Holly Dawson believes her job is a calling.

She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.

Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.

George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans’ benefits.

When Dawson worked for him, Grellinger paid an agency $37 for two hours of her time each day. Dawson received $13 an hour, higher than the national average for home health aides. She had to pay her own taxes and health care benefits. Dawson says she can’t remember the last time she could afford health insurance.

Dawson says she has been a home health aide for 31 years. She has never done it for the money, rather to help people like Grellinger, she says.

But the conditions of home health work are leading many aides to seek better pay and benefits.

On an early September morning, home health workers held a rally in Cleveland. Jasmine Almodovar, 35, chants with the crowd: “We want change and we don’t mean pennies!”

She says she earns $9.50 an hour, which is actually just above average for a home health worker in Ohio.

“We work really long hours, really hard work,” she says. “A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”

Almodovar says her last raise was four years ago. She makes about $21,000 a year so she makes too much to qualify for Medicaid, but paying for a plan on Ohio’s federal exchange doesn’t fit in her monthly budget.

“I don’t have a retirement plan, I don’t have life insurance, I don’t have medical,” she says. “Because by a government basis, I’m 90 percent above the poverty level — but I’m in poverty.”

Home care workers are mostly women. More than half are women of color, and 1 in 5 are single mothers. A recent analysis by the Brookings Institution found that while the ranks of home health workers grew exponentially over the past decade, their earnings dropped when accounting for inflation, says Martha Ross a researcher at Brookings.

“People aren’t shocked about a fast food worker not having health insurance,” she says, “But someone who is in the health care sector providing necessary health care who does not have health insurance? Just on the face of it, it’s wrong.”

Under the Affordable Care Act, there are financial incentives for hospitals and doctors to keep patients healthy. Ross says home care workers should be considered – and compensated – as vital front-line personnel in reaching the new goals.

And the U.S. Labor Department says more than a million new home care workers will be needed in the next decade.

“They can contribute to better care,” Ross says. “Down the line that can contribute to reduced costs through reduced hospitalizations or going back into a nursing home and over time you can take those savings and put them into increased earnings for that home care worker.”

Home care workers are often trusted advisors for the patients, says Lisa Kristosik with the Visiting Nurses Association of Ohio.

“People get real confused about how to navigate the health care system,” she says. “And they know because they’ve seen it. Because they’re in the homes. And they are in the homes for hours on end.”

This story is part of a partnership that includes WCPN Ideastream, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

HHS Secretary names members for federal Health Information Technology Policy and Standards Committees

California’s public health department has failed to adequately manage investigations of nursing homes statewide, resulting in a backlog of more than 11,000 complaints – many involving serious safety risks to patients, according to an audit released Thursday.

California State Auditor Elaine M. Howle found that the complaints had been open for a year on average – a time frame she called unreasonable and “very concerning.” Nearly 370 open complaints arose from situations that put patients in “immediate jeopardy,” meaning they caused or were likely to cause serious injury or death, according to the review, which looked at cases open as of April 2014. In the Los Angeles County district, 65 immediate jeopardy complaints were open an average of 514 days.

The public health department, which is responsible for ensuring safety for residents at more than 2,500 facilities statewide, doesn’t require investigations to be completed within a certain time, leading to wide discrepancies from office to office, according to the audit.

“Holding district offices accountable for promptly completing investigations is critical to ensuring the safety and well-being of the residents in long-term health care facilities,” Howle wrote in the 82-page report.

State public health officials said in a written statement that they would be reporting on their progress to the auditor. “We appreciate the opportunity to improve our operation,” the statement read.

The state audit was prompted in part by Kaiser Health News reports that the Los Angeles County Public Health Department was ordering inspectors to close cases without fully investigating them. The reports, published by the Los Angeles News Group, also led to a critical county audit.

The state auditor found that the quality of investigations was inconsistent across California. For example, inspectors in the San Francisco office closed cases without having them reviewed by supervisors as required, the report said. And inspectors elsewhere failed to follow state laws requiring investigations to begin within 10 days. In one Sacramento case involving a 97-year-old resident who fell, the inspector didn’t begin the investigation until nine months later.

Mariko Yamada, a member of the state assembly who requested the audit, called the nursing home investigation process “mangled” and said the department has failed to do its job to protect some of the state’s most vulnerable residents. As many as 300,000 residents in California receive care each year in the facilities.

“There has been almost a culture of indifference,” she said in an interview.

The audit found particular problems with investigations into incidents reported to the state by the facilities themselves. In Orange County and most of Los Angeles County, for instance, the inspectors performed on-site investigations in less than 20 percent of such cases reported in 2012 and 2013.

In general, when inspectors found problems at nursing homes, they didn’t always follow up within the required time to ensure the facilities filed plans to fix the problems, according to the audit.

The audit recommended that the department establish a formal process to monitor investigations into open complaints and incidents reported by the homes and that it set a time frame for their completion. The auditor also urged that the department determine how many inspectors are necessary to reduce the backlog and keep up with new complaints.  The department has repeatedly said that it lacks enough resources.

In a response to the audit, state Public Health Department Director Ron Chapman pledged to increase supervision of the district offices, noting that the state already had made improvements to its oversight of Los Angeles County. But the department said that it did not agree with the auditor’s recommendation to set a firm timeline for finishing cases, saying instead that it would work to improve timeliness.

The findings didn’t come as a surprise to Joe Rodrigues, the long-term care ombudsman for the state. Rodrigues said there has long been “questionable oversight and management” of the department’s licensing and certification division.

“It is a flawed system,” he said. “It isn’t doing everything it can do to protect residents.”

Carole Herman, president of the Foundation Aiding the Elderly, agreed. The number of open complaints is “horrific, “she said.

“How many reports are there going to have to be before the governor and the legislature pay attention?” she said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

2015 Joint Board & Labor Council Election and Consent to Serve

DEADLINE EXTENDED: The deadline to submit your consent to serve form has been extended until November 14, 2015.

Are you interested in serving on the Alaska Nurses Association Board of Directors and Labor Council? Elections are quickly approaching! AaNA is in need of individuals to fill five joint seats on the Board and Labor Council. Please select the appropriate form below to fill out and return to AaNA by November 14, 2014.

Board Vice President / Labor Council Director
Open to any Alaskan Registered Nurse who is a member of an AaNA Bargaining Unit
Term January 1, 2015 – December 31, 2016

Board Labor Council Designee / Labor Council Director
Open to any Alaskan Registered Nurse who is a member of an AaNA Bargaining Unit
Term January 1, 2015 – December 31, 2016

Board Director At Large / Labor Council Director
Open to any Alaskan Registered Nurse who is a member of an AaNA Bargaining Unit
Term January 1, 2015 – December 31, 2016

Board Director At Large / Labor Council Director
Open to any Alaskan Registered Nurse who is a member of an AaNA Bargaining Unit
Term January 1, 2015 – December 31, 2016

Board Director At Large / Labor Council Director
Open to any Alaskan Registered Nurse who is a member of an AaNA Bargaining Unit
Term January 1, 2015 – December 31, 2016

Download the Consent to Serve form here.

Please submit Consent to Serve form to Andrea Nutty by November 14, 2014.