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The titles are virtually identical: home health aide and home health attendant. And so are some of their tasks; both groups help the city’s elderly and chronically ill with bathing, preparing food and taking medications. But, as any aide will tell you, there is one major difference: Because aides do not contract with the city, they lack the standardized wages and benefits of attendants.

At an April 15 rally, roughly 5,000 of the city’s home health aides, almost all black and Hispanic women, gathered at the Midtown Hilton Hotel and voted to approve a possible strike. Wearing T-shirts emblazoned with “Invisible No More,” the name of their campaign, the caretakers watched as a parade of politicians, including City Council Speaker Gifford Miller, took to the podium to pledge support for the group’s efforts to pressure their agencies to increase wages by reducing administrative costs.

Though aides and attendants have similar duties, aides also perform simple medical tasks, such as monitoring blood pressure and dressing wounds, which requires additional training and separate certification. “We take care of sick people, but when we get sick we have nothing to fall back on,” said Joyce Bryant, 53, who earns about $8 an hour working for Alliance for Health, a Brooklyn agency. Many agencies do not provide health insurance.

The proposed walkout is part of a campaign by the home care division of the Service Employee International Union local 1199, which represents 23,000 home health aides like Bryant, to force agencies across the five boroughs to raise wages to $10 an hour by 2006. Workers are also asking for paid sick and vacation days.

Home health attendants work for agencies that contract with the Human Resources Administration, and are thus covered by the city’s living wage legislation. But home health aides have no such luck. Because their agencies don’t hold contracts with the city, they currently earn close to $7 an hour, while attendants earn about $9.

Despite the wage disparity, some aides say they prefer their work to that of an attendant because of the additional duties involved. Typically, aides care for clients that are more medically fragile than those served by attendants, though both groups are considered indispensable to ailing and elderly New Yorkers.

“This piece of health care industry cross-subsidizes other aspects of the health care industry,” said Kevin Finnegan, assistant director of SEIU New York State Council. Hospitals reduce costs when patients recover at home, he said.

If a strike occurs, some agencies would likely try to shuffle available aides to clients most in need, said Michael Elsas, the president of Cooperative Home Care Associates, an agency in the Mott Haven section of the Bronx. Other clients would have to depend on family members and neighbors.

In cases where family members live far from their loved ones who depend on aides, the looming strike is particularly unsettling. Duane Balfield of Philadelphia, worries about his sister. Paralyzed, she lives in Manhattan and depends on home care 24 hours a day. “If they strike,” Balfield wonders, “what’s going to happen to my sister?”

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