On the home front

Ella Hampton’s house in central Oroville is small, with an immaculately kept lawn. In the driveway sits Hampton’s old Pinto, slowly gathering rust, with two flat tires; she’ll fix it someday if she can put the money together. The house is modest, but Hampton hopes never to give it up.

She had it built in 1979, after a quarter-century of work in Oroville’s Pacific Growers cannery, packing peaches, grapes and tomatoes. During many of those years, Hampton tacked on a second shift working as an aide at a convalescent center on Gilmore Lane. This house is the product of decades of 70-hour workweeks.

Today, Hampton is able to stay here only because of California’s In-Home Supportive Services program.

At the age of 73, her knees are fragile and she suffers from serious kidney disease.

Her Social Security income is far too low to allow her to pay for a private caregiver. So in 1990, when her health began to fail, she turned to the IHSS program, which serves low-income disabled people.

For the past 11 years, IHSS worker Doris Laughlin has visited Hampton five days a week, doing the full gamut of home care: cooking, shopping, vacuuming and ironing; assisting Hampton with bathing; taking Hampton’s blood pressure; and driving her to the doctor. Without such help, Hampton, who has no family in California, would almost certainly need to be in a skilled-nursing facility, living with much less dignity and independence (and at substantially greater cost to taxpayers).

Laughlin, an employee of the private agency Addus HealthCare, which contracts with Butte County to serve roughly 350 IHSS clients, has been doing home care work for nearly 15 years. Short and broad-shouldered, she looks younger than her 59 years.

Laughlin’s father was a drill sergeant in the Marine Corps, and you can see traces of his influence as she operates in Hampton’s home. She’s constantly on the move, jotting down notes to herself, straightening the kitchen, making sure Hampton’s medicine is in order.

Laughlin has an excellent persona for a caregiver: She radiates competence and warmth but has no air of patronizing sticky-sweetness. After all these years together, she and Hampton have an easy style of banter.

“I’m afraid we’re going to have to chuckle on out of here,” Laughlin announces, nudging Hampton to stop telling me her life story. (Hampton has an appointment to get to.)

“It’s all right,” says Hampton with a smile. “Just hold on and we’ll get there.”

Hampton and Laughlin say that their arrangement marks the IHSS system at its best: It’s given Hampton more than a decade of stable care provided by a worker with a wide range of paraprofessional health skills. Their 11-year relationship is partly a testament to the personal strength of both women. But Laughlin argues that their situation has worked so well partly because she and her fellow Addus employees are represented by a union, the United Domestic Workers of America.

The UDWA local, for which Laughlin serves as shop steward, has meant decent wages and health benefits. It also means that when Laughlin herself is sick, or just needs a break, Hampton can easily find a reliable backup worker. All of this, Laughlin says, has allowed her to commit to the home care field, and to Hampton.

The vast majority of Butte County’s IHSS clients—and IHSS workers—have more difficult situations. Those not served by Addus, more than 2,000 people, are cared for by individual providers, or IPs—caregivers hired, fired and supervised directly by the clients or their family members. (In fact, roughly 60 percent of the county’s IPs are themselves family members—typically, women in their 50s or 60s caring for their aging parents.)

Butte County IPs earn $6.44 an hour, just above the minimum wage, and have no health, pension or vacation benefits. Turnover is very high (especially among the non-family workers), which means that clients often must scramble to find replacements. And the workers, some of whom have sacrificed long-held jobs in order to care for their family members, find themselves earning barely a subsistence wage.

All of this is about to change. Prodded by a 1999 state law, Butte County will soon establish what’s known as a “public authority” that will serve as employer of record for its IPs, thus allowing them to unionize. Though the county currently sends out IPs’ paychecks, they are unable to negotiate for wages and benefits with it—or any agency, for that matter. If the experiences of other California counties are any guide, establishment of a public authority will lead to the largest unionization in Butte County history and, with it, substantially higher wages and benefits and a more stable IHSS workforce.

But there’s plenty to argue about in the fine print: Union activists fear that the county will drag its heels on creating the public authority until January 2003, the legal deadline, unnecessarily leaving IPs to suffer for another year and a half without health insurance. Other observers worry that if too many of the new public authority’s resources go into increased wages and benefits, not enough will be left for other reforms, including new systems of training and background checks for IHSS workers.

On a Saturday in late July, a dozen IPs and a few of their clients gather in the rec center of an Oroville mobile-home park. They’ve been called together by the UDWA, which is beginning to talk to workers about the changes in IHSS and the forthcoming union drive.

The group includes a man who cares for his wheelchair-bound wife; two mothers who care for their severely autistic adolescent sons; a woman who cares for her 98-year-old uncle; and several young women who care for non-family members. In a semicircle of folding chairs, they tell their stories.

