What Do Unions Do for Direct Care Workers? Assessing Employment and Economic Outcomes

Our study investigates unionization trends among direct care workers (DCWs) in the United States and examines the association between unionization and their wealth outcomes.

This is a cross-sectional study using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 to 2023.

Our study is based on US representative household surveys. The sample includes 17,522 DCWs (eg, personal care aides, nursing assistants, home health workers).

The prevalence and trend in labor unionization among DCWs and the association between their union status and wealth outcomes (hourly wage, employer-sponsored health insurance, pension plans, and poverty status) were analyzed. Union status identified by formal union membership or coverage by a union without formal membership.

The sample was composed of mostly women (87%); they had a mean age of 41.8 ± 14.5 years, 38.1% were non-Hispanic White, 30.4% were non-Hispanic Black, 21.6% were Hispanic, and 9.9% were Asian and other. Overall, 12% (n = 1850) of DCWs were unionized. The Cox trend test showed decreasing in unionization rates over the study years. In fully adjusted models, unionized DCWs earned more than nonunionized DCWs ($1.2; 95% CI, $0.8-$1.6; P < .001). They were also more likely to have employer-sponsored health care insurance (odds ratio, 2.0; 95% CI, 1.8-2.3; P < .001) and pension plan (odds ratio, 1.8; 95% CI, 1.6-2.0; P < .001), with higher employer's contribution to health insurance ($561.2; 95% CI, $303.1-$819.3; P < .001). Also, unionization was negatively associated with DCWs' poverty status (odds ratio, 0.7; 95% CI, 0.6-0.9; P < .001).

Unionization is an effective means of improving the financial well-being of DCWs, a workforce that is currently facing challenging working conditions and high levels of turnover.