Photo: Service Employees International Union

On February 25, 1999, 74,000 home healthcare workers in Los Angeles voted to join the Service Employees International Union (SEIU). This moment demonstrates the growth of what is today the second largest union in the nation, and its strategy to organize workers laboring in hard conditions without much contact with other home healthcare workers.

Home healthcare work is a rapidly growing field and one where workers have a hard time. Like most care work, the pay is low, sometimes at or close to the minimum wage. Think about this. We pay people we trust to care for the most vulnerable members of our society, our elderly and very young family members, extremely low wages. This is completely bonkers. Moreover, home healthcare work is hard and gross. Unlike babies, the elderly and infirm are heavy and can be violent. Like babies, they produce a lot of bodily fluids that can go everywhere, and they also have other health problems.

Moreover, it's not as if there's some huge hiring hall for home health aides. These are workers, often with very limited education, who do not much meet each other. We are a long way from the organizing model of the United Auto Workers (UAW) and other industrial unions, who organized the many thousands of workers on the floors of GM, Ford, and Chrysler in the 1930s and 1940s. Organizing single workers or small groups of workers is hard and time-consuming, especially with the lack of a culture of solidarity that can develop when you can get to know your coworkers.

And yet, SEIU has over a million members in part using this model.

To make all these issues even more challenging, home healthcare workers exist on the edge of the public and private sector. They don't usually work directly for the states, but they're paid through an agency of the government. This has led governments to fight granting collective bargaining rights to these workers and requires extensive legislative campaigns to do so, which has happened in several states in recent years, including my state of Rhode Island.

These workers are mostly women of color. A study of Los Angeles County homecare workers in the 1990s showed that 83 percent are women and half are over age 45. About 39 percent were Latina, 25 percent African-American, and seven percent Asian-American. Overall, these workers spoke 100 languages in Los Angeles County alone. Moreover, and to make all of this even more complex, 49 percent of California homecare workers at the time were family members of their patients. In California, they made the state minimum wage and had no health insurance, pension, or vacation pay. Esperanza DeAnda, one of the activists who would soon become a union leader, recalled that "We were the invisible workforce. Nobody even knew we existed."

This made sense since the job could have 40 percent turnover in a year.


It would seem no one would really be able to organize these workers. But SEIU was already rising as the union of low-wage service workers. Its Justice for Janitors campaign had already put it on the map in Los Angeles as a union that was pro-immigrant and pro-service work. But SEIU put in the resources for a real campaign.

The first task: find the workers! This was a problem the UAW definitely had never faced. SEIU sent organizers to senior centers, doctor's offices -- wherever they could find lists of workers, including by digging in trash cans. This succeeded for one core reason: the workers really wanted to be organized. In fact, the campaign took off like gangbusters once they found some workers to start the process. Within the first six months, starting in late 1987, they signed up 12,000 workers. No single homecare worker knew that many other workers, but most knew a few, and those networks built up real organizing capacity. The organizing office gave workers a place to come together, meet each other, and build solidarity. It was necessary because this was going to be a long haul.

The SEIU office had other functions too. It could help workers find new jobs. It also helped the union mobilize workers for the legislative actions needed to organize these workers. The homecare workers became a major catalyst for the fight to raise the minimum wage in California during the 1990s, which succeeded in a fifty cent raise from $3.75 to $4.25. They fought hard against a horrible situation where the state could withhold their paychecks when the government faced a budget impasse, winning a lawsuit to end the practice. They were a force to contend with in stopping bills to reduce their services. Then in 1996, the workers became serious leaders in a campaign to raise the minimum wage to $5.75, doing a ton of door-to-door canvassing. All of this built up organizing capacity, militancy, and activism, even if it didn't win them a union contract yet. Organizing on a smaller scale took off in San Francisco and Alameda County as well.

To get a union contract, SEIU had to find a bargaining agent with which to negotiate. The first lawsuit that named Los Angeles County was tossed out by a judge who basically said no government entity was required to bargain with the union. So that was a big problem. Instead, SEIU worked with consumer groups to create an independent agency that would organize this work and thus provide an employer of record. The creation of a public authority worked, with three laws passed in 1993. SEIU and its allies then had to set up those public authorities and make them functional, which took lots of time. It took another direct action campaign to finally get one in Los Angeles County in 1997. Finally, there was a bargaining agent.


When the 74,000 home healthcare workers of Los Angeles County voted to join SEIU Local 434B on February 25, 1999, it was a huge victory for the labor movement, enough to forestall the nation's near-annual decline in union density for a year.

It wasn't perfect. In fact, one of the deals, which makes sense from the perspective of the "consumer," a word I hate when describing people using social services, was that they had the right to hire or fire a worker without cause. Obviously, someone needing homecare needs to feel comfortable, so homecare providers couldn't quite use some of the classic organizing tactics, like an auto plant shop steward of old banging on the machinery with the contract. The clients wouldn't like that! But this did create a universal and individual firing mechanism.

Nonetheless, this was a real victory. In Los Angeles, SEIU was able to get the workers $6.25 an hour and a medical plan for the first time on a five-year contract. This was similar to the contracts it had gotten in its San Francisco and Alameda County campaigns, except that in the former, the wage was pushed up to $9.70. The main difference, though, and the reason why the LA campaign is what we are focusing on, is that the LA campaign organized 10 times more workers than either of the other two campaigns.

Today, SEIU has continued fighting for homecare workers and has become a national leader in fighting for the rights of the low-income workers who make up the American working class. This is the real American working class, not the mythological white working class in industrial states that the media obsessively focuses on. Those people are working class too, but the actual working class is in fact by far the most diverse segment of the country.

Why It Matters Today

I hardly need to explain to readers of Wonkette the many ways COVID-19 has exposed the flaws of the American healthcare system. Healthcare workers, both home aides and hospital workers, have been at the front lines of the pandemic response. But their pay and working conditions often remain quite poor. We call them "heroes" for their response to the pandemic. But in our society, designating someone a hero all too often means we don't have to pay them or keep them safe. We just pay them lip service to make us feel good about ourselves. They didn't ask to be heroes. They signed up for a job, sometimes to take care of their own family members, sometimes other people. We usually know a few homecare workers because they take care of our own aging or debilitated family members. They need much better money. They need safe working conditions. They need to not get COVID-19. They need a voice in the workplace. If we think of these workers as heroes, how about we actually do something about it so they are treated with dignity on the job?

For Further Reading:

Eileen Boris and Jennifer Klein, "Organizing Home Care: Low-Waged Workers in the Welfare State"

David Rolf, "Life on the Homecare Front," Journal of the American Society on Aging

Delp and Katie Quan, "Homecare Worker Organizing in California: An Analysis of a Successful Strategy," Labor Studies Journal, March 2002.

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Erik Loomis

Erik Loomis is Associate Professor of History at the University of Rhode Island. He's the author of A History of America in Ten Strikes (The New Press, 2018).


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