What Kind of Movement?

It will take a movement to join the three corners of the care triangle: people who need care, families who care for and about their members, and people who give care for a living.

Each corner already has its grassroots beginnings, but they rarely make common cause. They are split by their relationship to the problem--whether they are users and buyers of care, or people who make a living at caregiving. Consumers want affordable, low-cost care, but people who care for a living must have livable wages and benefits. Care interests are split again by the sector of the service world they inhabit--childcare versus eldercare, chronic illness and disability versus acute illness, physical health versus mental health. Then, they are split yet again by the sector of the economy that presides over the resources they need--multiple levels of government; private agencies and firms that provide services and employ caregivers; and employers everywhere that control employees' time and may or may not provide fringe benefits crucial to meeting family care needs.

The way out of this impasse can be glimpsed in efforts like the disability-senior-labor coalition in California that is helping home health workers upgrade their pay and working conditions, while helping consumers get better-qualified and more reliable caregivers. A year ago, Service Employees (SEIU) Local 434B won the right to represent 74,000 homecare workers in Los Angeles County. It was the biggest influx of new union members in a single vote since 1941, and it was a long time coming. Home healthcare workers get paid from a mix of federal, state, county and private money, and when they first tried to organize, courts said they were independent contractors (who aren't allowed to organize) and that even if they were in a position to organize, they didn't have a single employer with whom to bargain.

To get around the courts, a coalition of labor, seniors, disability activists and other advocacy groups got state legislation authorizing counties to create Public Authorities to run the state's large In-Home Supportive Services (IHSS) program. The authorities serve as employers of record for homecare workers.

Many consumers were afraid of the new model. "We did not want to see IHSS become like an HMO, where companies come in and dictate the hours, what's to be done and for how long," says Lillibeth Navarro, a disability activist and consumer representative on the governing board of LA's Public Authority. "I myself had those misgivings," she admits, "but I also knew that we consumers were affected by the situation of our homecare workers. They had no health insurance, and we needed them for our survival. If they were sick or had a loss of health, we suffered." Verdia Daniels, president of 434B's executive board and a homecare worker for twenty-two years, adds that consumers became union allies "when they saw they couldn't keep their providers; the providers had to leave homecare and get other jobs because they couldn't support their families."

When homecare workers started to unionize in earnest, leaders of the disability community feared they would be out-organized. So they went into low-income housing units where there were clusters of seniors and people with disabilities. "A lot of seniors are fiercely independent," says Navarro, "and they don't want to admit that they need help even though they might be falling all over the kitchen and bathroom." The younger activists explained the IHSS program and the dynamics of homecare. "They see us in wheelchairs, and they see us functioning and they see there is life with disability--and it's OK," says Navarro, explaining how she helped make alliances with seniors.

Since unionizing last spring, Los Angeles's homecare workers have gotten a modest 50-cent pay increase, bringing them up to $6.25 an hour. In San Francisco, where the union (SEIU Local 250), the Public Authority and consumer groups have been working together for much longer, and where there are only about 5,500 homecare workers, the coalition has achieved a $9 per hour rate, a comprehensive health insurance package and, just recently, dental benefits. Donna Calame, executive director of the San Francisco Public Authority, says better compensation is having an impact on the quality of care. "I do see a different kind of person coming in to be a healthcare worker. They seem more stable."

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