Doris Laughlin is here, sitting to one side, not doing much talking. But she chimes in at various points: When one IP complains that the county doesn’t reimburse her for the long mileage she drives to get to one of her clients, Laughlin says, “We’ve got mileage in our union contract at Addus—that’s something you’ll be able to fight for.” And when another IP laments her family’s health insurance situation (her household income is too high for Medi-Cal but much too low for her to insure herself on the open market), Laughlin rings out: “And we’ve got health insurance. All of this you can fight for, once the county gets moving.”

The meeting isn’t only a litany of complaints. Several IPs pointedly say that they love their work, or that they’re grateful that IHSS allows their loved ones not to be institutionalized. But all of them are eager for health insurance, and no one is pleased when union organizer Molly Hillis warns that the county might wait until 2003 to permit negotiations.

Home care work can be an isolating experience; this meeting is the first time that several of these people have met any of their fellow IHSS workers. “I feel like I’ve been just so blessed by God,” says Jackie Zamarripa, who cares for an 87-year-old neighbor in a Thermalito mobile-home park. “I never realized how much more difficult other people’s situations are. My heart went out to those families with autistic kids, and the parents have no insurance. Here you are taking care of the sick, and if you get sick, what happens?”

One Wednesday afternoon, during a break from her duties with Ella Hampton, Laughlin leads me on an “IHSS tour” of Oroville, where she seems to know someone on every block. Our first stop is the home of Alma Troxel, an IHSS client who has been wheelchair-bound for 18 years. Troxel is a petite woman with a musical, high-pitched voice. Her uncle was Oroville’s chief of police in the 1930s, and her aunt owned and operated a hotel on Myers Street. “And didn’t you also have a relative who was a judge here in town?” Laughlin prods.

“No, no,” says Troxel. “Who is it you’re thinking of? Was it Lisa … ?”

“No, her family were all crooks.” At this the two of them burst out laughing.

Laughlin and Troxel have been friends for years. They met because Troxel’s son was once married to a daughter of one of Laughlin’s IHSS clients. Sardonic humor seems to be their usual mode. Later in the hour, they have a long laugh at the expense of Troxel’s disability.

“Remember a few years ago, when you reached over your stove and burned your arm? We almost had Alma toast!”

“Oh, Lord,” says Troxel between chuckles. “I think of that every time I go by that stove.”

Troxel’s caregiver, a slender 74-year-old IP named Norma Heath, returns from a shopping trip. Troxel hired Heath seven years ago, after she interviewed three candidates from a list provided by the county. “One woman, I didn’t like the way she was talking at all,” says Troxel. “She sounded like she was going to take completely over in this house. But Norma is wonderful.”

“Alma’s been very lucky,” says Laughlin. “Norma makes it possible for her to stay here at home.”

“I love to do this work,” says Heath, as she settles into a couch opposite Troxel’s wheelchair. “But I’m looking for another client for the early part of the day. I can’t quite make ends meet as it is.” Heath worked in nursing homes for many years and started to do IHSS work after she retired, in order to supplement her Social Security income.

She says she’s eager for the union to arrive for IPs. I ask what issues she would raise if she someday sits on the union’s bargaining committee.

“My issues would be vacation pay, higher wages and just respect. A lot of these people [in town], when I tell them what kind of work I do, sort of turn up their noses: ‘Oh, that kind of work.’ We’re not low-class people just because we’re scrubbing people’s toilets or cleaning someone’s kitchen floor.”

“And doesn’t this house look good?” says Laughlin. (It does; the kitchen is gleaming.) “I wish that my house could look like this, but I use up all my cleaning energy over at Ella’s.”

“Oh, I feel the same way—don’t be lonely!” says Heath. “I know people who work as plain housecleaners, without having to do any personal care, or bathing, or any of that. And they’re getting $10 an hour.”

“Honey, they’re getting $15 an hour some places in town,” says Laughlin.

According to many critics, this is the great structural flaw in IHSS as it currently operates in Butte County. Why work for $6.44 an hour when you can do similar, easier work for much higher wages? For the 60 percent of IHSS clients who are cared for by family members, this isn’t always an immediate issue; their family caregivers aren’t about to abandon them, as long as they can eke out a living. But for the 40 percent who, like Troxel, are cared for by “strangers,” the problem can be acute.

Sure, there are some workers, like Norma Heath, who are deeply committed to care giving and willing to put up with the low wages. But the system doesn’t have an infinite supply of eccentrics and saints eager to give good care at minimum wage.

