[Home care workers are negotiating their contract in hopes the
state will allocate some of the $17.6 billion surplus to improve pay
and benefits—a test of the state’s Democratic trifecta’s will to
solve a crisis for disabled people and their caregivers. ]
[[link removed]]

DISABLED MINNESOTANS ARE FACING A HOME CARE CRISIS. WORKERS ARE
CALLING ON DEMOCRATS TO CHANGE THAT.  
[[link removed]]


 

Isabela Escalona
December 20, 2022
Workday Magazine [[link removed]]


*
[[link removed].]
*
[[link removed]]
*
*
[[link removed]]

_ Home care workers are negotiating their contract in hopes the state
will allocate some of the $17.6 billion surplus to improve pay and
benefits—a test of the state’s Democratic trifecta’s will to
solve a crisis for disabled people and their caregivers. _

Gail Larson and her partner, Ronald, pose in front of their home in
Bloomington, Minnesota.,

 

Gail Larson lives in Bloomington, Minnesota with her fiancé, with
whom she has been partners for 20 years. For years, they did not marry
due to a federal law that prohibits most married people from working
as Medicaid-funded personal care assistants (PCAs) for their spouses.*
Her fiancé, Ronald, is a veteran who suffered a traumatic brain
injury and has other physical and mental health needs.  

She describes how caring for a family member is unique because family
members never truly clock out, no matter how many hours the state
approves them for. “As a PCA , if the client is the person that you
live with, it’s all day, no matter how many hours we are given.”
The blurred line between spouse and PCA means she works many hours
that she is not compensated for, Larson says. 

She worries for the future, especially considering the lack of
retirement benefits and her own health ability to provide care for her
and her husband as the physical toll on her body builds over time. She
wonders, “Who’s gonna care for us when we need the care?”

She is not the only worker grappling with this question. Larson is one
of more than 20,000 Minnesota home care workers, whose salaries are
funded by Medicaid, negotiating a new contract with the state of
Minnesota amid a crisis-level labor shortage 
[[link removed]]that
workers say is driven by poor pay and conditions. The workers,
represented by SEIU Healthcare Minnesota and Iowa, are fighting for a
wage floor of at least $20 an hour (the current base wage is $15.25),
overtime pay, and retirement benefits. 

They labor in an industry where wages are low, and women of color are
disproportionately represented. A report
[[link removed]] by
the Center for Women, Gender and Public Policy at the University of
Minnesota finds that women make up 85% of the entire direct care
workforce in Minnesota, and of those workers, 36% are people of color.
“On a national level”, the report notes, “Black women are
overrepresented in direct care occupations, reflecting a legacy of
slavery and domestic servanthood that persists in our labor market
today.” Direct home care workers are also some of the lowest paid in
the medical field, with over 40% of those in Minnesota earning wages
that are below 200% of the federal poverty line.

Not only is the industry made up of marginalized and exploited
workers, the population these workers serve—disabled people—have
also been historically overlooked, underserved, and at times treated
as disposable. In Minnesota, tens of thousands of disabled people were
institutionalized at state hospitals through the 1990s. Patients who
died while in the state’s care without money or family relationships
were routinely buried in unmarked gravesites
[[link removed]], at times with
only a number to identify them. 

Today, people who are not able to receive the home care they need are
often forced into group or nursing home settings—which, too, are
failing to retain workers.

Union members say that one important part of stemming the crisis is
making sure that the labor of home care work is properly funded as the
healthcare work that it is, an important part of ensuring workers want
to stay in a demanding and high-stakes field.

Because Medicaid covers the salaries of the workers who are in
bargaining, union negotiations take place before the state’s budget
is finalized. Once an agreement is reached and ratified by union
membership, Governor Tim Walz will then include this on his state
budget proposal, which will then need to be approved by the Minnesota
state legislature in early 2023. Many workers insist that now is the
time for improved conditions for both workers and clients, considering
the Democratic trifecta
[[link removed]] in
the Minnesota Senate, House, and the governor’s office, coupled with
the massive state budget surplus of $17.6 billion dollars
[[link removed]]. 

Larson warns that, if underinvestment continues, “It’s only gonna
get worse, and the problem only gets compounded.”

A WORSENING CRISIS 

Tavona Johnson, a member of the bargaining unit, has worked as a PCA
for well over a decade. She lives in Austin, Minnesota, with her
husband, who has stage four colon cancer, and she supports him in an
unpaid capacity with his needs as well. 

“I have come from a long, long history of a family who has done this
work throughout their lives,” she tells Workday Magazine over the
phone. “Mostly all the women in my family have worked as a PCA at
one point in their life”—whether it was their lifelong career,
gaining experience for other healthcare professions, or “just
because they were expected to.” 

Johnson says she loves her job and her clients: “I really find value
in being of service to another person. That is something that truly is
a part of the core of who I am. When I am able to get my clients to
reach goals and do things that they never thought they would, that is
the optimal payment for this work.”

Tavona Johnson (right) and her long-time client Deanne Pena pose for a
photo in Pena’s home in Austin, Minnesota. They have worked together
for over five years. Photo by Isabela Escalona.

