Orange County’s Home-Care Program Is Plagued With Poor Pay and Shortages

Tonya Ginn and Monique Taloa, who provides in-home care for her sister. Photo by John Gilhooley

Monique Taloa pulls out a drawer that’s full with her sister’s prescription bottles. She sits down at the kitchen table of her Buena Park home and methodically sorts pills into a large plastic box with compartments as deep as an ice tray’s. “It is very complex because I don’t want to make a mistake,” Taloa says, her shimmering bracelets clanking on the table. “What happened with Tonya is that the doctor removed her from almost 19 medications and lowered the dosages of everything that she is on to the bare minimum because she was so drugged-up.”

That’s just one of many improvements Tonya Ginn—who suffers from a mental illness and seizures and has hydrocephalus, a condition more commonly known as “water on the brain”—has experienced since leaving a nursing home in 2012. As an In-Home Supportive Services (IHSS) provider, there’s never a typical day on the job for Taloa, but most begin early in the morning with personal-care services such as hygiene, an hours-long task. She also does the bedding, laundry and prepares meals for her sister, finely dicing up foods because Ginn’s teeth are mere fragments protruding from her gums.

All that doesn’t count managing her sister’s behavioral episodes whenever they arise.

Being a home-care provider isn’t a thankless job. Ginn, wearing a purple flower in her hair to match her tank top, is proud of her sister—and of the card she made to thank her. Taloa takes a break to retrieve it from an improvised letter holder. “When I get discouraged, because care providers sometimes get exhausted, I go back and read this card to remind me why I’m doing this,” she says. “You’re a social worker. You’re a nurse. You’re everything that they need you to be.”

But not everyone sees it that way—or has a tangible reminder of being needed. With low wages and a lengthy enrollment process delaying first paychecks by six weeks or longer, the program’s shortages of providers for North and South County isn’t hard to fathom. Represented by United Domestic Workers of America (UDW), IHSS providers make $11 per hour. The union is currently in a prolonged fight with the county to improve pay contracts and other working conditions, but negotiations with the Board of Supervisors, who set the wages, are at an impasse.

All the while, IHSS became a seemingly unlikely player in a larger war against public-sector unions waged by the Koch Brothers-linked Freedom Foundation. The nonprofit zeroed in on UDW’s dues, waging an ongoing campaign to have home-care providers opt out of union membership. As the political battles continue, a new test for IHSS looms in a county full of aging baby boomers.

“Orange County’s population, at least of those who are older than 60 years old, is going to grow by double digits over the next decade or so,” said An Tran, a division director with the county’s Social Services Agency, during a recent IHSS roundtable hosted by Assemblywoman Sharon Quirk-Silva. “As Orange County ages, I would imagine that the service demand for types of services such as IHSS will continue to grow as well.”

As of late May, there are 25,033 home-care providers for 31,504 eligible recipients. How an expected increase in demand will be met is an important question for not only the county’s disabled and elderly residents, but also the home-care providers by their side.

“Long-term care services aren’t something we think about when we’re 25 and we’re healthy and able,” says Bhumit Shah, a personal-assistant-services coordinator at the Dayle McIntosh Center, an advocacy group for people with disabilities. “But as we all get older, we develop illnesses and disabilities or a combination of both. It’s very important to have a robust system in place that protects a person’s quality of life and keeps them comfortable in their own environment.”

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Photo by Gabriel San Román

Before becoming the Gipper in Chief, California Governor Ronald Reagan signed legislation in 1973 that laid the foundation for people with disabilities to live at home, rather than be institutionalized or kept in nursing homes. Activists with the independent-living movement claimed a hard-fought victory. The labor movement caught up six years later when the newly formed United Domestic Workers of America won its first contract in the state for home-care providers.

But through the decades, IHSS has suffered from flaws that continue to burden it. In the past, those in need of home-care providers found consistent care difficult with high turnover rates. Back then, workers had no employer of record and struggled with minimum-wage pay. Legislation passed in 1999 established a new model for IHSS, with Public Authority agencies being the employer, clearing a path for collective bargaining. OC followed by establishing its own agency in 2002.