Troxel discovered this last year, when Heath was hospitalized for three weeks with pneumonia. Troxel found a backup worker through the county, and things didn’t quite work out. “It was my own stupidity,” says Troxel. “This woman was on drugs, but I didn’t realize it. I left out my checkbook one day, and I’d signed a check because I was expecting a bill. She tore out that check and wrote a check for 50 dollars to herself. I was lucky to get that money back.”

The nine California counties that have already created IHSS public authorities have tried to address this problem by creating new systems of background checks. Workers in other fields often resent such background checks, but all of the IHSS workers interviewed for this article were enthusiastic about the idea. These checks, they say, would relieve some of the psychological pressure of the job, the feeling that their clients are absolutely dependent upon them.

With background checks and a well-maintained work registry in place, Heath says, she’d feel that she could afford to be sick for a few days, or to take a short vacation, without worrying that Troxel would again fall prey to an incompetent or abusive substitute worker.

When Laughlin and I leave Troxel’s house, our next stop is Stacy’s Lunch Box, a quiet diner on Myers Street. We’re here to see Penny Beach, a former colleague of Laughlin’s at Addus, who now manages the diner.

When Beach gets a break from serving customers—the special today is Hungarian pork goulash—she joins us at a table and tells her story. A dark-haired woman in her early 40s, Beach has large, expressive eyes. She looks tired after the busy lunch rush.

Several weeks ago Beach opened her home to her mother, who suffers from Alzheimer’s-related dementia. The county office of Adult Protective Services has placed Beach’s mother under an order for 24-hour care.

Beach cares for her mother in the early mornings and evenings, but the county insists that she have an IHSS worker in place during the day. No problem, right? That’s what Beach thought, based on her own history of work at the Addus agency. But all three of the IHSS workers she’s brought in so far have been duds. One of them alarmed Beach by asking for a beer at the end of the day, while she was still on duty; another simply failed to show up one morning; the third allegedly ignored Beach’s mother all day, except for one moment when she jumped in front of the mother’s chair, shouted “Let’s boogie!” and started to dance.

Beach’s dog, thinking her mother was being threatened, leaped up and bit the dancing worker on the ass.

Beach’s mother’s social worker has started to urge her to give up the job at the Lunch Box. “She keeps needling me,” Beach says. “But I like this job. … I like coming in here in the morning. I take care of my mother six or seven hours a day, and that’s exhausting enough.” (On Aug. 6, Beach and her mother began to audition yet another IHSS worker for the daytime hours.)

As we leave the Lunch Box, Laughlin runs through the rest of her day’s agenda. “OK, now I’ve got to go back and cook for Ella. Then later this evening I’ve got a union meeting, to deal with a grievance my co-worker has raised about his residual payments.”

“Don’t you ever take a break?” I ask.

“My doctor keeps telling me to slow down, but that’s not the way I am. I was in the hospital a few weeks ago with congestive heart failure. I called up my son, who’s making good money as a personal trainer down in L.A. He’s just gotten a couple of famous clients. I said to him, ‘You’d better save some of that money—someday before long you’ll be taking care of me.'”

Laughlin came to home care work 15 years ago almost by sheer accident. After years of running a freight dispatch business near Los Angeles, she and her husband bought an olive orchard near Oroville and moved here for a quieter existence, planning to do some fishing. Around this time, they brought Laughlin’s 96-year-old mother-in-law to live with them during the final months of her life.

“That’s when I first realized how much I enjoyed caring for people,” she says. “Her mind was sharp as a tack, but she was so weak. She just needed companionship.”

Within a few months, Laughlin had given up managing the orchard and had begun her career as a home care worker.

Once she was established at Addus, Laughlin found herself doing more and more volunteer work for the union and two years ago became shop steward. “It was around that time that [UDWA] folks from all over the state started going down to Sacramento, to lobby for AB 1682,” the 1999 law that requires counties to establish IHSS employers of record by 2003.

“I sat there listening to these young IPs testify about their lives, and I thought: If this was my daughter, trying to get off of welfare, and they told her to go work for IHSS, she’d really be in a Catch-22 situation. She wouldn’t be earning enough to support herself. Yes, I know she’d be subsidized through food stamps and things like that, but that’s not the same. You need to be really supporting yourself to feel like a real person.”

The UDWA won its battle in Sacramento, but there are several hurdles yet to be crossed before Butte County’s IPs can begin to organize for better wages and benefits. The creation of the new public authority will be shepherded largely by the county’s IHSS Advisory Committee, which began to meet in January 2001.

This committee, as per the requirements of AB 1682, consists mostly of IHSS clients, along with a few social workers, community leaders and two IHSS workers. Those worker representatives are Doris Laughlin and Sarah Okumbe, an IP in Chico who cares for her 21-year-old daughter, who has severe developmental disabilities.