During the pandemic, Johnson continued working, while many made the
choice to leave the field for their own safety, which she described as
straining an already tight workforce. She describes an overstretched
workforce. “There’s not enough of us to provide services. During
the pandemic, I found myself running from patient to patient,
providing partial services, spreading myself among people so that they
can get some type of service.” 

“It’s taxing on your mind, body, and soul,” she says. “I’m
lifting, I’m bending. It’s not just that I’m sweeping a kitchen
or washing some dishes. I might have to transfer someone from their
chair to their bed. My body is breaking down.” 

“And I just don’t have anything to show for it,” Johnson adds.
“I have no savings and live paycheck to paycheck just to support my
household.”

According to Johnson, inadequate state funding for salaries and
benefits is making it difficult to retain workers, which is wreaking
havoc on the lives of clients. “People are being forced to be
removed from their homes because they can’t receive the essential
services that they need,” she says. “It’s just
heartbreaking.” 

 But the problems don’t stop at home care, Johnson says. “We’re
going to have a whole other crisis where the group homes,
rehabilitation centers, and nursing homes are going to be
overcrowded,” she warns. “And then those workers are going to be
stressed and start jumping ship.”

Home care workers warn that if clients cannot access the care they
need in their own homes, many will make the sometimes difficult
decision to move into group homes and nursing homes. Yet, these
facilities are also struggling with staffing shortages
[[link removed]] of
their own, and as the home care crisis worsens, and more people are
pushed into these facilities, shortages will only intensify, workers
warn. 

While the low pay, lack of sufficient benefits, and low staffing
levels harm the workers, it also impacts the quality of care their
clients receive. Many disabled people who rely on this care say they
are unable to find adequate coverage, and it is often difficult to
keep PCAs longer-term. 

THE “SNOWBALL” EFFECT OF STAFFING SHORTAGES  

Mao Yang, a 27-year old with cerebral palsy made the decision two
years ago to move into a group home in Eden Prairie, Minnesota. As the
youngest of eight siblings from a tight-knit Hmong refugee family, she
wanted to explore life and her identity more independently, as many
20-somethings do. Her siblings were working as her caregivers, funded
by Medicaid, for years. However, as they got older, they had their own
obligations with school and careers, and it became difficult to find
the coverage. 

Mao Yang lives in a group home in Eden Prairie, Minnesota. Photo
courtesy of Mao Yang.

In an interview with Workday Magazine, Yang explains that her group
home is facing staffing shortages that impact the quality of care she
receives. As an active community member, it was important for her to
find a group home that provided her with transportation into the
community. Metro Mobility, a public bus service for those with
disabilities and other health concerns, is not an option for her, or
many others with more complex care needs. She is often unable to
attend events and go into the community, as the group homes are
short-staffed and unable to accommodate. 

Yang emphasizes that she made the choice to live there and is grateful
to live in a group home. At the same time, she’s struggled with the
high rates of turnover at her facility, which impacts the quality of
care, while also feeling left out of decision-making. She describes
the experience of clients as “monkeys in the middle being passed
around and discussed and we’re not included in that discussion.” 

IMPROVING WORKING CONDITIONS IMPROVES QUALITY OF CARE 

Yang is outspoken, enthusiastic, and bold when it comes to demanding
the quality of care she knows she deserves, and she wants other
disabled people to feel empowered to do the same. She encourages other
disabled people living through situations where they are receiving
inadequate care, “Don’t be afraid to ask for what you want or
need. Be firm when it comes to asking for what you want and just
because no one has asked or questioned what you have wondered about,
that does not mean that you can’t be the first. So don’t be afraid
to be that one person.”

Yang’s attitude reflects the urgency of clients and home care
workers alike. The fight to improve staffing, pay, and benefits can
incentivize workers to join the field and improve retention, which can
also improve the quality of care clients receive. The fight for better
working conditions for workers, and the fight for improving quality of
care for clients, are inherently linked. 

Andrew, who asked for his name to be changed for this article, is a
36-year-old with autism who has lived in a group home in St. Paul,
Minnesota for over fifteen years. He enjoys fishing, hiking, and
creative writing. Like Yang, Andrew wants to be in the community and
shares a similar frustration toward his group home’s short staffing
that makes it more difficult to leave the home and be in the
community. 

While he has had his share of nightmarish experiences with PCAs in the
past, he lights up when talking about the good
experiences—caregivers who would go on walks in the woods with him,
who have shown him interesting music, or who went the extra mile to
make him delicious breakfast sandwiches. Andrew wants to see a change
in the industry so that the good staff can actually stay, improving
both the workers’ conditions and his quality of life. 

Andrew knows that staff are trying their best, but he still wants
people to know that these PCAs are a lifeline for people like him and
that this industry cannot continue to be underfunded and treated just
like any old job. With such high rates of turnover, Andrew says,
“Where does this leave me?” He adds, “I’m someone who really
needs this help.” He pleads that these jobs demand a serious
commitment and compassion for the people they work for and that
improving worker conditions is a step in the right direction. 

