathetic hearing. Absent that, however, all I hear is a union leader trying to get more money and more benefits for her members without regard for the ability of employers or individuals to pay, either in higher taxes, higher insurance premiums, or higher out-of-pocket payments.

  12. Peter-
    1. did not answer the questions
    2. not sure how reducing the administrative costs of healthcare is self-serving. Also not sure how price transparency is self serving.
    3. no idea how much it might save, but PNHP speaks of (I believe) up to $300 billion in admin. costs that would be eliminated under a ‘medicare-for-all’ scheme. Not sure how those costs would go away under single payer, but reducing the number of non-provider personnel in physician offices, physical therapy offices, hospitals, as well as hospice companies and home care companies– not to mention the fact that less space is necessary (lowering leasing costs).
    4. returning to the point of Ms. Henry’s post— can she or anyone else consider answering these ‘follow up’ questions?

  13. “As I believe I stated at THCB previously, once all rates are truly transparent, a remarkable thing will happen:
    Doctors no longer need to be a part of insurance plans. They can just publish their own rates, eliminate much of their billing staff, and go simply assist patients in filing claims when the dollars amount is high enough to warrant it.
    And the total cost of healthcare would decrease.”
    Posted by: Eric Novack
    Maybe Eric the dollars will come from the above brilliant self serving plan to lower healthcare costs.
    Any estimates as to the billions of dollars saved?

  14. Peter- I do not believe my questions were so difficult— nor are they ‘hostile’.
    Ms. Henry has presented an opinion about a group of people who provide health care services.
    Which of my questions are unreasonable? Perhaps you wish to try to answer the questions? Et tu, Neimon?

  15. This situation would not exist if men were the majority of caregivers. For some biological reason women seem to feel it their duty to look after others before looking after themselves.
    Eric, what would be the cost if those same patients were looked after in institutions – run by doctors? Your anti-union bias is quite noticable.

  16. Iraq war: $500,000,000,000
    Number of tribal factions dedicated to obstructing any kind of majority rule: Uncountable.
    Number of foolish decisions based on the idea of forcing democracy on an ancient tribal people at gunpoint: 1
    ’nuff said.
    It just requires the will to believe people deserve dignity and care. Anything else is quibbling and excuse-making because we don’t want to be weak enough to admit people are more important than things.

  17. Ms. Henry — how do you propose to elminate the inequities about which you write?
    Where would the money come from?
    If it involves ‘redistributing’ money from other areas of healthcare, specifically which group ‘loses’ in your scenario?
    What role do you envision SEIU playing in any solution you propose?
    Does SEIU have more to gain by central control over healthcare? Would that make your organization’s influence much greater given your lobbying capabilities?
    How does one ‘respect’ workers in the healthcare industry?
    What does ‘professionalizing’ mean?
    What level of compensation would ‘stabilize the industry’?
    Thanks for your prompt and complete response to these important questions.