The value of care: homecare workers went from being an invisible workforce to one of the most vibrant sectors in the labor movement, defending public benefits for the poor elderly and disabled.

Organizing homecare workers has breathed new life into the U.S. labor movement and provided a new political voice for thousands of the poor elderly and disabled in our communities. They didn't gain this voice overnight. In 15 years, homecare workers went from being invisible in the public's eye, dispersed and considered almost unorganizable, to becoming activists for the care of the elderly and disabled. Who are these workers, and what did it take for them to get here? Is this a model that can inspire other workers in the nation's economy to do the same?

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A Growing Crisis

It's estimated that the number of seniors in the U.S. will increase by 13 percent in the next 50 years. In California, the population age 65 and older is expected to double to roughly 7.2 million between 2002 and 2025 and triple to roughly 10.8 million by 2050, according to the California Policy Research Center. And according to a report issued by Citizens for Long-term Care, it's estimated that, nationwide, 13 million of the elderly and chronically ill and people with disabilities require support and assistance for some of the most basic activities in their lives.

Homecare workers make up a significant segment of the total direct care workforce for these elderly and disabled. In particular, homecare providers help their elderly and disabled clients in performing their basic daily activities, such as bathing, house-cleaning, meal preparation, shopping and getting to and from medical appointments. The ability for the elderly and disabled to live in their own residences and receive care there saves state governments millions every year. Candace Howes, associate professor of economics at Connecticut College, notes, "Because California relies so much on homecare instead of nursing homes, California's per capita Medicaid expenditures on long-term care are approximately half of the national average."

In California, Oregon, Washington, Illinois and Michigan, state governments hire and match homecare workers directly with consumers through an independent provider network. Consumers for these homecare services are low-income and unable to afford private care. Funding for homecare programs is made up of a complex mix of federal, state and county monies and distributed through governmental social service agencies. Some consumers hire their loved ones to care for them, while others are matched with a provider. Regardless of the circumstance, the county government will pay for the hours of service provided.

In states such as New York, all homecare workers are employed by private agencies contracted by the state: these agencies hire, fire and pay workers directly. This may seem like a tiny bureaucratic difference in structure, but it makes all the difference in whether these workers are able to collectively organize under the law.

In California, the homecare workforce of about 300,000 providers was structured under a program called In-Home Support Services (IHSS), where workers were officially not considered employees of the state or county. There was no official employer, and though consumers could hire or fire workers, they didn't pay them; the county in which they worked provided their paychecks.

"As one can imagine, the work is physically and emotionally grueling. It takes a very compassionate, special human being to do this job," says Miriam Escamilla, director of the Home Care Division for SEIU Local 715 in San Jose, California. "The make-up of the workforce and the consumers in California made it easier for lawmakers to ignore the voice of these workers. About 85 percent of the workforce are women of color, and 40 percent are immigrants. The consumers of state homecare services mirrored their providers, with a majority being women of color and poor."

Research on the workforce showed that though the need for homecare workers will grow exponentially as the age of the population does, low wages and lack of benefits will keep this sector from having the workforce numbers to meet the demands. Nationally, the average homecare worker makes $7.91 with no health benefits. And of the two million homecare workers nationwide, more than 20 percent earn incomes below the poverty level. Turnover ranges from 40 to 100 percent annually.

From Invisible to Visible and Political

While organizing healthcare workers in hospitals and nursing homes in the late 1980s, members of the Service Employees International Union in California came to view homecare work as part of a continuum of care for patients and the elderly. And because most of these homecare workers were paid by the county, and their wages and conditions were determined through legislation, SEIU also recognized that homecare workers were public workers as well. The idea of organizing these workers was considered radical.

A number of these workers were already organized under United Domestic Workers, an agency that contracted with counties. But SEIU wanted to pursue a different model. There existed no employer of record and no means through which to gain union recognition. They had no common worksite, since they worked in private homes. And the workforce was incredibly diverse; in Los Angeles alone, over 100 languages were spoken among the 75,000 homecare workforce.

The union was forced to come up with an organizing strategy that thought outside the traditional box. SEIU focused their work in two areas: grassroots, direct organizing with workers in their homes and neighborhoods, and political organizing in the state capitol to change the way lawmakers viewed these workers. Miriam Escamilla recalls, "One of the main things we did was to link with consumer advocates among the senior and disability communities. They were our allies in this process because they wanted to have a strong homecare program as well. Also, we had to approach the diverse communities in their languages and directly in their communities." The direct contact proved successful. Throughout the state, homecare workers overwhelmingly supported forming a union.

As a result of pressure from the ground through grassroots, political mobilization, in 1992, the state passed legislation allowing each county to be able to create a public authority (an agency that would act as the employer of record and would manage the funding for the program under the auspices of the county government) and also secured $800 million in federal funds for homecare through Medicaid.

This launched a ten-year campaign to establish public authorities in every county in California and win organizing rights for homecare workers throughout the state. Today, as a result of this work, over 300,000 homecare workers are organized into unions, 200,000 with SEIU. In 1999, when over 75,000 Los Angeles homecare workers joined Local 434B, SEIU made national headlines for winning the largest union victory since 1937. In 2000 and 2001, the states of Oregon and Washington followed California's example and granted public authority status to homecare workers, resulting in thousands more workers organized into unions. Just this year, 41,000 homecare workers in Michigan voted to join SEIU.

Today, homecare workers have moved their salary levels well beyond minimum wage, up to almost $10.50 in some counties. Workers in counties such as Santa Clara, San Francisco and Los Angeles also won healthcare coverage. The gains made by organized homecare workers have also directly benefited consumers. In a recent survey of homecare workers in San Francisco, Candace Howes of Connecticut College found that turnover rates fell by nearly 19 percent, due in part to increased wages and health benefits.

Homecare organizing, especially after the Los Angeles victory, created opportunities for the organizing of other non-traditional workforces as well. Currently, SEIU is organizing thousands of community-based developmental disability workers and private, home-based childcare providers. The idea that certain workers are unorganizable is no longer a part of union speak.

Resistance to Rollbacks

The great visibility of labor's victories in homecare has also made it a target for antiunion politicians. In 2005, in an effort to offset a huge budget shortfall, Arnold Schwarzenegger proposed a reduction of California's share of homecare worker wages to the minimum wage of $6.75, as well as no longer funding healthcare coverage. Schwarzenegger has also proposed the repealing of public authorities. Many advocates for a fully funded homecare program see this attempt at rollbacks as a shortsighted way to balance the state's budget. Any savings from the homecare cuts would be offset by increased state costs to other programs, according to the California Budget Project.

Miriam Escamilla thinks Schwarzenegger has another agenda. "Homecare represents a third of SEIU's membership in the state. The governor wants to undermine the strength of public unions in California."

Homecare workers throughout the state have been actively organizing to beat back the cuts. Democratic legislators have made the homecare fight a core issue in their budget battle with the governor. The most remarkable aspect of this fight is the level of political activism among the workers themselves. They have met with legislators and brought their consumers and families to lobby alongside them in the state capitol--all of this political participation from a workforce that up until 12 years ago did not even think of themselves as workers. Regardless of what new attacks are hurled at homecare workers, it's clear that workers don't want to go back to being invisible and voiceless. There are just too many lives at stake.

Raahi Reddy is a union organizer and labor specialist at the UC Berkeley Center for Labor Research and Education.