When Phyllis Nollet's husband died two years ago, it was a dark time for the chronically ill senior who subsists almost entirely on Social Security payments.
The 89-year-old has suffered multiple cardiac arrests, strokes and a host of other complications. For her, getting to medical appointments, grocery shopping and even eating can be a daily challenge.
For several years, she and her husband relied on California's In-Home Supportive Services (IHSS). The state's 40-year-old program provides financially strapped elderly or disabled residents with homecare workers.
For the three months between her husband's death and the time it took her to navigate the program's bureaucracy, Nollet was often alone at her house in National City.
"I wasn't going to doctor visits even though I was supposed to," Nollet said. "Everybody [family members] worked. They can't take off work to take me to the doctor's."
Despite not getting paid, Miriam Infante, the homecare worker who'd assisted Nollet's husband, tried to make time to visit Nollet.
"I like to take care of elderly people," said the 57-yearold from Mexicali. "I have fun. It's something I like, I enjoy. I get real close with them."
Today, the two are back to spending 35 hours a week together. Between meals, chores and hospital visits, they enjoy drives to the beach, chatting or watching TV. They even made a trip to Tijuana, Nollet said with a wry smile.
"When she comes, my day begins," she added. "When she leaves, my day ends. She keeps me going."
While having access to a home-care worker seems indispensible to Nollet, those in the industry have had to fight for legal and often public acceptance. The federal government continues to debate whether to grant home-care workers minimum wage or overtime protections. This comes as cases of worker fraud have led some political leaders to demonize the industry as wasteful and illegitimate.
California, with roughly 360,000 home-care workers, is one of 22 states that guarantee these employees a minimum wage. However, the workers are often not paid for overtime; nor are they reimbursed for the expense of driving on the job. While the federal government could pass overtime protections as early as this summer, Gov. Jerry Brown has signaled support for limiting overtime hours in an effort to control costs.
The value of home care is also being debated at the local level. Echoing similar efforts around the state, the union representing home-care workers in San Diego County has requested an hourly wage increase of 70 cents for its members. The roughly 20,000 home-care workers in the county, organized by United Domestic Workers of America (UDWA), make $9.50 an hour.
Speaking to the county Board of Supervisors, which negotiates the union contract, UDWA Executive Director Douglas Moore made his most recent appeal last Wednesday: "We want you to put people first by supporting our county's most vulnerable citizens and the workers who take care of them."
The county has not granted a wage increase since 2009, and the union's labor contract expired more than a year ago, with still no agreement in sight.
"We have a lot of competing programs in the Department of Health and Human Services," Supervisor Diane Jacob countered, "and we have declining state dollars to fund all those programs."
In-Home Supportive Services makes up about $45.5 million of a roughly $120-million state-funding pool for many of the county's social services, which include child welfare, foster care, adoption, adult protective services, the CalWORKS welfare system and the CalFRESH food-stamps program.
Money for those social services is fully reimbursed by the state and federal governments. However, county officials said homecare workers' wages, which are capped by reimbursement rates at $12.10 an hour, cannot be increased without decreasing funding for other programs.
If a wage increase were granted to home-care workers, other social services would have to be cut, Jacob said. "This board, along with our management team, has prudently managed finances, and that's why we retain our AAA credit rating," she said.
However, not all the supervisors are convinced that home-care workers are getting a fair shake.
"I think there's a lot of what I call moving those shells around on the table,'" said Supervisor Dave Roberts. "And I think sometimes people lose track of where we really are."
At the same time, the county recognizes the value of maintaining a system that, to a certain extent, supports home-care workers and their clients.
"We know everybody wants to remain in their own home," said Pamela Smith, director of aging and independence services for the county's Health and Human Services Department. "Everything that we have been doing over the last 15 years has been about building supports to help people stay in their home."
The demand for home-care workers could be about to get a lot bigger as the "silver tsunami"—the name given to the aging population—builds.
"This is the first year where we are going to be experiencing the baby boomers come on to this program," said Matthew Maldonado, lead union negotiator for UDWA in San Diego. "We're not sure what that's going to look like, but I don't think we're ready for it."
The home-care workforce is projected to be the fastest-growing occupation in the country during the next two decades, according to the federal Bureau of Labor Statistics.
There are roughly 2.5 million home-care workers in the country, according to the Paraprofessional Healthcare Institute (PHI). By 2020, that number would need to jump to more than 4 million to satisfy the growing demand.
"To meet the rapidly increasing demand for home-care workers, we need to ensure these jobs are quality jobs with adequate wages, benefits, training and opportunities for advancement," said PHI spokesperson Deane Beebe. "In California, more than half of home-care workers, primarily a female workforce, depend on public assistance like food stamps and Medicaid to take care of their own families."
During the last decade, San Diego County has seen a steady increase in the number of people receiving In-Home Supportive Services, according to county data. However, the county's numbers have leveled off recently as abuse in the system triggered increased worker regulations, officials said.
At the same time, advocates continue to argue that home care should be prioritized because it's less expensive than nursing homes and hospital visits.
State officials seem to agree. The state has started rolling out its Coordinated Care Initiative, which was passed by the Legislature in 2012 amid the budget process and is aimed largely at increasing the use of In-Home Supportive Services. The new program has been designed to eliminate unnecessary hospital and emergency-room visits by making it easier for the elderly and disabled to access home-care workers. San Diego is among the eight counties where it will be implemented first.
If California continues on its current path, there will likely be significantly more seniors like Nollet who receive in-home care.
At the same time, home-care workers will probably be like Infante—just as poor as the people they serve.
"She's always broke. So am I. So, we just joined forces," Nollet said. "We would love to eat out occasionally. We don't have money enough to do that."
"I wouldn't be here without her," she added. "Being a 28-year heart patient, I've struggled to survive. I'm so grateful because she has freed me up to do the things I can do."