The Supreme Court Kicks Out the Ladder Under Home Healthcare Workers. Who’s Next?
Blog Post
July 3, 2014
Staying out of poverty just got harder for thousands of American home healthcare workers thanks to the conservative majority in the Supreme Court. In Harris v Quinn, the Court weakened the ability of home care workers to negotiate better wages. It is a significant setback to those trying to improve the job quality and wages of one of the country’s fastest growing and most important occupations. Similar in many respects to the early education workforce, home health aides are on the frontlines of our public healthcare system, caring for some of our most vulnerable citizens. They provide a wide variety of services to the elderly and disabled, from administering medications and monitoring basic vital signs, to preparing meals and, most important, providing comfort and company to those who are home-bound. It is not an easy job, but it is one that a person can get without a lot of formal education and training.
Home health care occupations are classified by the Department of Labor as having a Bright Outlook", which means above average growth over the next decade, and thousands of job openings. Two factors - our aging population and a growing body of evidence that people are often better off at home than in hospitals or nursing homes – are driving the market for home care aides. But despite strong demand, it remains a very low-paid occupation. In many states, home care aides make minimum wage, not enough to keep themselves or their families out of poverty. In fact, many home care aides could qualify for Medicaid themselves.
In Illinois, where a group of home health aides voted to join the Service Employees International Union (SEIU), things have gotten better over the last few years. Their wages have more than doubled, from a meager $7.25 an hour to a slightly better $12.25 an hour. Under their union-negotiated contract, wages will rise again on December 1st to $13.00 an hour, or $26,000 a year – still not a salary on which to support a family, but one that at least provides some economic stability to workers without college degrees. In exchange, the workers are required to contribute 2.5% of their wages to support the union’s negotiating activity – or about $650 a year. Not a bad deal, unless you just don’t want to be represented by a union no matter what, which appears to be the case for Pamela Harris, the plaintiff, who provides home care to her disabled son.
Requiring all workers to contribute to the cost of the collective bargaining processes from which they benefit has been standard practice for decades. In the case of public sector unions, the right to subtract dues from all affected workers was upheld by the Supreme Court in the 1977 Abood case. Without this requirement, workers would face strong incentives to “free ride” on the agreements, accepting higher wages while not paying any of the cost of securing them. The Court’s decision does not overturn Abood, but rather rests on the special legal classification of home health aides who are considered “joint employees” because they technically have two employers, one public and one private. While they are paid through state Medicaid and Medicare funds and their wages are established by state agencies, patients (or their families) are responsible for hiring and firing the homecare aide and can demand a specific array of services as part of their terms of employment. The rationale for splitting the employer role into two parts is to ensure that patients and their families were empowered to find a caregiver who is compatible with their particular needs, not one chosen by faceless bureaucrats.
Justice Alito’s opinion exploits this loophole to the detriment of the caregivers, arguing that their classification as joint employees makes them different from other public sector employees and, therefore, not privy to the same rights or obligations. The decision uses a feature of the law designed to give patients and families more control over their healthcare providers to strike a blow against public sector unions. It is an interpretation that will make it even harder for millions of already vulnerable workers to earn a decent wage. It is also counterproductive to our efforts to improve the quality of health care while also reining in costs. Patients with high quality home health care are less likely to end up in the hospital, which costs the state and taxpayers much more money than regular visits from a home health care aide. The cost savings are still there if the home health care aide actually makes a living wage, as they were in Illinois thanks to SEIU.
Paying poverty wages to the people who care for the aging, disabled, and infirm is not a winning strategy for keeping down healthcare costs. While homecare jobs have low educational requirements – a high school diploma and some additional training is generally enough – they are not unskilled. To the contrary, home health aides need good communication and problem-solving skills, they need to be flexible, responsive, and patient, and they often have to navigate emotionally explosive terrain with patients and their families. These jobs are unskilled only in the sense that we stubbornly refuse to recognized caregiving as something that can be improved through training and that can lead to better outcomes for recipients when delivered by a well-trained provider. Once again, the parallels with the early education workforce are striking. Compensating these caregivers the same as a fast food worker will not lead to a high quality workforce. We want them to be able to make good decisions as they care for our loved ones, and that requires decent wages and investments in training – which is what SEIU helped deliver to Illinois’ homecare workers.
Monday’s decision did nothing to improve the quality or affordability of home healthcare in the United States but it did put yet another roadblock in the way of thousands of American workers seeking good jobs and pathways into the middle class. As we think about how to improve the wages and skills of the early education workforce, it’s hard to not feel discouraged. When weakening unions becomes more important than caring for low-income children and adults, we all lose."