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July 16, 2019

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Caring for vulnerable while living in poverty: Nevada home care workers fight for better pay

Lizabeth Bonilla Minimum Wage for Nevada

L.E. Baskow

Lizabeth Bonilla speaks at a SEIU rally near the McDonald’s Restaurant on West Sahara joined by other minimum wage workers to support raising the minimum wage in Nevada on Thursday, March, 26, 2015.

Lizabeth Bonilla Minimum Wage for Nevada

Lizabeth Bonilla speaks at an SEIU rally near McDonald's on West Sahara Avenue joined by other minimum-wage workers to support raising the minimum wage in Nevada on Thursday, March 26, 2015. Launch slideshow »

For the past 42 years, Lizabeth Bonilla has worked doing what the families of the ailing or elderly can't or don't want to do — dressing wounds, carrying the weak and bathing the dying. At 59, her body always seems to ache.

But it's the pay that grinds her down and exacts the greatest toll on her daily life.

Bonilla sleeps in a recliner in the living room of the cramped two-bedroom apartment at Desert Inn and Mojave roads that she shares with her daughter, two grandchildren and a disabled roommate. It’s all she can afford on wages from work with an unpredictable schedule that varies from 15 to 30 hours per week, earnings she supplements with food stamps and Medicaid. She can't take a second job because she's never sure, week to week, what hours she'll be asked to work.

For the $10 an hour Bonilla makes as an in-home care worker, she could ache less and earn more by booking guests at a salon or cashing out gamblers at a casino cage.

When Bonilla urged Nevada legislators last month to raise the state minimum wage to $15 an hour, critics wondered why she didn't just get a higher paying job.

They told her to go back to school; to get an education to advance her skills. But Bonilla, who holds a nursing degree, didn't enter her profession for the money. She says being a home care worker — tending to the needs of housebound, sickly people — is her calling.

“I choose to do this. Because I know there are people who have it worse. It’s the ones who can’t afford it that I want to care for,” she said. “So many of these people are forgotten. Sometimes I come in and their sheets are dirty, there are maggots in the bed. You can’t do that to a human being. I don’t want anybody to die alone.”

Bonilla is educated, skilled and compassionate. She’s exactly who you’d want taking care of your dying loved ones. But in the home care industry, she’s far from the norm. Few workers are willing to make the sacrifices she does; most heed her critics’ advice and leave the industry for jobs that offer a livable wage. More than half of the home care workforce turns over each year, leading to less experienced workers, a lower quality of care and an open door for elder abuse.

As lawmakers discuss raising Nevada’s minimum wage, advocates charge that the debate strikes at a larger issue: what kind of people do we want taking care of our sick and elderly, a population poised to explode over the coming decades?

Bonilla’s experience is widespread among home care workers, the nation’s fastest growing workforce. The country’s 2.1 million home care providers make a median wage of $10.01 an hour and an average of $18,600 a year, according to the Bureau of Labor Statistics and the National Employment Law Project. More than half of workers are able to work only part time or part of the year due to a combination of unpredictable schedules, a shifting client base and cuts in Medicaid. As a result, 56 percent rely on public assistance while about 48 percent live in households with incomes below the poverty line. Almost 60 percent are uninsured or rely on public assistance for health care needs.

"I have to humble myself to get food stamps and Medicaid because I don’t have any health insurance (from my job)," Bonilla said. She also receives no paid sick days. “If I get sick, I have to go to work. I can’t stay home because then I won't get paid.”

On April 15, Bonilla will join dozens of her colleagues at the College of Southern Nevada’s Charleston campus for a nationwide event to demand higher wages and improved workplace protections for home care workers, part of an effort that kicked off last month in Carson City and has a presence in 21 cities across nine states. Bonilla will be joined by low-wage workers from other industries, as well, as they push for a common goal: to raise the federal minimum wage to $15 per hour.

The campaign, backed by the Service Employees International Union (SEIU), models itself after the collective action of fast food and retail workers who in the past two years helped raise the minimum wage in several states, and on Wednesday, compelled McDonald’s to raise its pay floor and offer benefits to some 90,000 workers. While many home health aides participated in those protests, the new campaign marks the industry’s first independent push.

Only about a quarter of home care workers are unionized, and the right to organize without fear of retaliation is one of their core demands. But the industry’s decentralized workforce — about a third of whom are immigrants, 20 percent of which are undocumented — creates an additional challenge. Many home care providers don’t know they have the right to organize or form a union, while others are too vulnerable to speak out.