Forty-five years after the birth of IHSS, home-care providers have only recently won overtime and paid-sick-leave benefits. A more livable wage in OC, though, proves even more elusive.

On May 8, a sea of green shirts populated the grounds outside the Orange County Board of Supervisors building in downtown Santa Ana. Home-care providers, disabled clients and union organizers turned out more than a year after contract negotiations began to send the board a clear message about higher pay and better benefits.

“In three years, we want home-care providers to be making $14 an hour,” Donta Harrison, UDW’s regional coordinator in OC, says through a bullhorn.

His statement is met by workers chanting, “Raise! Raise! Raise!”

“Today is the day that they can give home-care providers the $14 an hour they need to take care of their clients,” Harrison adds. “We are also asking the county to make sure everyone has adequate safety equipment and supplies. You deserve the same respect as any other worker in the state of California.”

But the all-Republican board met the mobilization with a collective shrug.

Just down the street from the rally, at the two-story building where UDW makes its headquarters, Harrison pointed out the problems and solutions from the union’s perspective on how to improve the lot of its members and IHSS itself. “One of our fixes is offer people more than minimum wage,” he says. “They have to make this job more attractive; otherwise, you’re going to have an aging population that people are just going to forget about.”

With that in mind, the union proposal calls for boosting hourly wages up to $11.50 this year and $14 by 2020. “I’m not sure if it’s an ideology they’re subscribing to,” Harrison says of supervisors’ inaction. “It is very much giving off the appearance that they just don’t care for poor people.”

OC’s Board of Supervisors declined to comment for this story, with one citing ongoing negotiations with the union and UDW’s filing of an unfair labor practice (ULP) complaint against the county.

The May rally signaled that members are fed up with the impasse. Union reps also criticize the county for refusing to make its own smaller funding contribution, tapping into $95 million in state and federal funds approved for wages and health insurance. They recall better relations with the county until the Freedom Foundation began eyeing UDW’s membership rolls. But collected dues help to fuel a legislative agenda. Citing a statewide growth in the senior population, from 5.2 million to 8.4 million by 2030, UDW, in concert with other organizations, is pushing a “Care Agenda for California” in the form of recruiting half a million home-care workers by 2020.

The county acknowledges shortages. “SSA’s IHSS program and the IHSS Public Authority continue to strive to meet the needs of all current and future IHSS recipients,” spokeswoman Laura Turtzer writes on behalf of both agencies. “The IHSS program is a state and federally regulated program; Orange County implements the program in accordance with these regulations. As a result, we collaborate with our sister counties in order to communicate with the state the need for additional funding in order to be compensatory with program growth.”

Until then, a simple truism remains. “They can’t find providers who are willing to do the job,” Harrison says. “South County seniors are suffering.”

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The battle between public-sector unions and the Freedom Foundation finds an unlikely venue at an IHSS Advisory Committee meeting one afternoon. Sam Han, the foundation’s California director, already claims a small victory of sorts just by walking into the drab County of Orange Social Services Agency building in Santa Ana. Last year, Han’s small legion of canvassers tried distributing fliers urging home-care providers on their way to orientation to pass on joining the union. When UDW officers became aware of the situation, they confronted the canvassers; county counsel responded by banishing canvassers to the public sidewalk.

Those contentious fliers rest next to agenda packets for committee members and guests to pick up. Han is first up on the agenda and briefs the group on the history of the Freedom Foundation’s efforts to inform home-care providers in OC of their ability to opt out of union membership.

A promised showdown with UDW never materializes. Instead, Han faces his fiercest criticism from Kristine Loomis, a visiting Riverside County IHSS Advisory Committee member. Loomis brought her power wheelchair to a standing position while addressing Han, who spun around in his seat to listen attentively. “I was disabled in midlife, and when that happened, there was no union representation for IHSS,” Loomis says. “I haven’t heard you say anything about what your organization does to protect us. I lived through years when the government would have decimated IHSS. It really was the union that stopped that from happening.”

