Organizing Home Care: - School of Social Service Administration

Draft Paper Not for Citation or Quotation with Authors’ Permission 4/24/2007
service specifically in order to access Medicaid funds, since those who qualified for
Medicaid were eligible for a home attendant only under physician approval and nurse
supervision. In the early 1970s, the Department increasingly characterized the service as
medical, and in 1973 obtained federal approval for Medicaid coverage. Since Medicaid
had no spending caps and paid 50% of the cost, the City began to transfer more and more
of its elderly caseload to the Home Attendant Program. The number of publicly employed
homemakers, which peaked in 1972, dropped precipitously, as the City assigned cases to
either housekeeping or home attendant service. In 1972, eight of its vendors providing
housekeeping services were Community Development Agencies stranded by Nixon’s cut
of OEO funds. DSS, however, found their delivery “inadequate in quantity and quality,”
with 1800 complaints out of 3300 cases in 1971 alone. The Home Attendant caseload
grew 231% from about 2,000 cases to 7,000 in 1977 to 11,500 in 1978. Under additional
public funds, the labor market for vendor agencies and independent contractors
mushroomed. 88
These contracting arrangements varied tremendously. Henry St. Settlement
organized its employees to petition for higher wages, conveying their workers’ complaint
to the city in an attempt to gain greater funding. In contrast, the incompetent Morrisiana
Development Corporation delayed paying its workforce, precipitating a unionizing drive
in 1977. While the vendor agency recognized the workers, the Human Resources
Administration [the main agency within DSS] refused to bargain with them; the state
ended the effort by cutting off the contract and reassigning the workers to other
vendors. 89