Twice a day, Irma Nuñez drives her old blue Toyota to the home of a quadriplegic patient she has cared for over the last eight years, one of many stops she will make before her long day is done.
She arrives at Thomas Draa's home at 4:30 a.m. and helps get him out of bed, get dressed for work and stretch his legs.
For eight years, Nuñez has made the same wage: $10 an hour.
"I'm willing to come out and do the service for people, even though the pay is not good," Nuñez, a certified personal care assistant, told the Las Vegas Review-Journal. "I like helping people. That's what I like, you know, I like my job. And since I know how to do it, it makes it easy for me."
Personal care aides provide a crucial lifeline to their housebound clients, many of whom are elderly or disabled. In addition to performing duties such as grocery shopping and providing companionship, they help clients with essential daily activities like bathing, eating and cooking.
Nuñez is one of nearly 13,000 home care workers in Nevada and a member of the Service Employees International Union, which is fighting for a bill in the state Legislature that would give more rights to workers and their clients.
Senate Bill 340, also known as the Nevada Home Care Workforce Safety and Standards Act, would create a board of state health officials, disability advocates, workers and agency owners to examine home care in Nevada and issue recommendations to improve quality-of-care and working conditions.
The median hourly wage for personal care aides in the state is $11.07, according to the union.
The measure also would enable workers to seek training and benefits such as paid sick leave, protective equipment and health care coverage to address the shortage of quality care that seniors and people with disabilities are facing in Nevada.
Its sponsor, state Sen. Dina Neal, D-North Las Vegas, said the time is right to help home care workers.
"The pandemic has called attention to a dire situation that is putting workers, seniors and people with disabilities at risk," she said. "Nevada families can't wait anymore."
The bill is close to Neal's heart.
Before her father, trailblazing state Sen. Joe Neal, died Dec. 31, he was cared for by a home care worker whom Dina Neal calls "Miss Tina." She helped the family bathe her father — who was Nevada's first Black state senator and served more than three decades in the Legislature — as well as get his pajamas on and assist him to and from his chair.
"Miss Tina became a part of our lives," Dina Neal told health care workers at a rally for the bill. "We needed to build that rapport with her because she was there to help us, but we needed her. We couldn't do it."
Most of the funding for home care services in Nevada comes from taxpayer dollars flowing through the state's Medicaid program.
But the state Medicaid reimbursement rate for home care has been cut to its lowest level since 2003. Factoring for inflation, the rate then would be $26.68 in today's dollars.
Instead, the new rate is $16.52 per hour. That means the agency that lines up clients for Nuñez is making nearly two-thirds as much as she earns for providing the care.
The SEIU says home care agencies are being driven out of the state at the same time demand for workers is increasing.
Those who remain in the industry are often barely able to get by.
One in five home care workers in Nevada is uninsured, and nearly one-third are on Medicaid themselves, according to a Guinn Center for Policy Priorities study on personal care aid workers released in September.
About half are middle-aged or older. About 84% are women.
Calls to the Personal Care Association of Nevada, which represents many of the agencies that supply in-home care, for comment about the bill were not returned.
But Connie McMullen, who represents the association, told a Senate committee that a home care employment board is not needed.
There are already laws in place to accomplish what the bill aims to achieve, she said, adding that grievances should be investigated and reported to the state to force a company to comply with existing regulations and wages.
The measure would "only drive up costs for Medicaid services and Nevada," McMullen wrote in a letter. "Nevada is just beginning to recover from a pandemic that has put unbearable strain on many small businesses in the state, not to mention people in need of services who have found themselves unemployed."
She said the state cannot afford to increase funds, pointing to a 3.3% reimbursement increase that was approved in the 2019 legislative session but rolled back during a special session in July called to cut budgets due to the COVID-19 pandemic.
People on the front lines say the bill is vital to keep more home health and personal care workers from fleeing to other states.
Erma Henderson, a 62-year-old home health care worker, noted that other states have enacted similar legislation. That includes Illinois, which last year reached contract agreements that gave a 28% wage increase to 30,000 home care workers.
"I'm thinking about the next generation of home care workers. Who's going to take care of me?" said Henderson, who often ministers to and performs gospel music for her clients. "I consider home care work to be God's work. It takes a special type of individual to do it."
For Farren Epstein, a paid caregiver for her 36-year-old son, Medicaid coverage is crucial, but not enough.
Her son, who is paralyzed from the chest down, needs 24-hour care, but gets 26.75 hours a week covered by Medicaid.
"If my son's admitted to the hospital, even though I need to be there, I don't get paid. There are never any vacation days," she said. "I constantly feel like I'm living in a pressure cooker because I don't make a living wage, and he doesn't get enough hours."
On the same day she woke him up and prepped Draa for his workday, Nuñez returned to his home around 2 p.m. to help him get some rest and prepare his sleeping space for the night. His cockatiel, "Old Man," chirped in the other room.
Wearing blue gloves, she held Draa's chair and used it as a platform to help hoist him onto the bed.
"One, two, three," she said before lifting his legs.
Both Nuñez and Draa have been vaccinated for COVID-19, which removed one major worry from their close-quarters relationship.
Draa, 47, a biology and geology teacher at Desert Oasis High School in Las Vegas, held virtual classes from his home in the morning. He hired Nuñez after he broke his neck in a car accident and needed help to continue living in his house.
Draa said he has tried other home health care workers, but Nuñez was the perfect fit because she always has a smile on her face and adapts to the needs of her clients. She knows when he's depressed and knows when he needs someone to talk to.
"My life's in her hands every day," he said. "It makes my life functional again."