When it comes to taking care of people who need help—small kids or people who are sick—that’s my life. I love it," says Jennifer Clarke. Before moving to East Flatbush from Jamaica, Clarke asked her brother, already living here, to poke around for jobs in the medical field. He had a friend working as a home health aide, and Clarke (who will, for the record, only state that she "looks to be in her mid-30s") has been a home health aide since coming here 13 years ago, and now works for All Metro Health Care.

Although it’s not part of the job description, home health aides often become family to their patients. Under supervision of nurses who occasionally check in on the elderly, as well as convalescing or disabled patients recently discharged from hospitals or nursing homes, home health aides spend hours taking blood pressure, monitoring blood sugar, and assisting with physical therapy. Home health aides also prepare meals, clean bed sheets, and bathe patients.

"We become the nurse, we become the therapist. We become the family member. The only thing we’re not doing is diagnosing the patient," says Angelique Grinnege, a 39-year-old from Trinidad who lives in Bed-Stuy and has been working for Omega the past four years. Many health aides also act as bookkeepers, budgeting patients’ Social Security checks so there’s enough to eat and pay rent until the next check arrives. "The agency says we’re not supposed to do [this]," Clarke says, "but how can you leave a little old lady who has nobody and who cannot do it for herself?"

Nevertheless, home health aides fill all these roles for about $6 or $7 an hour. Most lack health coverage, which is especially distressing considering the aides endure such physically grueling work as lifting patients, or being assigned to someone with TB, meningitis, hepatitis or other contagious diseases.

The home care division of Local 1199-SEIU (Service Employees International Union) is fed up. The union, which represents about 70 percent of New York’s 30,000 home health aides, is demanding $10 an hour, health coverage, and paid sick and vacation time. At a rally held on April 15, over 5,800 workers filled the midtown Hilton and overwhelmingly voted to strike in early June if contract negotiations underway with 12 home health care agencies fall flat.

Getting the workers’ support, however, hasn’t been simple. The workforce is decentralized and "invisible"—hence the name of the union’s campaign: "Invisible no more." As demonstrated by SEIU’s organizing in Los Angeles, it’s possible to rally workers. In 1999, 74,000 L.A. home health aides came on board. (The contract won in California, which operates under an entirely different system from New York’s, is presently threatened by Gov. Schwarzenegger, however.) While federal cutbacks are squeezing home health care work, Kevin Finnegan, assistant director of New York State Council of SEIU, says the demographics of an ageing population and an increasing trend toward home health care means the field is expanding.

Several workers spend free time "phonebanking" at Local 1199-SEIU’s office. One is Beverly Gordon, a 48-year-old from Jamaica, living in Flatbush, who after ten years earns $6.95 an hour. Gordon sometimes gets hang-ups as well as yellers upset that the union didn’t win an improved contract when it organized her agency All Metro a few years back. Many also fear bosses retaliating against pro-union workers by taking away hours.

Gordon, however, is resolved to "fight to the end," saying "Gone are the days I’m scared… We are the company. They—[the employers]—are only the name." She remembers the company telling workers not to join the union, warning about high dues and loss of pay if workers went on strike. (Actually, 1199 has a strike fund to pay walkouts.) Gordon received a pen that said, "Vote no to 1199 SEIU." She took that pen, signed her union card, and now uses it to sign up co-workers. "[All Metro] can’t give us money, but they can spend it on a pen?"

According to Finnegan, "We costed everything out and there’s enough money" to pay workers $10 an hour. Federal and state funds for home health aide work—on average it’s $17 an hour from Medicaid and Medicare, more from private insurance companies—get funneled through a Certified Home Health Agency (CHHA, pronounced "cha"), such as Visitor Nurse Services. The CHHA takes out about 21 percent for administrative costs, and then subcontracts the work to a Licensed Home Care Services Agencies (LHCSA, pronounced "licksa") passing along the remaining $13. The LHCSA takes out another 21 percent for administrative costs, yet workers end up with $6 or $7.

As of now, LHCSAs aren’t required to report how they spend their dollars. Last year, after 1199’s lobbying effort, Governor Pataki reluctantly signed a bill—taking effect by 2006— requiring LHCSAs to report expenditures. "At the end of the day, the law will have little impact," says Finnegan, but maybe legislators will realize "the government is subsidizing [the owners’] Jaguars."

The home health aide industry is similar to the garment industry, where employers make pennies from workers, but the high volume of subcontracted work adds up. The labor pool is also like the garment industry’s—a mainly low-skilled, immigrant woman. Training for home health aides is about three to four weeks. So, although the job is demanding, Finnegan says, "The reality of this market is—if this worker doesn’t do it, the companies will find others."

Many of the aides are optimistic, however. "If we go on strike, we are going to lose a day’s pay, but agencies are going to lose millions," Clarke says, pointing to what happened when New York City’s home care attendants went on strike in 1992—employers settled right away. Home care attendants actually require less training than home health aides, since they do none of the medical tasks like taking blood pressure; but attendants, who’ve been unionized longer and are funded through the Human Resources Administration under living wage laws, already receive higher pay than heath aides.

Presently, 1199-SEIU has the support of politicians including Senators Clinton and Schumer, as well as backing from several community organizations and religious leaders. The union even has support from some patients. When All Metro’s Beatrice Whitehead told one of her patients about the union’s campaign, the patient told her to leave a stack of union cards to give the aides filling in for Whitehead. The 61-year-old Whitehead, who hails from Guyana but who now lives in East Flatbush, has been a home health aide for seven years, is worried her patients will suffer if the strike happens. Like many aides, she says that "You have to prepare the patients."

Clarke is exhausted but still resolved after her 70-plus hour workweeks (with no overtime). She doesn’t think that most New Yorkers realize how many thousands of people have home health aides working inside apartments. "Because not all of us wear uniforms," she says, "they think you’re a housekeeper or a babysitter." For her patients’ sake, she’s praying the employers concede and "let the whole city be in peace, because trust me," says Clarke, "if we strike, this city’s going to be turned upside down, inside out."