Paying fair

The state's patchwork system of services for children, the mentally ill, the retarded, and
the elderly is collapsing. The first step toward fixing it is giving care workers a living wage.

By Kristen Lombardi

NO ONE DENIES that proponents of a living-wage bill for human-service workers are in for a tough, even grueling, legislative fight. Some hold out little hope that the measure will actually make it through the state legislature. But those familiar with the patchwork of agencies serving children, the poor, the elderly, the mentally ill, and the mentally retarded in Massachusetts say the system is collapsing, and that the bill is the first step toward fixing it.

The legislation, newly filed after dying in committee during the last legislative session, would ensure a "living wage" for some 60,000 human-service workers at private agencies that contract with the state -- that is, a wage equal to what a family of four in Massachusetts must earn to pay for rent, utilities, food, and clothing. The figure works out to $11.89 per hour if the job pays for health insurance, $12.89 if workers must buy their own coverage. If the bill were to pass, it would raise wages of some 20,000 employees who work at more than 450 agencies that take in at least 25 percent of their funding from state grants for human-service programs. Child-care workers, home-health aides, direct-care workers for the mentally ill and mentally retarded -- virtually everyone in the human-service workforce would be affected.

No one suggests that the bill is cheap. It could cost taxpayers as much as $98 million -- just $2 million less than the state has offered the Boston Red Sox for a new baseball stadium. Unlike the ballpark, though, the living-wage act would not be a one-time deal. This legislation, if it were to pass, would require the state to include enough money in the budget every year to pay human-service workers at least $24,731 a year - though that figure could fluctuate as the poverty line is ajusted. Right now, the median wage of human-service workers is $21,610, according to the state Department of Employment and Training. (Compare that with the average annual pay in Massachusetts -- $43,206, up from $23,098 in 1988.)

Since the state began privatizing its human-service programs in 1990, workers who are employed at private agencies yet paid with state funds have received only three pay raises, totaling six percent -- even though the cost of living has risen 28 percent during the same period. Today, privatized employees earn as much as 40 percent less than their state-employed counterparts. Workers, in short, have subsidized the cost of privatization.

It's true that since 1997 the state has tried to address the disparity, allocating nearly $100 million to a salary-reserve fund to boost incomes in the field. But by the time that money reaches the pockets of workers statewide, it doesn't even amount to chump change. This past year, for example, human-service workers received 23 cents more in their weekly paychecks. That isn't enough to make a local call at a pay phone. Or to buy a stamp, or a pack of gum.

THERE ARE consequences to not paying privatized workers a living wage. Turnover among veteran employees is at an unparalleled 60 percent. The average worker stays on the job for just nine months. Vacancy rates at agencies statewide hover around 30 percent. Right now, clinics are finding it so difficult to attract qualified employees that they're recruiting in such far-flung places as Puerto Rico, France, and Germany.

Scott Bock, who directs the Dedham-based Riverside Community Care, which serves mentally ill and mentally retarded people at some 50 sites around Boston, is so desperate to fill empty positions that members of his staff have traveled as far as Canada to scout potential employees. After screening and interviewing 15 Canadians last month, Bock ended up hiring only one. He wanted to hire more, but the rest couldn't afford to live in Boston at the current wage level. "We're not a very attractive industry," Bock says. He recognizes that recruitment may be hard for any industry when the general unemployment rate is at a record low, but he says that human-service providers have it doubly tough: "We cannot attract people with the kind of money that's on the table."

Ultimately, it's clients who are hurt most by low wages, which lead to high turnover and understaffing. After all, human services center on caregiver/client relationships. But constant staff turnover can leave clients reluctant to form bonds.

No one knows the value of a qualified and committed worker better than Katie Eves of the National Alliance for the Mentally Ill, or NAMI/Mass. The Westford mother watched her mentally ill son, Jason, sink further and further into severe depression after he moved to Northampton and had to sever ties with his case manager. In many ways, Eves says, his case manager acted as an adult caretaker. She ensured that he kept his therapy appointments, that he took his medication, that he handled life's surprises with ease. Jason, Eves says, "really liked and trusted his case manager. . . . He thought of her as his friend." Because of understaffing, though, Jason spent months on a state list waiting for another one. At times, he'd call up his former case manager. Eventually, his illness overwhelmed him; two years ago, he committed suicide at age 26.

The loss of her son has left Eves convinced that the staffing problem in the field can make quality care impossible. "People who have a mental illness are fragile," she says, "and little things could tip them over." She adds, "Families are very concerned about the turnover because it can disrupt the road to recovery."

