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 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 require additional training and separate certification. “We take care of sick people, but when we get sick we have nothing to fall back on,” says 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 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.

Some agencies say they would pay more if they could. “The notion that any money is misdirected to unnecessary administrative costs is simply not true,” says Lyle Churchill, vice president for marketing, communications and development for the Visiting Nurse Service of New York, an organization that contracts with more than a dozen agencies that provide home health aides. In addition to paying wages, state reimbursements for at-home care must cover a host of other expenses, including training, billing and oversight, Churchill says. Without more money from the state, he says, increasing wages is impossible.

Despite the wage disparity, some aides say they prefer their work to that of attendants because of the additional duties involved. Typically, aides care for clients that are more medically fragile than those served by attendants.

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

If a strike occurs, agencies will likely try to shuffle available aides to clients most in need. Other clients would have to depend on family members and neighbors. For families who live far from their loved ones, the labor dispute 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?”