Two years after their contentious battle to form a union, home-health workers have begun contract negotiations that are likely to center on Minnesota's chronic and worsening shortage of people willing to care for the state's most vulnerable and frail residents.

Clutching banners that read, "Fix the Homecare Crisis," activists with the union representing some 20,000 home care workers converged on the State Capitol this week, calling for major improvements in a state-funded program that helps nearly 30,000 residents who are elderly or disabled live in their own homes.

The negotiations that began Friday are expected to focus on improving wages and working conditions in a profession that typically pays just $10 to $13 an hour, often with few benefits. Such improvements could cost state taxpayers tens of millions of dollars annually, but the shortage of home health workers has reached emergency proportions across the state, as home care aides jump to better-paying and more permanent positions in nursing homes, hospitals and other facilities.

"The pool of people willing to do this kind of work has shrunk dramatically," said Oriane Casale, a labor market analyst with the Minnesota Department of Employment and Economic Development.

The shortage has put unprecedented strain on people with chronic illnesses and severe disabilities.

People who were accustomed to getting round-the-clock care for basic tasks, such as bathing and dressing, are now going days without assistance. The gaps in care have threatened patient health and left more people isolated in their own homes and apartments, workers and their clients note.

With job vacancies near a 10-year high, caregivers are migrating toward wealthier, private-pay clients who typically pay more for less-intensive care, say agency owners. Clients who require more demanding care, such as regular lifting or help administering a feeding tube, say their ads for help on online job boards often go unanswered.

"People can afford to cherry-pick the easy clients and ignore those of us who really need help," said Linda Wolford, 53, of Roseville, who has a spinal muscular disability that severely limits her mobility.

Kim Higgins, 52, who has quadriplegia from a spinal cord injury she suffered 30 years ago, said her life was "thrown into turmoil" following the sudden departure a year-and-a-half ago of one of her longtime caregivers, who left for a better-paying job and more regular hours.

Most weekends, Higgins no longer has someone who can lift her out of bed and help her shower each morning. As a result, she can no longer venture out on weekends and is instead confined to her bed from Friday evening until Monday morning.

Without regular daily movement, Higgins says, the muscles in her neck, shoulders and arms tighten up and atrophy. Weekends used to be a social time for Higgins, with family and friends stopping by her apartment and trips on her wheelchair to the park near her apartment in Hopkins. Now, she has stopped accepting visitors because she does not want people to see her bedridden, unbathed and depressed.

"I consider myself a strong and independent person, but the past year has been really, really tough, both physically and emotionally," Higgins said.

Poverty wages

Home care workers have long complained privately of low wages and limited benefits for work that is typically part time and can be highly sporadic. Nationally, about 1 in 4 home care workers live below the federal poverty line, and over half rely on some form of public assistance, according to a recent analysis by PHI, a nonprofit research and consulting group. In Minnesota, nearly two-thirds of home care aides are part-time and are paid a median hourly wage of $10.89 — slightly more than janitors and restaurant cooks, state labor market data shows.

SEIU Healthcare Minnesota, which is demanding a $15 wage and expanded training for home care aides, this spring called on the Legislature to increase Medicaid funding to cover the cost of overtime for home care workers. Several other states have already taken the step, responding to new federal regulations mandating overtime pay protections for in-home workers. The request went nowhere.

The shortage of home health workers has been compounded by a strong rebound in Minnesota's labor market. In the Twin Cities, home care workers are in such high demand that some agencies are offering $500 sign-on and referral bonuses.

"The bonuses are nice, but they don't go nearly far enough," Casale said. "There are simply not enough people who are willing to take these jobs at such low wages and with these kinds of working conditions."

'I really love Scott'

Jasmine Laducer-Kitto, a 31-year-old caregiver from New Brighton, is among those considering a new career. For the past 11 years, she has provided regular care for a Roseville man, Scott Semo, who is unable to bathe, dress or move on his own after suffering a major brain hemorrhage. Each day, Laducer-Kitto does a range of critical tasks, such as deep-suctioning a breathing tube and physical therapy, that once were performed only in hospitals or nursing homes.

But Laducer-Kitto says she can no longer support her family on a $12.65 hourly wage, no benefits and intermittent work. Her last paycheck of $394 was too small to pay the rent or to buy new school uniforms for her daughters, ages 5 and 10, who each have just one pair of pants. She worries about the coming winter months and whether she will be able to afford jackets and boots for her growing daughters.

"I really love Scott, and it scares me to leave, but it's time to move on," she said. "I have to be able to support my girls."

Delores Flynn, 72, who is Scott's mother, said she understands why Laducer-Kitto is looking for better-paying work, though she fears the day she leaves. The last time Scott went temporarily without a caregiver, not a single person responded to their online ads for help, forcing his elderly parents to do consecutive, back-to-back shifts for weeks at a time, she said.

"You know, people will never stop being disabled. They will never stop getting old. They will never stop needing care," Laducer-Kitto said one day this week as she helped Scott into a walker. "The least we can do is show them some respect."

Chris Serres • 612-673-4308