History of Personal Care Attendant Unionization
Unionization of personal care attendants, or home health aides was first attempted back in the mid 1980s. These PCAs are hired, fired, supervised, and trained by the elderly or disabled individual they provide assistance to.
While there are individuals who pay for these services privately, a large portion of those employing the services of a PCA do so with the help of Medicaid. Each state administers this program differently. Some states set wages while other states provide a set amount to the person qualifying for services and allow that individual to set wages.
California was the first state to organize PCAs, doing so at the county level. Oregon, Washington, Illinois, and Michigan followed suit shortly thereafter organizing against the State. More detailed information on each state that has either unionized or attempted to unionize PCAs is available under the "Find Your State" tab.
In most states, a shell employer in the form of a PCA Workforce Council is formed. The union and the PCAs typically bargain and negotiate with this council instead of directly with the state. This idea was developed back around 1999 after the courts decided that PCAs were not employees of the State or the County. In order to justify unionization, the unions knew they had to create some type of an employer of record. This is how the Home Care Authorities and PCA Workforce Councils were born. These serve as the faux employer of record and allow for a pseudo employee/employer relationship to be formed. The question of whether or not this is constitutional is yet to be determined. The Supreme Court has ruled in Harris v. Quinn that PCAs in these unionization schemes do not have to pay agency or fair share fees. There is currently a case in Minnesota challenging the constitutionality of this unionizing scheme.
Unionization of PCAs has often come with controversy. With charges of intimidation, voter fraud, and embezzlement in California, and violation of campaign finance laws in both Michigan and Montana, there has hardly been a state where this has passed free of controversy. In addition to the controversy, the deceptive way unionization has been passed has also gained media attention. Missouri is only one example of a misleading ballot initiative that was described as a way to protect health services for seniors and people with disabilities, but in reality, was nothing more than a backdoor way to implement unionization. Like numerous other ballot initiatives, it never indicated the proposal had anything to do with unionization.
Only a small percent of the PCAs paying dues or fees are receiving health insurance as the result of a union contract. The increase in wages for many has been minimal and barely offsets the cost of dues. Meanwhile, SEIU and AFSCME have raked in hundreds of millions of dollars between dues, fees, and money intended to provide health insurance or training for the PCAs they are supposed to represent.
With the high cost of dues and minimal benefits, unionization has proven to be an unsuccessful way to better the PCA workforce. It also undermines the relationship between a PCA and the individual that hires them.