“We have to join together and not be afraid to speak out,” said M. Yolanda Florian, a Las Vegas home health aid and an executive member of SEIU. “This won’t happen out of the kindness of anyone’s heart. It will happen because we have the right to ask for it, to fight for it, and because we can demand to the government to see the needs of these people.”

Most home care workers are employed through private agencies or as independent providers, but unlike their wage peers in retail and fast food, the majority ultimately are paid by the state through Medicare, Medicaid or other public services.

In the eyes of the federal government, home care providers are little more than babysitters. Due to a loophole in the Fair Labor Standards act called a “companionship exemption,” their work is regarded as akin to nannying, excluded from basic labor rights like minimum wage and overtime.

Try telling that to the millions of patients who rely on home caregivers to shave them and change their diapers, clip their toenails and change their oxygen tanks, or just talk to them.

The workers — 91 percent women and 56 percent non-white — help the elderly, sick and disabled with everything from grocery shopping and housekeeping to eating, bathing and administering medication. They often are the only person patients will have contact with all day. The work is physically and emotionally exhausting, and though it’s billed as unskilled labor, caretakers say it’s anything but.

“We’re their housekeepers, their physical therapists, their psychologists,” said Florian, 45. “We’re everything to these people ... We spend most of the day taking care of other people, but we can’t take care of our own families.”

In 2013, the Department of Labor announced new regulations guaranteeing minimum wage and overtime protections for home care workers for the first time in 40 years. But a federal judge struck down the new standards in January, citing executive overreach. The Obama administration has appealed the decision.

Wages are just part of workers’ grievances in the push for a standardized industry. Most agencies don’t offer retirement, transportation compensation, sick days or holidays. Some fail to pay on time.

On a recent Friday morning, Bonilla foraged for change in her couch cushions to make the $5 in bus fare she spends daily to go to work. She knows it’s cheaper to buy a monthly bus pass for $65, but she can’t afford one. Her last paycheck was hundreds of dollars less than she expected after her agency said they didn’t receive her complete timesheet, leaving her with $150 to last two weeks. The shortfall forced her to choose between paying her phone bill and paying for power. She said this happens all the time.

Still, Bonilla knows she has it good with her company. As the state’s only unionized home care agency, her employer covers costly training and hiring fees and provides investigations into client complaints before firing workers. Other agencies don’t guarantee such protections.

Florian, meanwhile, has had her hours reduced. Agencies often divide patient care among multiple aides to avoid paying overtime or benefits.

Home health agencies argue that limited budgets and further cuts in Medicaid force them to choose between reducing labor costs and raising prices. Many say raising wages would force them to cut hours or raise patients’ out-of-pocket costs, which could ultimately force clients into institutional care. But as revenue in the home care industry has grown by nearly 50 percent over the past decade, workers’ average hourly pay has decreased by almost 6 percent.

And experts say that upping wages and increasing protections can be more cost effective for states’ long-term care spending. Illinois, for example, has saved more than $600 million a year in Medicaid costs since shifting spending away from costly nursing homes and toward the home care model, according to a National Employment Law Project report. However, high turnover and recruitment problems have prevented more states from expanding their home care programs to help balance long-term care spending.

Advocates argue that raising wages to $15 an hour is as much about meeting the care needs of clients as it is about a living wage. With its current turnover rate, the industry won’t be able keep pace the growing need for home caregivers as Baby Boomers age. The country’s elder population is expected to more than double by 2050. Demand for home care workers is projected to increase by nearly 50 percent, or 1 million workers, by 2022 — five times faster than other jobs overall.

“It seems like the older our clients get, the more they’re cutting (what) we can give to them,” Florian said.

Relief could come from the state Legislature, if lawmakers, and then voters in 2016, approve raising the minimum wage from $7.25 to $15 an hour. Until then, Florian, Bonilla and their peers plan to keep speaking out.

"Everybody thinks we’re just a bunch of peons," Bonilla said. "They say we’re not smart enough to go back to school and get a better education. That’s not what the story is. This job that we do is very important. I care about my patients. ... We’re compassionate, and that’s it. When you get old and have nobody to take care of you, then come talk to me."

Follow Andrea Domanick on Twitter at @AndreaDomanick and fan her on Facebook at

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