NOTHING ILLUSTRATES the direness of the situation more clearly than the fact that client- and provider-advocacy groups have joined the living-wage campaign. For the first time, organizations like NAMI/Mass and ARC Massachusetts (formerly the Association for Retarded Citizens) are aggressively advocating on behalf of the human-service workers who care for their family members. Trade associations, too, such as the Mental Health and Substance Abuse Corporations of Massachusetts, which represents 114 such agencies statewide, have taken the unusual step of making employee salaries the number-one lobbying item. Elizabeth Funk, the MHSACM's president, says that she's "pleased" whenever she sees the list of people behind the living-wage legislation. "What's interesting," she explains, "is that the problem has become so blatantly obvious that those who aren't normally front-and-center are now front-and-center."

Taking a longer view, the living-wage campaign -- specifically, the newly forged connections between workers, providers, and clients -- could pave the way for lasting gains in a field where poor wages are just one sign of deep problems. After more than 10 years of static and under-funded budgets, the complex system of caring for the state's most vulnerable citizens is collapsing. It took a lawsuit in federal court to get the state to agree to eliminate the years-long waiting list for services at the Department of Mental Retardation; it will cost $114 million over five years to deal with the 2000 families still waiting for housing services. The Department of Mental Health has a similar waiting list for basic services that hovers at around 16,000 -- and this doesn't include the 3000 adults waiting for residential placement. Providing these services alone would require as much as $300 million. Or consider that providers have been forced to skim staffing budgets to cover 50 percent increases in utility expenses this year -- increases that aren't figured into state contracts. Covering this shortfall would cost another $45.7 million.

In many ways, these complicated problems cannot be fixed without first addressing workers' wages. For if the industry cannot attract and retain people, it cannot expand and improve programs. What the living-wage campaign signifies is the start of a much-needed coalition to push for long-term solutions. Says Rick Colbath-Hess of the union Mass Serve, which is spearheading the effort: "If we can cement the bonds between [industry] players and succeed in this campaign, we could dramatically change the types of resources [that] are directed toward human services."

WAGES HAVE been so low for human-service workers over the past decade that the population on the frontlines is changing. Positions that used to be filled by people with college degrees are now filled by those with high-school diplomas -- who are willing to work for less money. "The field is taking in less educated people," says Carol Phillips, a 20-year veteran who works at a group home in Methuen. It's become routine to find workers who aren't familiar with basic practices, such as how to lead a blind person. Or who don't understand that a disabled person may butt a worker's head to get attention, rather than as an act of violence. Direct-care workers must be skilled in safe restraints; they must teach skills; they must know emergency first aid. "The way the situation is now," Phillips says, "providers have to spend more money on training workers, which takes away from clients."

The experiences of long-time human-service workers like Christine Hamel are becoming more and more common. After 15 years as a direct-care worker with the mentally ill, the mentally retarded, and substance abusers, Hamel has yet to earn a living wage. With a bachelor's degree in education, she makes only $20,000 a year. "Experience doesn't matter in human services," she explains, "because we're funded by government contracts."

These days, Hamel cannot recall a more unstable time for her profession. Poor wages have created an ever-revolving door at the Holyoke group home where she helps alcoholics and drug addicts try to piece together their lives. On any given day, she can be found with any one of 25 clients, administering medication, teaching life skills, and shuttling them to the corner store. It's labor-intensive work, yet the draining nature of serving addicts isn't what drives Hamel's colleagues away. She has watched fellow employees resign in tears because they couldn't afford to repair their cars and pay rent on their meager salaries. Last year, while working at a program for the mentally ill, she saw so many co-workers come and go that she became the most senior staff member after just 12 months on the job. Hamel ended up leaving the program as well, but only because her night-shift schedule prevented her from spending time with her husband, who works days.

"Nobody initially looks at this [field] as a stepping stone," she says, "but people have to decide whether to make ends meet or move on."

Hamel survives by juggling several jobs -- and she's not alone. "There isn't a human-service worker I know who doesn't hold two jobs," she says. All 10 of her co-workers moonlight on the side. She even has a friend who cares for the mentally ill by day and drives a tow truck by night. And, she says, "there is an incredibly high burnout rate among human-service workers who do stay."

Though Hamel knows she could make more money doing something else -- or the same amount minus the stress by flipping hamburgers at Burger King -- she cannot imagine quitting. "I do it for the clients," she says. "All the little victories you see them have keep you going."

THE HUMAN-SERVICE industry hasn't always united around one cause. When it comes to advocating for the profession, worker, provider, and client groups have often pursued similar yet separate agendas. The wage issue has traditionally fallen under the domain of employee unions. Providers, on the other hand, have lobbied hard to boost agency contracts overall. Meanwhile, advocates have appealed to legislators for better services.

Surmounting these differences has been a slow process. Carol Beard of the Greater Boston ARC admits that families have just begun to realize the importance of speaking out on behalf of those caring for their loved ones. "It's taken families time to see that we need to stand up for workers," she explains. Providers, too, have had to warm up to the idea of advocating for employees first. In fact, organizers behind the living-wage campaign have spent nearly two years trying to build the coalition that exists today -- and it's not nearly as large as they had originally planned.

