We are the ILWU: Local 1000 Home Healthcare Operators, Hawai’i

The ILWU’s newest local, Local 1000 Home Health Care Operators, was chartered in September of 2022 and currently represents approximately 125 members in the State of Hawai’i. These workers operate independent home care facilities that provide housing, meals, care, and supervision for disabled and elderly patients who do not have family to care for them and cannot afford to pay out of pocket for a care facility. Funding for the patients is provided by the government through federal and state funds.

The workers who operate these facilities and performs this important but underpaid care work are largely Filipina immigrants. A group of them decided to unionize with the ILWU so they can more effectively fight for fair compensation for the care they provide. They also want a stronger voice with state legislators to help improve industry regulations to benefit both patients and operators and reduce red tape such as ensuring that licensing of facilities occurs in a timely manner.

Local 1000 members told the Dispatcher that they currently receive approximately $1442 per month, per patient. That includes room and board, care, and supervision. Compare this to the market rate for this kind of care: Patients who pay out of pocket at care facilities pay between $5,000 to $6,000 per month, said Local 1000 member Rosemarie Sebastian.

The organizing effort has been spearheaded by the ILWU International, Hawaii staff led by International Vice President (Hawai’i) Sam Kreutz, and organizers Will Chang and Mathew Yamamoto. Vice President Kreutz said that the organizing effort for home healthcare operators is just getting started. “These operators perform important care work for poor and working-class elderly and disabled people in our state. Local 1000 will allow them to have a greater voice in Hawai’i, so legislators can understand their needs so that patients get the best care possible.”

Rosemarie Sebastian, Local 1000 Treasurer

I’m a primary caregiver at our care home. I inherited it from my mother-in-law. I’ve been in this industry for nearly 30 years. There are many levels of caregiving and different types of care homes. We run a Type I ARCH (Adult Residential Care Home). We can care for up to five patients. I care for ambulatory patients, meaning they are walking, and they’re able to do their ADLs (Activities of Daily Living). I get paid by the state. Most of the people that I care for are disabled. I take care of the elderly sometimes, but technically, my patients are disabled individuals. They are not necessarily old. My youngest patient is 56; the oldest is 75.

There are challenges, but it is rewarding. I can understand why my mother-in-law did this business for 48 years before she retired. I saw how compassionate she was in caring for people. These are homeless people. They don’t have families that can take care of them. They’re sick. They have no one. We have a home that we can share with them. We are motivated by compassion, but it’s also a job.

It gives me a lot of flexibility. I was able to care for my children. That’s the kind of flexibility I like. My mother-in-law is also getting old, and so is my father-in-law. This will also allow me to care for them at the same time. I would not be able to do that if I worked outside the home. Is it fulfilling for me? Yes. Is it rewarding? Yes, I like helping people. The people become like your family, you know, after a while, and I like that.

I was a substitute for my mother-in-law for a long time. I observed, and I learned the business. There are so many crazy, unnecessary redundancies in our paperwork. I learned that there are so many regulations that don’t make any sense. When I asked questions, someone at the Department of Health told me, it was either I comply with the laws, or not do the business at all. I thought that was so wrong. That was so disrespectful to our industry. I understand why they have all these laws, regulations, and oversight. But no one is listening to the concerns of the caregivers.

I used to work for a construction business, and while I was in the construction industry for about 13 years, and so then I realized, oh my golly, this is what we need. Now I have joined the union. Let’s do it. It was a no-brainer.

I work so hard to care for patients. I realized that I was only making 23 cents per hour, calculating 24/7, 365 days a year. It’s true that I work only to support them during the day, but my patients are to be protected, under my supervision 24 hours a day. So there’s a lot of unfairness, I would say. Can the state afford to pay us more? Of course. They just have to figure out what is important.

There are a lot of clients for Type I ARCH. A majority of Type I ARCH caregivers are baby boomers. They are all going to retire soon. What do you think will happen to their patients? They will go back to being homeless; they will go to a boarding house when that’s not the right home for them. The government should do something to motivate younger people, especially the people who are the majority in this business–Filipino nurses, and LPNs. CNAs. The state should give them incentives to go get their licenses to run these facilities. The Health Department could do better processing applications faster. I don’t know why they are taking forever. They are talking about shortages and lack of capacity, but are they doing something about it?

You know, we can’t even go on vacation because we have a hard time hiring people to come and substitute for us. CNAs can go work at the homes of people who are rich and can afford to pay them $25 per hour or more. With my $1,400 per person, I can’t afford that. So we don’t even have vacations. We don’t have medical insurance. We just get the $1,442.90 per client.

