George Allen bends down and places his hand under the elbow of a man who is supine on a thin mattress on the floor. At the head of his bed, a crumpled bag of Lay’s Sour Cream and Onion Chips. Beside it, two half burned candles. They’re in a small room in an abandoned building in the middle of Las Vegas. It used to be a law office. Now, it’s temporarily home for a handful of people.

“One, two, unh!”

The 61-year-old man, Larry Younger, groans as Allen lifts him into a black office chair. “Your black presidential chair,” Allen says.

It’s early July, and Younger is one month out of the hospital where doctors inserted a rod into a leg he had broken three years earlier. Allen, who has been Younger’s home care worker for the last five months, says he had to talk his client into the surgery. “I had to whip him on the way there,” he jokes.

For Allen, taking care of Younger means taking care of him wherever home happens to be at the moment — even if his client is technically homeless. Younger has been living in this office for the last month and a half. He considers himself lucky. The electricity is still on in the building, which means they have air conditioning. Allen raises the blinds and points to a metal shed next to the office, where Younger and some others had been living but was too hot in the scorching summer heat.

“Cat on a hot tin roof,” Younger quips, laughing. “It was like Larry in a hot tin cave.”

Allen gets paid $11 an hour to provide basic care to Younger. As a home care worker, he helps him get dressed, eat, and shower. He might take Younger to the Second Baptist Church for a meal, or to an all-you-can-eat buffet so he can fill up. He collects Younger’s mail. They’re waiting on his Social Security disability benefits, which will allow Younger to move into permanent housing.

“George helps me a lot,” Younger says. “I mean, he doesn't get paid for half of the hours he helps me.”

Allen demurs. 

“I get paid,” he says. “I get a chance to bother you.”

But right now, Allen says he isn’t getting paid to care for Younger, who is in the process of being transitioned from Medicaid managed care — provided by an insurance company — to regular fee-for-service Medicaid, which is paid directly by the state. He says he’s been told he’ll get back pay, but he’s not sure.

“I'm caught in between the system right now ... but as a home care worker, I would lose my client if I stop taking care of him. What happens? I could lose my client to another person, to another agency. So I have to do retention in order to keep my paycheck coming and to keep my client from having a lack of care,” Allen explains. “Sometimes in this business you don't even get paid.”

Allen’s phone rings. It’s his son, Gideon.

“There's no mail today?” Allen asks his son. “There wasn't no mail for him? There was no mail from Social Security. Okay. Well it was a holiday last week so it's probably taking them time to get things done. We're just in a waiting stage, so we just got to wait. All right. Thanks, and I'll take care of you for taking care of him.”

Allen, 57, takes care of many people: Younger; his other clients; Gideon, who is developmentally disabled; and his clients’ children, even. But he says the money he’s earning isn’t enough to make ends meet: Allen is homeless and on Medicaid, despite the fact that he often works 10 hours a day, six days a week. 

(He finally started making $11 an hour this month after years of making $10 an hour; but he often works overtime or hours he can’t bill for, such as in Younger’s case.) 

He’s also struggled to control his diabetes, alternating between taking out payday loans to afford his insulin and trying home remedies. He’s struggled to cope with his hospice patients dying in his arms, with no therapy to help him.

Allen lives his life at the nexus of some of today’s hot-button policy issues, from health-care reform and the high cost of insulin to payday loans and the fight for a $15 an hour minimum wage. He’s someone who feels invisible but whose issues are being made more visible by Democratic presidential campaigns — a candidate brought him up on stage during a recent swing through Las Vegas — but he still wonders whether it’s all talk or whether real change is possible for him and other home care workers.

“People take care of their dogs in America more better than they take care of the home care worker,” Allen said. “Home care workers are nobody, and he's invisible until you need him.”

***

Allen was born and raised in Camden, New Jersey, which he notes holds the distinction of having some of the highest homicide rates in the nation. But a 16-year-old Allen found an escape in politics, campaigning for Democrat James Florio, a longtime New Jersey congressman who went on to become governor. He said he was the only black kid working campaigns at the time.

“Congressman Florio kind of like raised me up,” Allen said. “He took me under his wing and gave a poor kid like me from the community the opportunity to see other things in the world.”