If these groups are reaching out to each other now, they're doing so out of political necessity. After years of fighting for human-service programs on Beacon Hill, Steve Collins, who heads the Massachusetts Human Services Coalition, has learned that legislators like nothing more than a divided advocacy community. Agencies that tout their own agendas can be dismissed as self-serving. Workers who lack management support can be faulted and ignored. As for advocates, he says, "If it's just us bleeding hearts, it's the goo-goo liberals wanting more money again."

Colbath-Hess puts it more bluntly: "The only way to get anywhere politically is for the three constituencies to work together."

A united front may be needed now more than ever. No matter how appropriate and essential the living-wage legislation may seem, it is a money bill -- and one that could come at the worst possible time. Signs of an impending economic downturn have become all too apparent. The drop in tax revenues by 1.6 percent, or $23 million, between December 1999 and December 2000 marks only the latest indication that the red-hot Massachusetts economy is slowing -- or worse (see "Prosperity's Thin Veneer," News and Features, December 1, 2000).

A slower economy, of course, means a smaller reservoir of funds subject to state taxation -- which, in turn, diminishes the likelihood that legislators will embrace the notion of spending millions of dollars on a living-wage bill. Even when the economy was in full swing, the climate on Beacon Hill appeared hostile to human-service workers' needs. No sooner had the 1999 legislation been filed than it was banished to the Labor and Commerce Committee for further study. "This bill failed once because of its enormous cost," says Clif Cohen, an organizer with Service Employees International Union Local 509, "and that's still its biggest hurdle."

The hurdle has been made far higher by the budget cuts that will probably be needed to make possible the rollback in state income taxes that Massachusetts residents voted for last November. This fiscal year alone, legislators must draft a state budget that uses $450 million less in revenues to accommodate the first phase of the tax cut. All told, in the next three years, $1.2 billion in state monies will be lost because of the rollback. Governor Paul Cellucci has claimed that this will not jeopardize the state's current spending on social services, education, and health care. But the political climate on Beacon Hill has become downright frigid when it comes to new appropriations. House and Senate leaders already expect to approve only a handful of funding increases. "Legislators have made it clear that they don't want to hear a thing about expanding services," Collins says. Although a living wage would simply stabilize the existing system, he adds, "they could just say, `Workers are very deserving, but our hands are tied.' "

This isn't to say that the living-wage campaign is doomed, however. This time, it boasts a bigger, more inclusive group of backers. Even organizations that stand to gain nothing from the proposed legislation, such as the Massachusetts Lawyers Guild, the United Brotherhood of Carpenters, and Eviction Free Zone, have signed on to the effort. The coalition is also making more noise these days. Last month, as many as 100 workers, providers, and client advocates showed up at the State House for a December 4 lobby day, during which the living-wage campaign was officially unveiled. Several weeks later, on December 21, many of them appeared again, demanding more money for wages at a budget hearing held by the state Executive Office of Health and Human Services.

And the case for establishing a living wage has resonated on Beacon Hill. Right now, as many as 60 state representatives -- or half the House -- have joined the legislation's main sponsor, Jarrett Barrios (D-Cambridge), and signed on as co-sponsors. It isn't surprising that more and more legislators are responding. Of the myriad problems facing the human-service system, the wage issue is probably the easiest for legislators to wrap their arms around. As Bock of Riverside Community Care explains, "Legislators understand best that low-paid staff are really poorly paid, and that something needs to be done about it."

The whole concept of a living wage has already entered the political discourse; 50 or so municipal ordinances have sprung up in states including Michigan, Maryland, and California. In Massachusetts, Boston has raised its hourly minimum to $7.49. Cambridge now requires city contractors to pay their employees a $10-per-hour minimum. And students and unions continue to pressure Harvard University to boost its minimum wage from $6.50 to $10 an hour, plus health insurance.

Those behind the human-service effort hope to capitalize on such high-profile campaigns. "We're trying to extend the concept of [these] laws," Colbath-Hess says. "Human-service workers are viewed like menial laborers, as if the work they do isn't important."

In the end, though, the engine that's driving this campaign is the crisis in the field itself -- a crisis that's sure to persist if workers' wages go unchanged. As Colbath-Hess says, "Everyone wants the best care, but they don't necessarily see that it will take an upgrading of salaries to make it happen." But this newfound coalition, he vows, "isn't going away until they do."

Whether the living-wage campaign will amount to anything more than a symbolic gesture remains to be seen. But if nothing else, it has already gone a long way toward rejuvenating those who work in a profession that's long been undervalued and neglected. And that, in itself, marks a lasting gain.

Kristen Lombardi can be reached at klombardi[a]phx.com.