History of the Home Care Movement

Our Local played a pivotal role in the history of giving home care providers a voice on the job that would improve the lives of hundreds of thousands of workers throughout the country and those they provide care to.  We take great pride in our contributions to the movement and our continued leadership within it to ensure that as the demand for home care increases, we have an environment that attracts workers to deliver quality care to those in need.


Efforts to organize consumer-employed Medicaid home care providers date from mid-1980s campaigns in Illinois and Los Angeles by predecessors to SEIU HCII and ULTCW (Locals 880 and 434B (later 6434), respectively).  The first opportunity for recognition and real bargaining came in California in the mid-1990s, when the legislature gave counties authority and funding to establish “public authorities” to manage their widely dispersed consumer-employed provider workforces. After a number of counties did so—with union recognition and improvements in labor standards following shortly behind—the legislature in 1999 mandated that all counties take on similar responsibilities related to the provider workforce by 2003.

In the 2000s, the independent provider (IP) organizing model spread not only throughout the rest of California’s counties, but also began to take hold in other states. Oregon voters approved a ballot initiative to create a statewide version of California’s county-based public authorities, and Washington voters followed suit in 2001. In 2003, the Illinois legislature recognized its IPs as employees of the state for the purposes of bargaining over the various terms and conditions of their employment set by the state, and the Massachusetts legislature did the same in 2006. As discussed in more detail below, the well–established bargaining relationships in each of these five states (California, Oregon, Washington, Illinois, and Massachusetts) have led to significant improvements in labor standards not only in the form of higher wages, but also through the establishment of basic benefits such as health insurance and paid time off and through increased access to training and other career development opportunities.

Building on these successful examples, five additional states have since adopted similar approaches to developing their IP workforces: Maryland (2007 Executive Order and 2010 statute); Missouri (2008 voter initiative); Connecticut (2011 Executive Order and 2012 statute); Vermont (2013 legislation); and Minnesota (2013 legislation). Unions have won representation and are currently bargaining contracts in four of these five states.  In Minnesota, various structural changes to the home care program are in the process of implementation, and no union has yet sought representation under the new law.

In addition to making progress in the fight against poverty-level wages, the established bargaining relationships in California, Oregon, Washington, Illinois, and Massachusetts have led to numerous significant gains for the IP workforces in these states. Examples include:

Healthcare—four of the five states with current contracts (all but Massachusetts) provide some form of state-funded health insurance for providers;

Training—all five states have succeeded in making some form of training available, either on a voluntary basis (paid or unpaid) or as a mandatory employment requirement for which providers are paid to attend;

PTO—Oregon, Washington, and Massachusetts all provide some form of paid time off;

Grievance process—all contracts provide for a grievance process, which have been used primarily to resolve payroll-related problems but have also addressed other issues including disputes over eligibility for work in state programs;

Career advancement—Local 775 has led the way in creating a wage scale that helps to stabilize the workforce and improve the quality of services by rewarding experience and advanced training;

Health and safety—a number of states now provide items such as gloves, masks, disinfectant wipes, and hand sanitizer to providers;

Transportation benefits/reimbursement—at least two California counties provide public transit benefits, while Washington and Oregon reimburse providers for personal vehicle use when transporting consumers;

Labor-management cooperation—a number of contracts create either standing labor-management committees or issue-specific joint committees to address workforce issues;

Registries—a number of contracts require registries operated by the state to make referrals based on seniority or experience (after accounting for consumer preferences such as language), while others establish a procedure for providers to contest their removal from a registry.


California: History and Statutory Basis for Bargaining

The first step toward collective bargaining for providers in the California In-Home Supportive Services (“IHSS”) program was SB 485 in 1992, which added Section 12301.6 to the Welfare and Institutions Code authorizing counties to establish public authorities to coordinate the delivery of IHSS services. SB 35 in 1993 provided a state funding mechanism for the creation of such authorities. Seven counties used these enactments to create public authorities between 1993 and 1999, starting with Alameda and San Mateo counties in 1993 and continuing with San Francisco, Santa Clara, Contra Costa, Los Angeles, and Monterey.

SEIU won a representation election and was certified as the bargaining representative of IHSS workers in Alameda County in 1994, followed by San Francisco in 1996, and secured first contracts in each county in 1997. By the time 74,000 workers in Los Angeles voted to join SEIU in 1999, workers in Contra Costa, Santa Clara, and San Mateo counties had elected SEIU as well.

The California legislature fully embraced the public authority model in 1999 with AB 1682, which required all counties that had not yet done so to either establish a public authority or adopt one of the alternate methods provided in statute for managing their IHSS workforce. Subsequent legislation, AB 2235 in 2002, provided that any county that had not adopted one of the alternatives set out in AB 1682 by January 1, 2003, would be required to become the employer of its IHSS workers.

In the wake of these mandates, all but two of California’s 58 counties established public authorities.  The five California home care locals (SEIU Locals ULTCW, UHW, and 521, AFSCME UDW, and the joint SEIU/AFSCME Local CUHW) have now been elected as the representative of IHSS providers in 55 of the 58 counties.  According to CAPA’s most recent estimate from August 2013, this means that approximately 365,000 providers are now represented for collective bargaining.


Contract Highlights

Although contracts vary since they’re bargained with each individual county, as a result of having representation for collective bargaining, IHSS providers in California have achieved substantial improvements in their working conditions and bringing recognition to the important work they do.

By being united, IHSS providers have experienced contracts that may provide them with improvements such as better wages, eligibility for health insurance benefits, training opportunities, improved health and safety conditions, transportation benefits, referral registries, grievance procedures, and labor-management committees.

For specific ULTCW contract highlights by county, click on the county below:


Union Security and Duty of Fair Representation

California law allows the union to negotiate for a service fee not in excess of dues.  The employer shall deduct such fee from non-members. In practice, the fee amount charged varies by county, with many but not all county contracts providing for a service fee equal to dues. For example, eight of the ten ULTCW contracts set a service fee equivalent to dues, while one county (Alameda) sets fees at 98% of dues, and the final county (Los Angeles) assesses fees on a cents-per-hour-worked basis that exempts non-members working fewer than twenty hours per week from paying service fees and results in those working more than twenty hours paying a sliding amount up to the full amount of dues.