His job was to walk a bag of money to the Catholic church — “because the community always paid their tithes” — and he made a little money doing so.

“Nobody touched that bag,” Allen said.

As an adult, he moved to Providence, Rhode Island, where he tried to get a start. He worked in security and lived in weekly hotels, but it was hard to make a living. One of his friends, who had just moved back to Providence from Las Vegas, suggested that he make the trek out west.

“He said, ‘George, go to this specific place in Golden Gate Casino,’ and he handed me a note and said, ‘Take it to them and show this to them and they will hire you,” Allen said. “And they did.”

Allen brought two of his sons with him to Las Vegas, one of whom passed away from an overdose a few years ago. But for Allen, family is a fluid concept. He refers to one of his client’s sons, who he helped raise, as his son, too.

“He calls me dad. I remember her saying one day when they was real small and she got mad at me and she told the boy, ‘He's not your dad,’ and he said, ‘He's daddy all the time,’” Allen said.

When they first got here in 2003, Allen said he went to social services to get help with a deposit so he and his sons could get a foothold in Las Vegas. Instead, he said, social services called the state to try to take his son — a disabled adult — away from him and also offered to give him a bus ticket to send them back to New Jersey.

It took some persuading and an appeal to a supervisor, Allen said, but eventually he got the money for the deposit. Over the years, he and his son lived in various places. They had an apartment on Charleston Boulevard for awhile. Sometimes, they lived in the weekly hotels, which he said “robbed [him] to death.”

Allen started off working at the Golden Gate before moving to the Riviera, where he worked surveillance and security. But very quickly, the work became untenable. Allen was falling asleep on the job, and he was laid off. He wound up in the hospital, where they found that his blood sugar was 900 milligrams per deciliter.

“The doctor walked in and said, ‘Mr. Allen, how come you're not dead?’ and I said to him, ‘Well, God ain't finished with me yet,’ and he said, ‘Well, get your paperwork in order,’” Allen said. “And that was over 10 years ago. I'm still here.”

Allen tried to keep his diabetes under control, but he said it was often a choice between paying his rent or buying insulin. At one point, he turned to payday loans to help him stay financially afloat, but he said that they have ruined his credit.

“The payday loans, boy, that was a trap, and I knew it was a trap, but I had no choice,” Allen said. “I had to have medication, and if I had spent money on medication, that was the rent money that I spent on medication, so I still had to borrow. It was like a no-win situation, a vicious revolving door, and you just had to do it.”

When he couldn’t afford the insulin, he turned to home remedies. Sometimes he put cinnamon in hot water and drank it like a tea. Sometimes he cut up or ground down bitter melon — a long green cucumber-looking vegetable commonly grown in Asia, Africa and the Carribean that has been shown to lower the body’s blood sugar — and added it to his food.

“That's how I survived, especially during the 2008 crisis when everybody was losing their homes, didn't have any health coverage,” Allen said. “It was very sickening for me because here I am, taking care of people who have health coverage, and I'm in the health field and I didn't have insurance coverage.”

Then, Congress passed the Affordable Care Act and, along with it, an expansion of state Medicaid programs, which Nevada opted into. Allen was suddenly eligible for Medicaid.

“That helped me get insurance or I would've been dead. Between the payday loans and Obamacare to help some of the people who didn't have Medicaid, if it hadn't been for those two actions, I wouldn't be sitting here talking,” Allen said. “I wasn't sure how good the cinnamon and water was going to help, how good that vegetable was going to help, but I survived. It helped me survive.”

Now, he’s on metformin, a drug used to treat high blood sugar levels caused by type 2 diabetes, along with cholesterol pills and high blood pressure pills, all of which are covered under Medicaid. But he’s still grappling with the side effects of his disease. He’s been diagnosed with diabetic neuropathy, a type of diabetes-associated nerve damage, and diabetic retinopathy, where high blood pressure causes blood vessels in the eyes to bleed. He had cataracts, too, which a woman from his church whom he was caring for paid to have removed.