We are happy to take care of these patients because that’s what we decide to do as our job. But I feel like I am a charity to the government. Do we need a union? Yes, we do. And I’m all for it. I encourage everyone to join this union. And hopefully, a lot of the other Filipinos in our industry will see that now.

Esther Pascual

I am a home care operator. Before we can become an operator, we have to go through training as mandated by the Department of Health and then pass an inspection before we can open our care home. We are licensed by, and under the supervision of, the Hawai’i Department of Health, and we are ruled by many regulations.

I’ve been in doing this for a little over 50 years. So why a union? Since nobody in the state is advocating for us, we have to advocate for ourselves. We are looking for someone with a heart to help home operators. When we have a resident in our home that are Medicaid patients, they are a ward of the state. They are what we call a Level One patient. They can be on their own independently, but we have to supervise their medications, and doctor’s appointments, and transport them to the doctors. We feed them. We have the burden of care even though they are independent. The rate we are paid is $1,442.90, per month which includes housing, meals, and utilities, So to us right now, in this kind of economy that we have, we believe that we receive the right. compensation. We have 24 hours responsibility for patients. For many years we have been going back and forth to the Capitol to testify and asking for increased pay. We need to have a strong voice. What we’re lacking is people who can help us. Now we found this union. I’m just hoping that we can be successful this time with the help of the ILWU.

When it comes to hearing, why haven’t we all been able to come together to support what is supposed to be good for our industry? Because the state only notifies us about hearings maybe a day or two in advance. We cannot leave our homes without a substitute who has proper training and who is qualified to handle the patients in our homes. If we cannot get anybody to substitute for us, then we cannot go to the state capitol for the hearings. That’s why there are not many of us at the state capitol to testify. How we can all get together on the same day and at the same time? A big problem for operators is finding substitutes and having the money to pay them so we can testify.

Our industry is a really big help to the state. We’re saving them millions of dollars every year. If they put these patients in a facility like a hospital or nursing home, it would cost the state $5,000 or more depending on the level of care. 

Jesusa “Susan” Quinapu,
Local 1000 President

I started in the care home industry 27 years ago. There are problems that we have had for many years. Number one was that care home operators did not have medical insurance for themselves. There was an organization that tried knocking at the doors of the medical insurance providers in Hawai’i, asking if we could receive medical insurance. Somehow nobody opened the doors for us; that was 28 years ago. Secondly, we don’t get raises. The last time we had a raise, it was only $8 a month per patient. Somehow, it’s so hard to get a raise. Third, the Department of Health was giving us a hard time on policies. It would take five or six years to license a facility.

The other problem that we have is liability insurance. Agents give different kinds of rates for premiums. That’s why caregivers now are grouped into different organizations based on getting the cheapest professional liability insurance rates.

Now I’m confident we can have medical insurance. I’m confident that we can have professional liability insurance for everyone. I’m confident that with the ILWU name, the State Department of Health, will have more respect for the caregivers. Because right now nobody cares. That’s how I feel.

I went to a private high school Catholic high school back in the Philippines. Before class, I would stop at the church, and I would say, “Lord, when I get older, I want to be a nurse. I want to take care of people. I want to take care of the elderly. I want to help out the sick.” When I came to America, I became a nurse. First I became a surgical assistant. After I passed my boards, I became a surgical nurse. But my daughter was very ill. Because my daughter was so sick, I had to find a job where I could stay home and take care of my children. That’s how I started.

But let me tell you how rewarding it is. My patients are Alzheimers and dementia patients. Even though they are not related to you, you feel the love. It’s something that money cannot buy. It’s very rewarding somehow. They can stay a long time in my home. Sixteen years was the longest. For most of them, it is around seven to nine years. They stay with me. Some will pass away in my home. We’re just like a family. I don’t know if that’s my calling, but I enjoy what I’m doing. There are times when I miss going to work. I don’t have the adrenaline rush like when you’re in the O.R. I still miss that. But you know, I love my patients.

What I learned through the years as a caregiver is that you have to take care of your children and you have to give them the emotions and nurturing of how you want them to be, because they are the ones who are going to take care of you, be it financially, be it physically, or be it mentally.

I had a patient with five children. Only one kid visited during the six years that he stayed with me. You know, there are different kinds of love. I want to be the one who nurtures my children, who takes care of my children, so when I get old, they will take care of me too.