This story originally appeared on PressDemocrat.com, also part of the Sonoma Media Investments news network.

The paperwork that stacks up for speech therapist Miriam Miller can take hours beyond her regular eight-hour workday to complete, not counting the roughly five patients she visits at their homes across the county during a shift, each with a different, specialized set of needs.

With no opportunity for overtime pay, Miller and a handful of her colleagues in the rehabilitation department at Kaiser Permanente said they spend much of their free time after work catching up on paperwork necessary to their caseloads.

“All of us often work for free,” said Miller, who has worked as a speech therapist at the Santa Rosa Kaiser campus for nearly two years.

After 12 years of work in rehabilitation services, she said she is now feeling the effects of burnout.

Miller, along with a small group of other home health occupational, speech and physical therapists, picketed in front of Kaiser’s Santa Rosa campus on Tuesday to draw attention to their demands ahead of their first contract negotiation session with Kaiser this week.

Demands include lessening the daily caseload for rehabilitation therapists so they can spend more time with each patient, overtime pay, wages and reinstated benefits equal to those of other Kaiser health professionals, said Michael Aidan, chief union negotiator and assistant executive director for Engineers and Scientists of California Local 20.

The modest department consists of about 270 employees across Northern California. The department became part of a union in late 2017, and it has never before had a contract with Kaiser.

Kaiser is currently in bargaining with the union, said Marty Ardron, vice president for continuum of care at Kaiser Permanente Northern California.

“We are optimistic that we will reach an agreement that is beneficial to our employees and also supports high-quality, affordable health care for our members,” Ardron said in an email statement in response to questions about the union’s assertions.

Patient care was not affected by the labor action, he said.

Home health therapists meet with patients at their homes and treat them for a variety of physical, occupational and speech therapy needs, as well as fill out paperwork to go with each patient.

Miller and two co-workers on the picket line, Vicente Arroz and Ping Wu, said in addition to treating patients they easily spend extra hours each day talking to an array of family members who want to understand how best to help their recovering loved ones.

This rigorous schedule and time spent reassuring families limits their ability to accomplish everything and get paid for their work, said Wu, who has worked two years at Kaiser as a physical therapist but has 20 years of experience overall.

Limited time and too many patients has been detrimental to Kaiser staff and, in the end, to their patients, Miller said.

“We have a lot of turnover rates in our department, too, and are constantly short-staffed,” Wu said.

Sonoma County Supervisor Shirlee Zane said all health care organizations in California, especially the biggest like Kaiser, are having problems recruiting employees. Though Zane said she sees Kaiser’s push for early release after surgery as a promising initiative, the home health therapists have difficult jobs to ensure that program works in the long run.

This story originally appeared on PressDemocrat.com, also part of the Sonoma Media Investments news network.

“These are super valuable people that need to be taken care of when contracts are negotiated,” she said. “People at the county level who need surgery go through Kaiser and I want to make sure they have that same type of excellent care.”

Most of the home health therapists love their jobs, said Arroz, who has worked over a decade at Kaiser and has been a physical therapist for 25 years.

“This is the ideal job because you get to help your patients function at their own homes as opposed to in a hospital,” Arroz said.

After a meeting earlier this year with Kaiser’s CEO Bernard Tyson, Zane said she feels that Kaiser is open to criticism and wants to improve the quality of care in Sonoma County.

“Kaiser is doing a great job with their innovative approach to care but can’t do it without supporting their employees,” Zane said.