SACRAMENTO — California’s in-home caregivers, a historically underpaid workforce that serves a rapidly aging population, could receive a significant boost in bargaining power under a new bill introduced recently.
The In-Home Support Services Employee-Employer Relations Act, authored by Assemblyman Matt Haney, D-San Francisco, would allow the state’s in-home supportive services (IHSS) caregivers to unite under one statewide bargaining unit. They would negotiate with the Department of Healthcare Services. Currently, workers bargain county-by-county with the boards of supervisors. Most only pay within a dollar or two of the minimum wage.
“These are skilled essential workers,” Haney said. “And they’re only getting more essential.”
The bill reflects the impending “care cliff” faced by the state as its population ages. By 2030, the Department of Finance projects, one in every five Californians will be over the age of 65. It means demand for in-home care will surge.
“We have a crisis,” said Fernando Torres-Gil, a UCLA professor and expert on aging and social welfare policy. “We have a huge and growing unmet need. We have a workforce that has been disrespected, and there are fewer people willing to do this kind of work.”
IHSS workers provide in-home care for low-income Californians over the age of 65 and those with disabilities. Over 650,000 people use the program, and more than 550,000 workers take care of them. Women and people of color comprise much of the in-home care workforce. About 85% of home care workers in the United States are female, according to a study from the nonprofit Paraprofessional Healthcare Institute, and 63% are nonwhite.
The vast majority of care providers are friends and family members of their clients, and they provide services ranging from food preparation and housekeeping to personal hygiene and toileting. Some have given up careers and other jobs to become full-time caregivers. Others work with several clients, trying to piece together enough hours to pay their bills.
“Caregiving is rough,” said Sydney O’Connor, a 27-year-old IHSS worker in Kern County who cares for her blind and diabetic partner, Jacob. “I do this because I care for my partner, because I care about people who need help.”
Leading proponents of the bill include Service Employees International Union Local 2015 and the United Domestic Workers, which together represent more than 400,000 workers. The unions argue that statewide bargaining power would give the IHSS workforce significantly more leverage to win improved wages and benefits. Increasing pay, as well as prestige, for in-home long-term caregiving jobs could pull the state back from the care cliff and save taxpayers money.
“The need for care is exploding,” said Arnulfo De La Cruz, president of SEIU Local 2015. “How are we going to attract future caregivers if current providers are making poverty wages?”
IHSS ensures dignity for older adults and people with disabilities
Russell Rawlings wouldn’t be able to live independently without the help of his IHSS caregivers. The 46-year-old, who lives with severe cerebral palsy, moved from Texas to California in 2001 in search of a friendlier place for people with disabilities. He estimates he’s worked with at least a dozen caregivers since arriving here.
Today Rawlings relies heavily on his friend and full-time caregiver, Darrow Sprague. Rawlings qualifies for 273 hours of care per month, which means the 54-year-old Sprague works an average of 65 hours a week with few breaks. They share a two-bedroom apartment in Tahoe Park.
“I’ve always caretaken, to some degree,” Sprague said. “This is what we do – we all take care of each other.”
Sprague helps Rawlings with almost every aspect of daily life. He wakes him up at 5:30 each morning, turns off his sleep apnea machine and removes the mask. After adjusting his bed so that Rawlings can sit up and enjoy a cup of coffee, Sprague uses a hydraulic lift to help hoist him out of bed and wheels him into the bathroom, where he assists Rawlings in using the toilet and taking a shower.
After the morning routine, Rawlings can largely manage by himself during the day. He wheels himself around the apartment in his chair using a joystick controlled by his left arm. Rawlings works remotely for a disability rights group, using a microphone to dictate text and navigating the computer screen with a roller ball mouse.
Sprague feeds Rawlings lunch and periodically empties the catheter bag on his leg. At night, he transfers him from his wheelchair into the bathroom, gets him ready for bed, and then helps him put the BiPAP mask on before turning out the lights.
Sprague earns $16.50 an hour, the Sacramento County wage for IHSS workers.
In Kern County, O’Connor’s partner Jacob requires constant care as he continues recovering from a 2016 kidney and pancreas transplant. Unlike Rawlings, whose needs qualify him for more than full-time care, Jacob only receives 74 hours per month of care. Since Kern County only pays IHSS caregivers $15.50 an hour — the state minimum — the couple struggles to make ends meet.
“I’m not making it financially at all,” said O’Connor, who estimates her debt sits around $17,000. “And my story is not unique.”
O’Connor works as a UDW staff member to make some extra money, and she also cared for her elderly neighbor to get some additional IHSS hours. But one night, O’Connor injured her back while lifting the neighbor up from a fall. She couldn’t continue helping and had to find two other caregivers to replace her.
UDW workers and leaders say Kern County has been so unwilling to bargain that the union supported a ballot measure to establish supervisor term limits. They hope a statewide bargaining unit will finally bring members some much-deserved raises and respect.
“This is important work, but the Board of Supervisors doesn’t see it that way,” O’Connor said. “They see us as glorified babysitters.”
How will the state afford higher IHSS wages?
There’s currently no minimum pay built into Haney’s bill. But the San Francisco Assemblyman hopes that if a version of the measure makes it to Gov. Gavin Newsom’s desk, it will contain a guaranteed wage that’s higher than the state minimum.
The proposal is certain to draw opposition, arguing that with a projected $22.5 billion budget shortfall, raising IHSS worker wages would put undue strain on the state’s budget.
But Haney and the bill’s supporters cite a 2020 state auditor’s report, which found that the IHSS program actually saves between $22,000 and $153,000 per person in taxpayer money for each person compared to institutionalizing patients in Medi-Cal funded nursing homes.
“If people cannot receive care at home, they might end up hospitalized, sometimes at state facilities,” Haney said. “The state often becomes the backstop when counties don’t adequately administer home care.”
Haney said he is confident that the effort will succeed. He pointed to the successful effort in 2019 that gave 40,000 childcare workers new rights to unionize at the state level and bargain with the California Human Resources department over wages and health care benefits.
“It’s always hard to spend money up front,” he said, “but in this case, not doing so will leave us with a lot of people who aren’t being adequately cared for.”
“We’ve got to figure this out,” Haney continued. “It’s better if we start now.”