He’d like to get a job that will pay for his health insurance, but for now, he has to worry about making sure he doesn’t go over the income threshold set by Medicaid. Here in the Silver State, anyone who makes up to 138 percent of the federal poverty level can qualify for Medicaid, $16,753 for a single person or $22,715 for a family of two. (He would qualify for subsidized coverage on the state’s health insurance exchange above that level, but would likely have to shoulder some out-of-pocket expenses.)

“If I go over the amount now, I'm going to be in big trouble,” Allen said. “I ain't going to be able to afford to pay for the medicine. I'm going to be back doing home remedies again.”

It’s been about two years since Allen became homeless. After he lost his apartment, he lived with and cared for the member of his church who paid for his eye surgery. But she was in hospice, and when she passed away, Allen had nowhere else to turn. He started staying with his clients or with his son, who has public housing because of his disability.

“Trying to keep the medicine, trying to find a place to live, trying to survive, taking care of my son, there's days I just wanted to give up and just lay down and get it over with,” Allen said. “The one thing that kept me going is prayer, and knowing that I could not leave my son alone, and having clients that I knew depend upon me because they had nobody else.”

***

At an all-you-can-eat Chinese buffet, Allen gets a call from his longest client, the woman whose son calls him “daddy all the time.”

“You’re lonely? You’re not supposed to be crying,” Allen says, trying to soothe her. When he gets off the phone, he explains: “She said she’s done. Ready to come home.” It happens a lot, he says.

She’s been diagnosed with bipolar disorder, Allen explains, but she doesn’t like taking her medicine.

The woman, he says, will take her cart and pull it to all the different food banks collecting food. One day, a man came up to her basket, took her chicken, and walked away. (Allen went and bought a chicken for her to replace it.) But he says people will “borrow things from her place like its Walmart.”

“I had to go and stay over there a couple of times to let the neighborhood know she's not alone,” Allen says.

Over the years, Allen has helped her and her family navigate the system. He made sure that she was enrolled with the proper Medicaid coverage. He got her son classified as disabled, got him on Medicaid and got him an IEP, or individualized education program, at school. He even got a power of attorney to take her son and daughter to their doctor’s appointments.

“I had to fight for all of that. Me, being from the East Coast, we had agencies like Urban League, NAACP, and other organizations that will help you fight,” Allen said. “Nevada didn't have any that when I got here.”

Allen said he starts getting calls at 6 a.m. from people who need help getting their kid on disability, or people who are on disability but are paying too much money in rent and they can’t afford it.

“When a home care worker walks in he has to have resources. He's a social worker. They don't have a job? We tell them where they can go sign up. They got problems with getting on Medicaid? He tells them where's the food bank,” Allen said. “Any problem that you have, we have a list.”

Sometimes, the home care worker even has to play psychologist. Allen said that once he cared for a police officer who was shot and paralyzed but reliving the memories of the shooting.

“He was having a seizure, and I said, ‘You have to take care of the baby. The baby is hollering.’ He had a newborn. So I put the baby in his arms while he's having the seizures, and he had to make a decision in his head how to protect that baby,” Allen said. “He calmed down, and he held his child.”

The job is more than “going in and wiping somebody’s behind,” he said.

“People fall through the cracks of the system, and the system don't even know they're there, and they don't send no one out to search for them,” Allen said. “The only person who knows they're there is home care workers. You want to know where everything is? You want to know where everybody is? You want to know what's going on in the community? The home care worker knows because he or she is dealing with that every day.”

Allen crisscrosses Las Vegas for his work — time he doesn’t get paid for — from the Westside out to Boulder Highway. One time, he had a client in Henderson, and he took the bus all the way there and back every time.

Allen is grateful for his work, though. He says that his clients are the ones who do the good work because, without them, he wouldn’t have a job. But he’s still frustrated.

“I get dressed up and put on my pressed pants and shoes and I go in and advocate for people who cannot advocate for themselves,” Allen said. “But I need a superman for me.”

***

***

On a recent Saturday morning, Allen approached a microphone at Victory Missionary Baptist Church. Sen. Bernie Sanders was there to share his vision for the future of the country and answer questions from community members. Allen’s was to be the last question.

“My name is George Allen and I’m a home care worker … My question is: We have a Constitution. We have a Bill of Rights,” Allen began. “How can we lobby for an economic bill of rights?”

