Home care workers help California’s aging population. Should they be covered by state unions?

Home care workers who provide assistance to elderly and disabled Californians could see more wage equality, according to a recent labor report, by shifting contract negotiations to the state level instead of bargaining individually with California’s 56 individual counties.

Currently, home care workers who staff one of the state’s largest, and most expensive, health and human services programs are represented by two unions, Service Employees International Union and United Domestic Workers. Those labor groups negotiate with individual counties across the state on behalf of the home care workers, who often care for relatives.

A report commissioned by the Legislature and published by the University of California, Berkeley’s Labor Center, found that there is wide variation in wages and benefits, with workers earning between $16 to $21.50 per hour in counties across the state. These employees are predominantly women of color and are two times as likely to experience poverty, compared to all California workers, according to the report.

The report’s primary author, Nari Rhee, the director of the Labor Center’s Retirement Security Program, said local increases to the minimum wage can lead to turnover among home care workers if their respective wages don’t increase proportionally.

“There’s a qualitative difference between a convenience store losing staff and having to retrain them, and somebody with a very serious disability and health conditions, losing their provider and then having to recruit and train a new provider,” Rhee said. Keeping turnover low is important to providing quality care, she noted.

Research indicates that shifting to statewide collective bargaining for home care workers would likely lead to wage-compression, meaning employees in counties that pay lower hourly rates would likely see higher wages, while those working in higher paying counties would likely see less growth in their pay.

“When you have a large bargaining unit, you get less wage inequality,” Rhee said.

More than 700,000 Californians took advantage of the Department of Social Services’ In-Home Supportive Services program last year, according to the report. A similar number of home care workers staff the program, Rhee said.

The number of recipients is anticipated to grow by 4% annually over the next eight years, continuing a growth pattern observed in the last decade.

California’s elderly population, which is growing at a faster rate than than the state’s overall population, is likely to exacerbate the anticipated shortage of home care workers, Rhee said. There are concerns about how the state will meet the demand for a larger healthcare workforce.

“The state is aging and that there needs to be services in place to help people age ... with dignity, to be able to stay in their communities,” Rhee said.

The IHSS program cost nearly $23 billion last year, more than half of which is paid for using federal funds. State and county funds make up the rest.

According to DSS the non-federal share of the program’s cost is expected to increase from $11 billion in fiscal year 2024-25, to $20 billion in fiscal year 2031-32.

“What is uncertain is what the state is going to be able to afford going forward given the change in administration at the federal level and potential changes in Medicaid policies.”

Advocates for healthcare access have concerns about how President-elect Donald Trump could reduce the amount of money California receives for health services from the federal government, which funds about half of Medi-Cal.

If lawmakers decide to bring home care workers under the umbrella of statewide collective bargaining, Rhee said there would need to be policy changes as to how the wage increases are divided between the state and counties. Under the current system, Rhee said the state has assumed an increasingly large responsibility for the program’s cost.