Stamford, Conn., school bus driver Jamille Aine’s employer doesn’t offer paid sick days. Advocates say the paid sick day benefit is especially needed for employees like Aine, who handle food or work with children.

AP / Douglas Healey

Stay home if you’re sick. That’s the best way to stop the spread of contagious diseases, such as influenza, tuberculosis and gastrointestinal viruses. Besides, you can’t do your job capably or safely if you don’t feel well. But many Americans simply tough it out when ill, going to work with pain, cramps, headaches, fevers or worse. Often, they have no choice.

On Labor Day weekend, consider this: As many as 43 percent of American workers in private industry don’t have paid sick days, according to 2007 data from the federal government. If they call in sick, they lose their pay and, sometimes, their jobs.

That number has risen over the years, part of a larger trend to cut back on sick leave. Among workers who do still have the once-venerable benefit, many have found their days reduced or lumped together as part of their vacation time. The United States — unique among industrialized countries — doesn’t mandate a minimum number of paid sick days for workers.

“Sick time is changing,” said Kim Stattner, an expert on absence management for Hewitt Associates, an international company that provides human resources programs and consulting. “The practices and designs are not as generous as they once were.”

As employers cut back, however, lawmakers are stepping in, with the support of labor organizations and health officials. In May, legislation cleared the California Assembly that would allow workers to earn one hour of paid sick time for every 30 hours worked. The bill, called Healthy Families, Healthy Workplaces (AB 2716), is pending before the Senate.

As many as 10 other states are also pondering paid-sick-day laws, including Ohio, where residents will likely vote in November on a ballot initiative requiring a minimum number of paid sick days.

Two cities, San Francisco and Washington, have already enacted legislation.

In San Francisco, full-time, part-time and temporary workers earn one hour of paid sick leave for every 30 hours worked, assuming they have been on the job for at least three months. Workers at companies with fewer than 10 employees can accumulate up to five days per year, and workers for companies with 10 or more workers can accumulate up to nine days.

The Washington, D.C., law requires workers to be on the job for one year before becoming eligible for paid sick leave. Workers can earn three to seven days depending on the size of their company and whether they work full or part time.

About 135 developed countries have laws requiring private and public employers to provide paid sick leave to full-time employees. In the United States, Sen. Edward M. Kennedy, D-Mass., and Rep. Rosa L. DeLauro, D-Conn., have introduced a bill, the Healthy Families Act, that would require businesses with 15 or more employees to give workers at least seven paid sick days per year.

Sen. Barack Obama is a co-sponsor of that bill; Sen. John McCain is not a co-sponsor and has not taken a position on paid sick days, though he is generally against employer mandates.

Karen Kerrigan, president of the Small Business and Entrepreneurship Council, an Oakton, Va.-based lobbying group with 70,000 members nationwide, said the costs of providing paid sick days are particularly difficult for her constituents. The new requirement would add to already high taxes and costly workers’ compensation, she said.

“This is a piling-on measure,” she said.

On the other hand, “The public supports it,” said Ruth Milkman, a professor of sociology at the University of California, Los Angeles, and director of the Institute for Research on Labor and Employment who has studied the proposed laws. “In San Francisco, the law was so popular that the people who were opposed to it didn’t even mount a challenge. Paid sick time is a human need that is self-evident.”

For school bus driver Jamille Aine, a cold is more than an inconvenience. His employer does not offer paid sick days, so if he can’t shake the bug, he may not be able to pay his bills.

Advocates say the paid sick day benefit is particularly needed for employees like Aine, who handle food or work with children.

Aine, who drives Stamford, Conn., students ages 3 to 17 to school, cited that as a reason he would like to have the financial flexibility to stay home when he’s sick.

“It’s not just for me, but for the people you drive,” he said.

An estimated 79 percent of low-wage workers and 80 percent of part-time workers do not have paid sick time, according to the Institute for Women’s Policy Research, a Washington, D.C-based organization that based its analysis on U.S. Department of Labor statistics.

The demand for workers in the service sector has grown substantially over the last two decades, but those jobs are much less likely to carry sick pay, said Jeremy Smith, a lobbyist for the California Labor Federation. Fewer workers today are covered by union contracts, which traditionally dictate paid sick time for their members, he adds.

Small companies are also chipping away at the benefit, Stattner said.

“Some employers look to generate savings from cutting sick time because they are trying to mitigate the cost increase of medical benefits,” she said.

Those employers and many others will resist legislation to mandate a certain number of paid sick days, said Peter Ronza, an adviser on employee compensation for the Society for Human Resource Management.

