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聽.
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鈥� 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聽聽for home health aides. She had to pay her own taxes and health care benefits. Dawson says she can鈥檛 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: 鈥淲e want change and we don鈥檛 mean pennies!鈥�
She says she earns $9.50 an hour, which is actually just above average for a home health worker in Ohio.
鈥淲e work really long hours, really hard work,鈥� she says. 鈥淎 lot of us are barely home because if we don鈥檛 go to work, we don鈥檛 get time off. We don鈥檛 get paid vacations. And some of us haven鈥檛 had raises in years.鈥�
Almodovar says her last raise was four years ago. She makes about $21,000 a year so she makes too much to聽聽for Medicaid, but paying for a plan on Ohio鈥檚 federal exchange doesn鈥檛 fit in her monthly budget.
鈥淚 don鈥檛 have a retirement plan, I don鈥檛 have life insurance, I don鈥檛 have medical,鈥� she says. 鈥淏ecause by a government basis, I鈥檓 90 percent above the poverty level 鈥� but I鈥檓 in poverty.鈥�
Home care workers are mostly women. More than half are women of color, and 1 in 5 are single mothers. A聽聽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聽聽a researcher at Brookings.
鈥淧eople aren鈥檛 shocked about a fast food worker not having health insurance,鈥� she says, 鈥淏ut 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鈥檚 wrong.鈥�
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 鈥� and compensated 鈥� as vital front-line personnel in reaching the new goals.
And the U.S. Labor Department says聽聽new home care workers will be needed in the next decade.
鈥淭hey can contribute to better care,鈥� Ross says. 鈥淒own 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.鈥�
Home care workers are often trusted advisors for the patients, says Lisa Kristosik with the Visiting Nurses Association of Ohio.
鈥淧eople get real confused about how to navigate the health care system,鈥� she says. 鈥淎nd they know because they鈥檝e seen it. Because they鈥檙e in the homes. And they are in the homes for hours on end.鈥�
This story is part of a partnership that includes , and Kaiser Health News.