Han trots a statistic of $90 million in statewide annual dues collected by IHSS provider unions in response. “For what purpose?” he asks. “To lobby the government for increased benefits and wages.”

“But that’s very important,” Loomis responds with an amused chuckle. “We need that.”

A 30-year-old Korean-American whose father is a pastor at Grace Ministries in Fullerton, Han joined the Freedom Foundation in 2017, a year after it set up shop in Tustin and immediately targeted UDW. “The IHSS workers themselves are taking care of their mother, father and son,” Han says. “It’s a lot of work. They’re not getting compensated for the full amount that they’re working. That’s the point, right?”

For Han, putting more money in home-care providers’ pockets doesn’t come by way of collective bargaining, but rather by opting out of union membership and its dues. “I help them get $50 a month,” he says. “That’s the greatest job in the world.”

The Freedom Foundation’s legal arm also finds home-care providers like Garden Grove’s Marie DaRe who claim UDW fraudulently signed them up. DaRe’s favorable settlement in the case inspired an onslaught of new lawsuits against IHSS unions.

Of course, legal battles and activism also undercut the union’s political influence in California—one loyal to the Democratic Party. “You can’t do any advancement on these Left Coast states without dealing with the union issue and their stranglehold on the legislative process,” Han says. “The only way to loosen that grip is to go after their money. It’s actually taxpayer money, which I think is absolutely ridiculous.”

The Freedom Foundation’s crusade against public-sector unions got a big boost from the Supreme Court’s Harris v. Quinn ruling in 2014. The majority opinion held that home-care providers in Illinois weren’t “full-fledged public employees” and couldn’t be compelled to join a union as a condition of their employment. The Freedom Foundation tried to take that message into IHSS orientations in Santa Ana, but the county rebuffed Han’s request for five minutes’ time. The nonprofit responded by pushing for the county to change orientation language concerning union membership. In January, the Board of Supervisors discussed the matter during a closed session under the perceived threat of litigation.

County counsel literally flipped the script. In the past, if providers asked about the union presentation during orientation, officials noted it wasn’t mandatory but encouraged workers to attend. Regarding membership? “Optional, not mandatory.” Now, without any prompting, the script emphasizes opt-out rights and no longer encourages providers to attend union orientation.

The union accuses the county of collusion with the Freedom Foundation and filed a ULP with the Public Employment Relations Board. “They created a specter and used the language verbatim,” Harrison says. Within two days of that closed session, Han released a statement saying they won. “I’m wondering if any other third-party group can just send an email to county supervisor staff and get that level of cooperation.”

Han denies any notion of collusion. The group is now pretty much done with IHSS in OC after reaching out to about 700 workers. It’s also emboldened by this summer’s Supreme Court decision in the Janus case, which holds that nonunion workers can’t be forced to pay fees to public-sector unions. “It’s almost like this prophetic journey,” he says, bringing his hands slowly together. “We’re coming into alignment with history.”

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Demetria Watkins sits in her wheelchair in her La Habra living room. Unlike most IHSS recipients, she doesn’t have a home-care provider who’s a relative, a fact that often exposes her to the program’s shortcomings. Having lived with disabilities since the age of 33, Watkins was independent for years before her health conditions worsened in 2012. She spent the next three years between St. Jude Medical Center and nursing homes.

“I got to the state that I’m in right now, where I need people to do things for me that I can’t do on my own,” she says. “I didn’t want to be in the nursing homes anymore. I felt that if I didn’t come home, if I just stayed there, I’d die.” The 56-year-old, who suffers from severe rheumatoid arthritis, neuropathies, fibromyalgia and Charcot-Marie-Tooth, wasn’t given much of a chance to live—30 percent to be exact.

After learning about IHSS while at a nursing home, Watkins started hiring home-care providers through private job websites. The program seemed like a godsend at first, but it was also a crash course for all involved. It took two or so months for Watkins to be officially entered in IHSS as a recipient. When that happened, the home-care provider she hired went through IHSS orientation and agreed to endure six weeks of work during enrollment before getting retro pay—a common lapse the county is trying to shorten. “IHSS Public Authority is carefully considering ways to speed up the provider-enrollment process to ensure providers are paid in a timely manner,” Turtzer writes. “While enrollment of new providers has taken up to six weeks in the past, recent process enhancements have sped up enrollment in as short as three weeks.”

