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Raising the Standard of Living for Workers While Raising the Standard of Care for Clients

Home Care work

An excerpt from the home healthcare handout that CURA produced in partnership with SEIU Healthcare Minnesota.

April 15, 2016

By Kaela Dickens

In 2014, Chou Moua was studying for a Masters in Development Practice (MDP) at the Humphrey School of Public Affairs. Although MDP degrees usually focus on international development, Moua chose to focus on local community development to apply later in new contexts. One local context Moua was very familiar with was home healthcare. He had worked as a Personal Care Assistant (PCA) for eight years, and was passionate about making his local community a better place one life at a time. In his last year of graduate school, Moua got the chance to benefit fellow PCAs and their patients through a unique CURA partnership with SEIU.

Service Employees International Union (SEIU) Healthcare Minnesota is a large statewide healthcare union that represents more than 15,000 healthcare workers from homecare, nursing homes, hospitals, and clinics. In 2013, PCAs won a huge legislative victory, giving them the right to organize for the first time under Minnesota labor law. SEIU provided the framework for those workers to form their own statewide union to advocate for better wages, working conditions, and quality, affordable healthcare for all.

The new unionized group of more than 20,000 PCAs (also known as home healthcare workers) was set to negotiate a contract with the state in 2015, and needed reliable data to justify their concerns and issue positions. But there was a dearth of information about PCA workers not only in Minnesota, but also nationally.

The home healthcare industry experiences famously high turnover rates, which makes gathering information about its employees extremely difficult. Additionally, many individuals working as PCAs are largely living in poverty; the vast majority are women, and they are disproportionately foreign born or ethnic and racial minorities. These groups are often underrepresented in traditional methods of research due to language, technology, and access barriers. Interestingly, the job sector is predicted to grow 48% from 2012–2022, the fastest of any sector. Nevertheless, wages have stayed stagnant.

SEIU knew that raising employment standards for the PCAs would not only elevate the standard of living of workers, but also the standard of care of clients. Healthy and happy workers are less likely to leave, and can therefore provide better for both their clients and their own families. SEIU needed to make up for this shortcoming of good data in order to present a solid case during the upcoming union contract negotiations. Camille Roberts, an organizer for SEIU, decided to seek the help of a CURA Research Assistant in gathering this data, which is where Chou Moua came into the picture.

Moua’s skills in research, his experience in home healthcare, and his passion for giving underserved communities a voice lined up perfectly with this undertaking. He and University of Minnesota Sociology professor Lisa Park set out to form a committee with representatives of CURA, the University of Minnesota, and SEIU PCAs to design the research process for the study. Together, the team came up with four main areas to investigate to glean as much targeted information as possible about the experience of PCAs (see sidebar).

Over the summer, Moua and Park worked with key PCAs from SEIU to design and test the principal survey questions. That fall they mailed out thousands of surveys to PCAs all over the state. They also held focus groups with ethnic minority PCAs, who were underrepresented in the survey responses, in order to gain a well-rounded representation of the population. Moua’s fluency in his native language of Hmong was an enormous asset in these focus groups, as he was able to erase the language barrier in interviews with Hmong PCAs.

Not everyone in the home healthcare industry was pleased with the 2013 union victory and this subsequent research. The widespread distribution of the survey was “hitting a political nerve” with some community members, causing them to lash out. “Although I was the target of racial and political aggression, I felt that my team members at CURA, SEIU, and the University of Minnesota were 100% behind me,” said Moua. Despite the support he felt from his team members, Moua maintains that this was one of his most challenging times as a graduate student. 

With 978 surveys and 21 focused interviews completed, the data collection was done. Moua, Park, and a few other University students spent the following weeks analyzing the data, writing a full report of the findings, and creating an engaging information packet with the most important findings that SEIU wanted to share.

SEIU utilized the report and related packet as an advocacy and education tool throughout the negotiation process. Members began the negotiations with the state of Minnesota by sharing the findings and providing data to back up demands. The research offered clear evidence of the issues facing the homecare industry and, ultimately, supported the solutions suggested by homecare workers to state officials and decision makers.

In 2015, the negotiations ended with some huge victories for the union: a base wage increase from $9.00 to $10.75, paid time-off benefits for the first time, a clear grievance process for unpaid wages, better and more consistent training opportunities, and a $250,000 fund for training. These addressed some of the biggest concerns raised in the research, and also elevated the industry standards in the state of Minnesota, which could stand as an example for other states as the PCA industry continues to grow.

Moua and Roberts were pleased with how the study turned out, and with the impact it had on the lives of PCA workers like themselves. Moua noted that the concerns of PCAs “are no longer just anecdotes...this community-driven study has been digested by the academic machine and spat out with legitimacy.” That legitimacy will go a long way as more people become involved in the home healthcare industry, as both clients and home healthcare workers.

Moua’s work on the project not only contributed to the success of SEIU’s negotiations, but also to his own educational pursuit to serve others. Throughout the study, he had lots of opportunities to apply tools he was learning in his graduate school classes directly to his work. “There were times when I learned one lesson one day and used it the next onsite.” The real-world application of his learning also amplified the human element of his academic pursuits. “Working in the community cemented my belief that cooperation, dialogue, and empathy go a long way to span boundaries between different groups of people.”

Moua is now continuing his work advocating for communities in China through a fellowship sponsored by both the U.S. and Chinese governments. He no longer works as a PCA, but he certainly attributes a lot of personal growth to his experience with the industry, both personally and academically. “I think both aspects fed into each other; me being a PCA gave me a personal understanding of this sector within the community and my work as a graduate researcher for CURA and the academic side gave me a lens to focus my work.”

SEIU wanted to know:

  • What is the gender, ethnic, racial, and socioeconomic makeup of Minnesota PCA workers?
  • What sorts of challenges do PCAs encounter because of the nature of the work and the industry?
  • Is the training PCAs receive adequate? How does that affect the quality of services they provide to clients?
  • What workplace and industry bargaining issues are PCAs most concerned about?

Main Findings of the CURA/SEIU Study of Minnesota PCAs

  • 82% of MN PCAs are women. 
  • Nearly a quarter of MN PCAs are Black/African American, which is much higher than the statewide population.
  • On average, MN PCAs work 29 paid hours, and 21 volunteer hours per week. 
  • They would prefer to increase their paid work hours to 36 hours per week.
  • The top three biggest challenges for PCAs included: emotionally taxing labor, difficult client behavior, and low wages with no raises or benefits.
  • The most rewarding thing about their job was, for most, a strong, positive relationship with their clients.
  • The biggest collective bargaining priorities included: higher wages, health insurance, and sick days/paid time off.

Kaela Dickens is a graduate assistant working on community visualization and communications for CURA. She is pursuing her Masters Degree in Public Policy, with a concentration in Administration and Leadership. After graduation, she plans to stay in the Midwest and make a positive impact in local government.