Friday, May 25, 2007

For New York, Big Job Growth Is in Home Care


By PATRICK McGEEHAN
Published: May 25, 2007
New York City’s economy has been booming, with unemployment dropping to historic lows and Wall Street getting most of the credit. But the typical new worker in the city is not a pinstriped investment banker or a corporate lawyer. She is a home health aide like Vivienne P. Smith.

Ms. Smith, a recent immigrant from Jamaica, cooks for and dresses elderly patients in their Brooklyn homes. Though she is a member of a large labor union, she earns just $7.50 an hour and receives no health insurance or other benefits.

In many ways, home-care aides are the garment workers of the modern New York economy. The working conditions may be better, but the low pay, skimpy benefits and weak prospects for upward mobility tend to draw mostly immigrant women with few marketable skills.
Jobs like Ms. Smith’s, poor-paying positions in health care and social services, have accounted for most of the growth in employment in the city in the last 15 years. Indeed, without the rapid health care growth, the number of jobs in the city would have declined since 1990, according to figures compiled by the federal Bureau of Labor Statistics.

The health care and social assistance sector, which includes not only hospitals, nursing homes and doctor’s offices, but also day care centers and food banks, accounts for a growing share of jobs across the country — about 13 percent of all American jobs in 2005. But that is still a far smaller share than in some parts of New York City. In Brooklyn and the Bronx, the sector now supplies about one-third of all private-sector jobs and wages, more than double the contribution of any other industry, the bureau’s data show.

“In terms of wages, the driving force in the New York City economy has been Wall Street,” said Michael Dolfman, the regional commissioner of the Bureau of Labor Statistics. “But in terms of employment, the driving force in the city economy has been the health care and social assistance sector.”

The number of jobs in financial services has shrunk in the last 15 years, even as average pay has soared in that industry.

The relative growth of health care employment in New York and other big American cities is a result of the decline of manufacturing and the aging of the population, said Mark V. Pauly, a health-care economist at the Wharton School at the University of Pennsylvania. At the same time, personal preferences and financial considerations have fostered a shift toward caring for the frail and elderly at home instead of in institutions, Mr. Pauly said.

Many of the patients of the home-care aides now working in Brooklyn, Queens and the Bronx are retired from the factories that formed the streetscapes of those boroughs half a century ago. With many of those shuttered plants having been transformed into high-priced housing, health services are playing larger roles in the local economy.

That growing dependence on a single sector worries some economists, particularly because its fortunes are largely tied to government programs like Medicare.

“I look at that and I think it’s expanding a sweatshop form of work with very low wages, very few benefits,” said James Parrott, chief economist for the Fiscal Policy Institute, a nonprofit organization financed in part by unions, referring to the rising employment in home care.
For most of those jobs, wages are low and rising slowly. In Brooklyn’s growing health-care sector, home-care employment more than quadrupled to 12,160 jobs between 1990 and 2005, the last full year for which data was available. On average, those jobs pay $27,413 a year.

Ms. Smith, 55, said she would not be able to survive on her meager pay if she were not living with relatives. She started out working full weeks and even some overtime. But lately, her employer, Partners in Care, a subsidiary of the Visiting Nurse Service of New York, has assigned her just one four-hour shift per day, she said. That amounts to just $30 a day, before taxes and the cost of her two-bus commute across Brooklyn.

“Sometimes, my pay just goes to buying something to eat and paying my fare,” said Ms. Smith, who added that she was no better off financially than when she was working in factories in Jamaica. “When you’re small and you’re talking about going abroad, the thought of it gets you excited. Then, when you come and see for yourself, you say, ‘Oh dear, it’s just the same.’ ”

Kevin Finnegan, a lawyer for the home-care division of 1199 United Healthcare Workers East, the health care workers’ union, said home health aides were paid less in New York City than in most other parts of the country.

“I believe that is a direct result of this huge immigrant population that is willing to work for lower wages,” he said. “For the same reason, the garment industry was here.”

Mr. Finnegan, who helped the union organize the home-care aides working for Partners in Care, said that in some places upstate, home-care aides had been able to demand as much as $12 an hour. “You leave New York City and the rates go up,” he said.

But Mr. Finnegan said some relief was on the way for many of the 43,000 home-care workers who are represented by the union. The contract with Partners in Care calls for raises to as much as $10 an hour this year, he said.

Karlyne A. Mills is dubious. A veteran home-care aide who immigrated from Haiti, Ms. Mills, who has worked at the job for 13 years, is still earning $8.30 an hour almost a year after she was supposed to get a raise to $9, she said. She receives about $300 before taxes for working three 12-hour shifts a week caring for a Brooklyn woman who needs to be bathed, fed and lifted in and out of her wheelchair.

“It’s getting a little frustrating waiting because we’re working hard,” said Ms. Mills, who lives in her mother’s home in East New York. “From the time that I became a home health aide, I always wondered why this job is so important and why our pay is so low.”

But Ms. Mills, 43, said she stayed with the work because she enjoyed helping people. For the first six years, she earned just $6 an hour, she said. For most of her career, she has gone without health insurance coverage for her daughter, now a sophomore in college, or her son, a high school senior, she said.

Having to take her children to a hospital as charity cases whenever they needed to see a doctor was “very horrible,” Ms. Mills said. She would like a job that provides health insurance for her whole family, but at the moment, she said, she would settle for that raise to $10 an hour.

Jay Conolly, director of human resources for Partners in Care, said the pay raises hinged on the release by the State Legislature of an additional $100 million in funding that was recently approved. Mr. Conolly said his company wanted to keep its workers happy because “we are in a growth mode, and the demand for home care has never been stronger.”

That growth should continue for years, said Mr. Pauly of the Wharton School, unless the government sharply curtails spending on health care.

“People who want to get control of health care spending should be careful what they wish for,” Mr. Pauly said. “Spending less on health care would actually be harmful to the local economy because it’s a good source of jobs.”

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