Either way, Watkins never stops looking for home-care providers. She’s working with Shah and the Dayle McIntosh Center to find consistent coverage. “We spent 50 years trying to get out of institutions and state hospitals,” Shah says. “I think people like Watkins and other consumers who have complex medical challenges or disabilities, if they don’t get the care they need, there’s no other choice than to go into institutionalized settings.”

Public Authority told Watkins on more than one occasion that there’s a difficulty in placing people in North OC. “People don’t understand how that feels, being a disabled person dependent on someone to come,” Watkins says. For the first three months of the year, she mostly had no IHSS providers. Being unable to afford private care on her Social Security Disability Insurance, Watkins resorted to racking up $4,000 on her credit cards to get such help. “I don’t know how I’m going to pay it,” she says. “From January to March, I had nobody, so I was using agencies.”

Only 18 percent of IHSS workers in OC aren’t related to their clients. When people such as Watkins can’t find help, the experience is as frustrating as it is isolating. On occasion, Watkins is left to her own devices without any assistance for things such as meal prep. Because of her limited mobility, it takes an extraordinary amount of effort just to get to a box of crackers or a bag of popcorn on her own and call it dinner.

In a letter to Quirk-Silva after her roundtable, Shah called the shortage of IHSS home-care providers willing to work for minimum wage the program’s “greatest obstacle.” The need for providers continues to increase, with a recipient pool expected to grow 6 percent to 8 percent by year’s end. As of late June, the Public Authority registry caseload count showed 691 providers for 1,733 recipients with identified disabilities, a number Shah says is hindered by the stigma of self-identification. “We need to grow the provider pool,” he adds. “I know all too well the trials and tribulations people go through in obtaining quality care.”

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Taloa abides by a simple adage: love heals. The home-care provider knows it to be true after first taking care of her elderly grandmother and now her older sister. Taloa’s grandmother survived six strokes but suffered from a multitude of maladies—severe diabetes, blindness, paralysis and Alzheimer’s disease—while living out what were thought to be her last days in a nursing home. “We took her out against medical advice, and they said she’d be dead in three to six weeks,” Taloa says. “She lived six years after that.”

The experience came during Taloa’s first foray into home-care almost a decade ago in 2009. She previously worked as an AT&T customer-service representative, making $33 per hour. Afterward, through IHSS, she started as a home-care provider with an hourly wage of $9.30 for 80 hours of approved work per month. “It was very, very difficult, but at that time, I was married, so it wasn’t as difficult, financially, as it is now,” she says.

At first, Taloa’s grandmother wallowed in depression, but her morale improved once she was at home with family. However, being a home-care provider was taking a toll on Taloa, who recalls one day crying outside her home, feeling hopeless. She didn’t want to put her grandmother back into a nursing home, but she felt burned out and isolated. “I was at my worst,” Taloa says. At that moment, a UDW organizer visited in hopes of signing her up, which she did. Before that, Taloa described herself as “anti-union 100 percent,” just the kind of worker the Freedom Foundation now craves.

“Once they got the maximum 283 hours a month for me, I was able to have two other care providers come,” Taloa says. “I was able to give my grandmother around-the-clock care.”

A year before her grandmother passed away in 2013, Taloa took Ginn out of her nursing home. She’s another medical miracle, having survived two “code blue” hospital emergencies. The last time, Ginn spent eight weeks in a coma. Taloa lists off numerous daily tasks she performs in caring for her sister.

Suddenly, Ginn grasps her hand. “I love my sister, and I know that she wouldn’t ever let anything happen to me,” Ginn says. “At the nursing home, I’d feel like I was being abused and neglected.”

The sisters turn toward each other and share a loving gaze. “I’m hoping that the perception of the people who are leading this county will change about home-care providers,” Taloa says. “Without a shadow of a doubt, IHSS is a source for saving lives.”

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