How Home Care Workers Came Out of the Shadows

How Home Care Workers Came Out of the Shadows

Caring for America:
Home Health Workers in the Shadow of the Welfare State

By Eileen Boris and Jennifer Klein
Oxford, 2012, 320 pp.

Caring for America—part feminist critique of the welfare state, part labor history, part organizing case study—is the story of home care workers, the fastest growing yet still mostly invisible segment of the nation’s labor force, and their complex relationship to the state. Mostly women and frequently welfare recipients, home care workers have typically bounced back and forth between government employment, private vendors, and work as independent providers and contractors. Bargaining power over wages has been miniscule, and, with private homes as worksites, working conditions have been difficult to monitor. This has put home care workers in a perpetually precarious position: one threatened, it often seems, from all sides.

Home care workers are also at the intersection of an evolving labor movement and a welfare state under attack. The postwar expansion of the welfare state created a burgeoning home care workforce. But while wages of other workers rose, pulled along by a strong postwar economy and peak private-sector unionization rates, wages of the mainly non-union home care workforce remained stagnant and close to the minimum. When women’s mass entry into the workforce in the sixties and seventies threatened a shortage of home care labor that might have raised wages, welfare recipients were recruited to blunt the upward wage pressure; concurrently, efforts to organize were often blunted by contracting out. In the eighties, when the Reagan revolution institutionalized a long-term ideological attack on the funding of government, the already low wages of home care workers became an essential part of cutting entitlement costs. All the while unions struggled to deal with the shift from organizing large numbers of predominantly male industrial workers gathered in a single workplace to organizing in the growing, more dispersed, and more female service sector. Organizing home care workers, who had no common workplace at all, presented one of the most difficult challenges.

All of this, however, changed in the nineties. In 1992 the Service Employees International Union (SEIU) announced a thrilling breakthrough: California legislation had authorized counties to serve as the employer of record for the state’s home care workforce, which had previously been deemed independent contractors. Successful lobbying efforts to win county-level authorization of collective bargaining followed. Close to 80,000 home care workers ultimately voted for union representation—a massive victory by any measure, and the largest union victory in decades. Today, 600,000 home care workers are organized into unions.

SEIU’s success in California seemed to signal a turning point, not only in home care organizing but also in reversing the decades-long dec...