Sanders, intrigued, pressed him for more details.

“This is disgraceful. George come on up here,” Sanders said, placing his hand on Allen’s shoulder. “This is what we have got to change. This is what we change in America. I’m not here to flatter George … This is enormously important work. This is more important than the hedge-fund managers that make hundreds of millions of dollars a year. So it goes without saying that home health care workers need a living wage.”

Sanders isn’t the only Democratic presidential hopeful giving air time to the plight of the home care workers on the campaign trail, either. California Sen. Kamala Harris introduced legislation last week that would create a domestic workers bill of rights, and Massachusetts Sen. Elizabeth Warren has touted higher wages, better benefits, and stronger rights to collective bargaining for home care workers.

As it turns out, Allen has been involved in the push here locally — led by the Service Employees International Union — to raise the minimum wage to $15 an hour since 2014. (He got involved when the union was reaching out to home care workers.) He’s participated in the fast food strikes put on by the union and has even gone to Washington, D.C. twice to lobby with them. On one of those trips, in 2016, he met with then-Senate Minority Leader Harry Reid.

When he got there, he told Reid, “I'm actually a blind home care worker. I had to have my eyes done. I had bleeding in the back of my eyes, but I was sent here to let you know about the suffering of home care workers and their lack of pay.”

Now, Allen is working with the SEIU to fight for better wages and working conditions for the roughly 13,130 home care workers in Nevada, who make a median wage of $11.07 an hour. Brian Shepherd, chief of staff for SEIU Nevada Local 1107, said the difficulty is that most home care workers, including Allen, work for small agencies scattered across the state, which makes the prospect of unionization difficult. 

“I think most unions would look at it as, ‘Oh, we're going to focus on one agency at a time.’ No, no,” Shepherd said. “We've got to focus on systemic change and that's the only way we're going to be able to actually fix the problem.”

Plus, he said the issue also isn’t so much with the agencies — who are financially constrained by whatever Medicaid will pay them to provide the services — as it is the state. The Legislature raised the reimbursement rate for personal care services by 3.3 percent to $4.39 per 15 minutes of service provided last session, but Shepherd noted it’s still 24 cents less than the 2009 rate.

“If I'm a home care agency and I'm getting funded at $17 an hour to provide care, there's a limited amount of money I'm going to be able to pass on to the workers,” Shepherd said.

The union is in the process of commissioning a study by the Guinn Center for a more comprehensive look at home care workers in the state, including an examination of the overtime and additional services workers may be performing but not reporting. It will also take into consideration the legacy of home care workers, who Shepherd noted have historically been black and Latino women and whose work has often been devalued as a byproduct of slavery in America.

“We've been having those conversations with workers that this is not by design that this work is devalued,” Shepherd said.

For his part, Allen said he’s disappointed that the Legislature passed and Gov. Steve Sisolak signed a bill earlier this year only raising the minimum wage to $12 an hour by 2024.

“It’s not what we asked for. We need more than that for the minimum wage for Nevada,” Allen said. “It was very hard for us to get help during the Republican governor's rein, but Sisolak promised that he would help us in this endeavor, and we want to make sure that he does.”

He chalks it up to Nevada being “behind the times.”

“They slow,” Allen said. “That's the reason why they don't want to go to, raise the minimum wage to $15 an hour.”

But Allen is glad that Democratic presidential candidates are talking about economic insecurity and, some of them, home care workers specifically. But he’s afraid it’s all talk and that home care workers will soon be forgotten about again.

“I’m invisible. Home care workers are invisible. Who cares about us? And probably after this political election is over, nobody will care about us again. We'll just become more invisible,” Allen said. “I'm not making a big stink about home care work. No, we love our jobs, or we wouldn't do it. But we go out and take care of other families, but then we've got to come home and look at our families and feel guilty about the fact that I gave all this time here and then I couldn't take care of my own family.”

But now, sitting here at the Chinese buffet, Allen’s clients are again — always — top of mind. His day wouldn’t be ending anytime soon. After he got Younger situated back at the office building, he would pay for a cab out of his own pocket to get to his bipolar client on the Westside as quickly as possible. 

She needed him.

***