During a quiet hour at the downtown Starbucks, Okumbe says that she’s very pleased with the committee’s work so far. “We’ve covered a lot of ground in just a few months,” she says. “I’ve been very impressed with the participation across the board.”

On July 24, the committee presented its core recommendations to the county Board of Supervisors: to create a public authority for the county’s IPs and also to maintain the “contract mode"—now served by the Addus agency—for the 350 or so clients who aren’t capable of hiring and supervising IPs and don’t have nearby family members to do that hiring and supervising.

Okumbe, who first came to Chico from Kenya as a student in 1971, says she hopes that the new system of IHSS public authorities will play at least a small role in normalizing home care in the public imagination. “For a while, people believed that breast-feeding was dangerous, like a primitive custom,” she explains, sitting perfectly straight in her chair. “And now the tide has turned—everyone sees that it’s best. I hope that the same thing will happen with home care. I hope that people will see that their disabled family members really ought to be kept at home, like in the old days, not put into institutions.”

The Board of Supervisors accepted the advisory committee’s recommendations, but there was one controversy that day. UDWA activists, along with several IPs, implored the supervisors not to wait until January 2003, but rather to enact the operating ordinance for the public authority within 90 days, so the union can begin to organize.

(The ordinance will designate a threshold of IPs—probably 15 or 20 percent of the workforce—who must sign statements of support for the union before an election may proceed. Most such union elections in California have been won by huge margins; in late 2000, 93 percent of Sacramento County’s IHSS workers voted to unionize.)

But the supervisors refused to make a 90-day pledge, saying that they wanted to be cautious about how the public authority would be constructed. (UDWA organizers charge that this concern is a red herring, since most counties’ public-authority ordinances are skeletal. The county could pass the operating ordinances quickly but still have plenty of latitude to sculpt the details of the public authority over the next year, they say.)

Cathi Grams, the assistant director of the county welfare department, says the county has some questions to ask itself before it goes forward: “For example, the administrative structure of the public authority—will it have an executive director? How soon can we get that person on board? We hope to move on all of this in a timely manner, but we also want to be sure of what we’re doing.”

A new consultant hired to facilitate the IHSS transition, Eldon Luce, will hold his first meeting with the advisory committee on Aug. 17. “In these public authorities, there’s an inevitable friction between unions’ wishes and other administrative goals [such as staff for training programs and background checks],” observes Luce, the director of Contra Costa County’s IHSS Public Authority. “So that can get pretty touchy. The true limit to these programs is what counties are willing to spend, and everyone has something they want to get under that bar.”

(The formulas are complicated, but in general county government picks up around 20 percent of the $17 million cost of its IHSS program, with state and federal funding picking up the rest. But if the overall expenses exceed a certain level, the county must pay for 100 percent of the excess.)

Luce says he’s confident that any friction in Butte County will be minimal—no major players actively oppose wage and benefit increases on the one hand or new training programs on the other. It’s simply a question of priorities. Depending upon how quickly the advisory committee comes to consensus on these issues, the Board of Supervisors might pass the operating ordinances by the end of the year.

Charlotte White works as an IP for her mother, Minnie Stevens, who suffers from emphysema and congestive heart failure. The two of them share a trailer south of Oroville with three aging poodles and a tiny orange kitten. As with all IHSS cases, they’re visited annually by a social worker, who evaluates Stevens’ needs and sets the number of hours for which White will be paid.

“They just cut my mother’s hours not too long ago,” says White. “It had been 90-something, and now it’s just 84.7 hours per month. They told me that they had changed the formula. They give you this list of tasks, and they ask you how long it takes you to do them, and it never makes much sense to me.”

In any case, White says, she works for her mother—cooking, cleaning, setting up the oxygen tank—far more than 84.7 hours per month. “That’s why I’m anxious for the union to come in,” she says. “So you can fight these things and have someone to back you up.”

But for all her frustration, White has no regrets about where she finds herself. “Sometimes I feel like I’m just a pushover,” she says. “I’ll feed any cat that comes wandering down the street. I just won’t see people suffer. And I’ll never, ever let my mother go into a nursing home. I’ll avoid that at all costs.”

Howard Croft, the national home care director of the Service Employees International Union (which is not related to the UDWA), says he hopes compromises like White’s will someday become less painful. "If we lived in a country in which health care were considered a right, we wouldn’t be going through these arguments," he says. "But here there’s almost no relief for family members who choose to do home care. … We’ve got to turn this into a national debate: Given our needs as humans, how rational are our health care policies?"