“They still love their people, but they can’t afford the kind of benefits that 3M or Best Buy or General Motors can afford,” he said. “California is saying, ‘OK, we need to have this as a paid benefit.’ But it turns out to be something small businesses can’t afford.”

Many employers have already begun to tinker with sick days.

The brokerage giant Merrill Lynch raised eyebrows last year when it sliced guaranteed sick days for employees from 40 to three.

According to Stattner, most companies that provide paid sick days offer about 10 a year. (Employees of the federal government get 13 a year.) Fewer companies than in past years allow employees to carry over unused sick days from one year to the next, but many provide a short-term disability benefit featuring partial pay for six to eight weeks. Moreover, some companies allow employees to purchase long-term disability insurance policies.

“Today, sick time is intended for casual or incidental absences,” Stattner said. “The short-term disability is for more serious health conditions requiring multiple weeks away from the office.”

Employers are also instituting plans that lump vacation, sick and personal days in one pool, a benefit referred to as “paid time off.” A survey by Hewitt showed that 30 percent of employers offered paid time off in 2006, up from 18 percent in 2000.

The idea behind general paid time off is that employees will be more judicious in how they use sick time. But such pools often don’t reflect the realities of real life, Ronza said. “What if you get sick and you use up all your time in the same year that you have a wedding planned?”

Others view the time-off pools as a sneaky way to reduce paid sick days and ease the managerial headache of keeping track of employees’ separate balances of sick, personal and vacation days. When employers offer 15 days of time off instead of two weeks of vacation and two weeks of sick time, for example, the reduced number of sick days can slip by relatively unnoticed.

“It’s a way of cutting back on paid time off,” says Vicky Lovell, director of employment and work and life programs for the Institute for Women’s Policy Research. “Employers don’t have to care why someone is out.”

Considering that humans have employed other humans since the days of the ancient Romans, it’s odd that no one really has a good grasp of what constitutes a fair number of sick days a year, Ronza said. According to the 2004 National Health Interview Survey, a government-conducted poll, the average worker takes off 3.9 days a year for their own illnesses or injuries and 1.3 days to care for ill family members.

But, Stattner said: “A paid-time-off bank breaks down those barriers. If you need 20 days off because you have an ill child, you have access to 20 days. You may have to use up some of your vacation time, but the person gets to choose.”

With more emphasis on preventive care as a means to reduce the long-term cost of health care, a few bold employers are offering employees one or two days a year specifically for prevention, Stattner said. Others reward employees who don’t use paid sick days by exchanging them for vacation time. Surveys show that nearly half of all workers each year do not miss a single day of work due to illness.

“The lack of utilizing sick time is a reflection of the employee’s dedication to the job,” she says. “Organizations do place value on those behaviors.”

The Associated Press contributed to this story.

58 %

of U.S. workers get paid sick days

49 % of workers don’t take any of their paid sick days in a given year

3.9 Average number of sick days a person takes each year to care for self

Sources for statistics: U.S. Department of Labor, Bureau of Labor Statistics; Institute for Women’s Policy Research; Hewitt Associates; Employee Benefit Research Institute.Making the call

There are right and wrong ways to let your boss know you’re a no-show. Most people instinctively know the best way to communicate with their particular supervisor and workplace. But if your illness has caused a sudden loss of common sense, follow these tips compiled from human resources experts and other sources.

•Do speak to your supervisor directly, if possible. Sending an e-mail is a tip-off of possible fakery.

•Don’t attempt to fake sounding ill by using the old tricks: speaking on the phone while lying in bed or bent over the toilet. Remember, if you were an actor, you’d have a SAG card.

•Do call in as early in the day as possible to give your supervisor time to plan the day without you.

•Don’t give your supervisor all the gory details of your illness, pain and suffering. It smacks of exaggeration. Make the call short and to the point.

•Do make the call yourself.

•Don’t have your spouse, child or — worse — mother make the call for you unless you are hospitalized and intubated. Be a grownup.

•Do apologize for the inconvenience to your employer.

•Don’t call from a baseball game, bar, airport or other questionable venue.

•Do call in sick when you’re feeling miserable, need to see a doctor, are contagious or can’t think straight.

•Don’t go to work looking like a walking corpse.

•Do get a doctor’s note if your illness requires medical treatment and a specified length of time off.

•Don’t use “feminine problems” as an excuse — especially if you’re not a woman.

•Do use sunscreen if you take a sick day to go to the beach.

•Don’t tell your boss you’ll try to be there after lunch. It won’t happen.

•Do know how your supervisor feels about employees taking sick days.

•Don’t call in sick on too many Mondays or Fridays. It will damage your credibility.