THE IMPACT ON FAMILIES 

Home care work is a unique industry because it takes place in the home
and is often provided by—or in close collaboration with—the
clients’ families. Johnson explains that “because you are
performing the most intimate of intimate duties, you form a
relationship that’s built on trust, dependability, and
reliability.”

While the intimate relationship that comes from this type of work can
form lifelong bonds between clients and workers, it can also be a
source of stress and hardship for family members who step into this
role. A spokesperson from SEIU Healthcare explained that with staffing
shortages, the union is seeing many family members who are forced to
leave better paying jobs with benefits in order to take care of their
loved ones.

The spokesperson explained that some clients are given a budget to
work with, meaning they can choose fewer hours but higher wages for
their caregivers, in programs that potentially incentivize clients to
receive less than the care they need, in order to pay a fair wage.
About half of the bargaining unit is employed under such programs, the
spokesperson said. For clients who receive less flexible home care,
where they don’t get to make decisions on budget, a greater share
are people of color, state data shows
[[link removed]]. 

At a Minnesota Legislature Senate Human Services hearing
[[link removed]] on
the long-term care staffing crisis in November 2022, Delores Flynn
from Roseville, Minnesota, spoke on behalf of her union. Flynn and her
husband, both 78 years old, are full-time, round-the-clock caregivers
for their 51-year-old son Scott, who suffered a massive brain
hemorrhage. 

Scott requires complex care. He is 6’2, 176 pounds, nonverbal, wears
a diaper, and needs to be transferred by two people at a time. Delores
asserted at the hearing that Scott “has a right to compassionate
care with dignity and respect in his own home.” 

While staffing was less than ideal even before, the pandemic has
brought a full-blown crisis for the family. With an intense workload,
low wages, and minimal benefits, Delores and her husband are now
full-time caregivers, struggling to find and retain workers to care
for Scott. 

The crisis in direct home care workers poses danger and physical
injury for both caregivers and clients, especially elderly parents who
often are forced into this role, despite injuries and disabilities of
their own. Both Delores and her husband have heart and back problems.
Delores needs a knee replacement and cannot schedule one due to the
lack of coverage for Scott. 

Delores’ husband has fallen while transferring Scott, resulting in
injuries for both him and his son, she explained at the hearing.
Delores has dislocated her knee, and Scott has suffered from head
injuries, bruises, sprains, and a fractured elbow. The family has had
to call neighbors and the Roseville Fire Department.

The state of Minnesota and the home care workers will be negotiating
through the end of 2022. Many caregivers and their clients agree that
it often feels like these crucial decisions and those in power are far
removed from the everyday realities of home care workers and the
disabled people who rely on their care. After decades of underfunding
and a daily crisis for care for so many families, the coming weeks
will tell if Minnesota state leadership will hear their calls for
change.

As Delores puts it, “If I could offer well over $20 an hour with
benefits, such as retirement or even overtime, a wage that people can
live on, then I could attract and retain the help my family needs and
other families need.”

_*Minnesota was granted a __temporarily waiver_
[[link removed]]_ from
this federal law during the pandemic._

_Isabela Escalona
[[link removed]] began working
with Labor Education Service and Workday Magazine in 2022. She grew up
in Oak Park, Illinois and earned her B.A. from Macalester College in
St. Paul in International Studies. Isabela worked as a Communications
Organizer at Centro de Trabajadores Unidos en la Lucha (CTUL) in
Minneapolis for three years. Along with her professional work, Isabela
has a shared art studio in St. Paul where she works on short films,
photographs, and other artistic projects. She enjoys watching movies,
reading, bike rides, hiking Minnesota’s beautiful landscapes
year-round, exploring antique stores, and spending time with loved
ones._

_Workday Magazine holds the powerful to account while bringing the
perspectives of everyday workers, and the organizations that defend
their rights, to focus. We emphasize long-form investigative
journalism to unearth the concealed and buried. Our publication is
based in Minnesota and covers the greater Midwest, along with
international issues that affect workers, like climate change and U.S.
militarism._

_Workday Magazine fulfills the mission of the Labor Education Service
at the University of Minnesota
[[link removed]] by
providing a public outlet to examine the conditions that workers face
on a day-to-day basis. We began publishing in the summer of 2000 with
support from Minnesota’s labor community. We were the first online
labor news publication in the United States._

* home health care workers
[[link removed]]
* Medicaid
[[link removed]]
* Minnesota
[[link removed]]
* SEIU
[[link removed]]
* Disabled
[[link removed]]

*
[[link removed].]
*
[[link removed]]
*
*
[[link removed]]

 

 

 

INTERPRET THE WORLD AND CHANGE IT

 

 

Submit via web
[[link removed]]

Submit via email
Frequently asked questions
[[link removed]]

Manage subscription
[[link removed]]

Visit xxxxxx.org
[[link removed]]

Twitter [[link removed]]

Facebook [[link removed]]

 




[link removed]

To unsubscribe, click the following link:
[link removed]