If and when the nation’s 14 million unemployed workers return to jobs, they will find some sobering changes in the workplace: They’ll earn less, pay more for health insurance, and receive fewer benefits, some as basic as paid sick leave. Decades of progress in the fight for better employee benefits have been wiped out, putting millions of families at risk of not being able to buy food or of losing their home over something common in families: getting sick.

For as many as 40 million people who work without paid sick leave, taking time off when they or their children are sick is a gut-wrenching decision. So, as President Obama turns his attention toward creating jobs, family advocates say employee benefits, including paid sick days, must be part of the equation. Yesterday (Sept. 12), Seattle joined the small parade in addressing this issue, passing a measure mandating paid sick leave for Seattle employees and becoming the third city in the nation to do so.

Even Seattle’s Starbucks Coffee Co., once famous for its generous employee benefits including health insurance for part-time employees, no longer offers paid sick days to its hourly coffee shop workers. In 2009, as the recession cut into profits, Starbucks continued to provide health insurance to part-time workers, but did away with sick pay and personal days for many of its frontline workers. Now those workers either go to their jobs sick or lose wages, even as reports indicate that in 2010 compensation for Starbuck’s CEO and founder Howard Schultz rose nearly 45 percent to $22 million, and the company’s net earnings reached $945.6 million.

Paid sick leave is fast becoming a national workers’ rights issue. Cities including San Francisco, Washington, D.C. and Milwaukee have passed laws requiring employers to provide paid sick days.

In Seattle, where Starbucks is headquartered, city council members on Monday approved legislation requiring companies to provide paid leave to employees when they or their family members fall ill. The Seattle council took the proposal a step further and also included paid leave for workers who fall victim to domestic violence to seek medical care or participate in legal proceedings.

“Seattle has never feared being a leader,” said Seattle Councilmember Nick Licata, who sponsored the ordinance. “A great city, a world class city, is one that cares for the welfare of all who work in its jurisdiction. This legislation is a model for cities, states, and the nation,”

A dozen states are considering paid sick days legislation. Connecticut approved a sick leave law in June. At the federal level, paid sick days legislation is in committee review as part of the Healthy Families Act. Key supporters are President Obama and Sen. Tom Harkin (D-Iowa).

For Mary Ignatius, a statewide organizer for Parent Voices, a parent-led organization in California that is fighting to pass paid sick day legislation, it is just good economic policy. “It is hard to be a good worker if it is at the expense of being a bad mother,” she said, “Having access to paid sick days would really help the economy; it would help employees keep their jobs, reduce employee turnover, and increase productivity.”

Nearly 40 percent of America’s workers don’t have paid sick days, in particular, those in low-wage industries such as child care centers, retail stores, and restaurants. A dining-industry study last year by Restaurant Opportunities Centers United reports that 88 percent of the restaurant workers surveyed did not have paid sick leave. About 63 percent of the workers said they have worked — cooking and serving food — when they were sick.

“A lot of momentum is building around the country,” said Vicki Shabo, director of work and family programs at the National Partnership for Women and Families. “We know that people see it as a common sense issue.”

According to a report by the Economic Policy Institute, if a parent without paid sick leave misses three-and-a-half days of work, the family loses the equivalent of its monthly grocery budget. Shabo said that families without paid sick days are more likely to use emergency rooms for routine health issues — increasing their health care costs — because they can’t take time off to go to the doctor’s office.

Opposition to paid sick leave legislation comes from business, chambers of commerce and the human resource industry. They argue that, with an uncertain economy, this is the wrong time to put more demands on business.

Some companies have threatened to leave cities or states that mandate paid health benefits. Others say providing paid sick leave would mean laying off current employees or cutting back other benefits like vacation time. Human resources spokespeople cite the potential for abuse: workers taking time off when they aren’t ill.

According to the Bureau of Labor Statistics, in the private sector, the average cost to employers for sick leave per employee-hour worked was 23 cents, and twice that for management-level employees. How the projected cost of paid sick leave is described depends on who is doing the math. Last year, a coalition of chambers of commerce fighting proposed paid-sick-leave legislation for New York City reported that the law would cost city businesses $789 million per year.

San Francisco was the first city in the country to require companies to provide paid sick days to employees. Companies, like Starbucks, which balk at providing paid sick days to employees elsewhere, are now required to do so by law in San Francisco. That mandate, however, doesn’t extend to workers in nearby Oakland.

Caroline Topeé, a single mom with an 8-year-old daughter, is a member of the Oakland chapter of Parent Voices. She said she was reprimanded at work for taking time off from her job as an administrative assistant when her child was too sick to go to school or day care.

Topeé lived in fear of getting sick herself and having to take off more days from work.“You would hear about it. I was scared that I was going to lose my job,” she said. “I had to take my daughter to school and tell the teacher that she had to be there. I couldn’t risk losing my job.”

In Atlanta, Sonya Underwood works in admissions at a local hospital. When she found out she was pregnant, she started saving up her paid sick days. Surprisingly, many hospitals don’t allow workers to use personal sick days to care for ill family members. “I had a plan,” said Underwood, who has worked at the hospital for 11 years.

But she couldn’t plan on delivering her baby four months early. She went back to work and continued to save sick days while her baby stayed in the hospital to gain weight. Now her infant is ready to go home, but still requires oxygen equipment and a heart monitor. Underwood says the hospital’s human resources office has told her she can use her banked sick leave only for her own illnesses, and not to care for her fragile baby.

“I don’t want to be a statistic; I don’t want to lose my job,” she said. “I have no one to take care of my baby. No child care accepts preemies. I have to be able to provide a home for him and electricity for his medical equipment.”