Care Workers Get a Seat at the Table
Colorado’s Direct Care Workforce Stabilization Board offers an experiment in worker power.
Osita Nwanevu
This article is part of a series from Osita Nwanevu on cooperatives and innovative worker organizing. Read another article from the series here: “The Baristas Who Took Over Their Café.”
The way she tells it, Sandra Sherwood first stepped into direct care work at 16, when she started caring for her grandfather who had suffered a stroke on his farm. “Mom and I headed over there, and when we got there, granddad couldn’t even make a sentence —it was all garbled, didn’t make any sense of what he was trying to say,” she remembers. “He would be in a wheelchair from then on because it affected one whole half of his body.”
“Everything got sold,” she continues. “The property, the chickens, the cows, the pigs — everything got sold. Granddad and grandma ended up moving in with my mom and dad and the family. It was then that I realized how important it was for us to take care of our elderly.”
Sherwood, now 62 and a home care worker, has been caring for others for many years now in an industry that hasn’t been able to take care of its own. Wages are low for the home health workers and aides who make up the direct care workforce, and benefits are meager. In Colorado, where Sherwood works, 41% of direct care workers are on some form of public assistance.
“The industry has been hard,” she says. “People don’t want to pay anything. People don’t want to give benefits. They don’t want to give the hours needed to support the person taking care of someone else’s loved one. There were times I could walk into my boss’s office and say, ‘I really need a raise.’ And they would literally get up laughing, open the door and say, ‘I am paying you what I have to pay you.’ ”
So when SEIU Local 105 called Sherwood and asked if she would help raise standards for direct care workers, she thought, “Well, if it doesn’t get done now, it will never get done — because this is something that’s been needing fixed ever since I’ve started in it.”
Sherwood is now one of the first to sit on of Colorado’s Direct Care Workforce Stabilization Board, a 15-member body that brings together direct care workers, patients, employers and state officials to issue recommendations for the industry. The state legislature moved to create the board in 2023 at the urging of the SEIU-backed Colorado Care Workers Unite, in which Sherwood is a longtime member-leader.
It’s one of nine industry standards boards that have been set up in six states and three cities since 2018, a wave that suggests boards hold promise as a means of expanding worker power that might complement traditional labor unions. “We view this type of vehicle as a way for workers to have a real seat at the table, to have real voice, real power now,” SEIU president April Verrett says.
Only about 8% of the direct-care workforce is unionized, and organizing can be slow going among workers who provide highly individualized care and don’t encounter many other workers, and who are split between a large number of agencies. Colorado has roughly 60,000 direct care workers across 700 to 900 agencies, according to SEIU Local 105 President Stephanie Felix-Sowy, the chair of the direct care board. “It’s a difficult space to have conversations,” Felix-Sowy says.
In two other states, especially powerful boards have emerged as models. In Minnesota, the Nursing Home Workforce Standards Board created by legislators in 2023 approved a minimum wage increase for nursing home employees to an average of $23.49 an hour in 2027, moved to guarantee 11 paid holidays, and is working to establish other standards. And in California, legislation raising the minimum wage to $20 an hour was paired with the creation of the Fast Food Council, an industry standards board that will be responsible for setting future minimum wage increases and will make proposals on working conditions that can be expedited into rules by state regulators.
There’s some precedent for these bodies in the United States. New York state, for instance, has been convening wage-setting boards on and off since the Great Depression. One of them authorized a $15 minimum wage for fast food workers in 2015. But labor experts and labor-friendly policymakers have taken a new interest in industry standards boards out of a hope that they might bolster worker power beyond the limits of traditional labor organizing, where workers must reach hard-fought agreements workplace by workplace and firm by firm. Industry standards boards hold the promise of elevating wages and boosting basic work across a given industry — and of approximating sectoral bargaining as practiced in Europe, where unions routinely negotiate industry or sector-wide labor agreements.
The industry standards boards that have been set up recently are only tentative steps in that direction, however. Colorado’s Direct Care Stabilization Board, for its part, can only issue recommendations that may later be taken up by legislators or regulators. But it could nevertheless become a lever for raising wages and improving conditions in an industry where organizing unions is structurally difficult.
The board was created with an awareness of the need to draw more workers into the field — Colorado is one of the fastest aging states in the country, and more than a quarter of its population will be 60 or older by 2050. Tens of thousands of direct care workers will need to be recruited and retained to meet demand —a tall order if the field continues to underpay, undertrain and overwork them. The board convenes to discuss and hear testimony about those problems. Every two years, recommendations that secure a majority vote are submitted to the governor and state legislature.
“The charge of the board was to come together and host hearings across the state that would be accessible for folks both within urban cities, as well as rural areas,” Felix-Sowy says. “The goal was to reach out to care workers specifically, but also to folks utilizing services in order to get their input on what was currently happening in the system, in the industry. And then most importantly, what was going to keep people in the industry — to retain people or recruit people? And questions we asked a lot of our folks in these hearings were, ‘What would entice people to come and work in this industry? What would it take for you to stay in this industry long term as a career?’ ”
That feedback, and the experiences of the workers and patient representatives on the board, shaped a first set of recommendations issued in September 2024, which included a base wage of $25 dollars an hour by 2026 and an hour of paid time off for every 25 hours worked. The board also recommended measures that would help inform workers about existing wage, overtime and other rights under Colorado law, as well as offer online access to training materials and information about and health benefits. It also suggested a website that could match patients with workers who have particular skills, like language proficiencies or specific certifications.
“What the board really wanted to hone in on were [creating] a place where workers could access their rights and resources, and [creating] a place where workers and clients could gain access to care or gain access to work,” Felix-Sowy says. “We had an individual who was a board member go days, sometimes weeks without a caregiver because the agency that she was going through couldn’t provide any care, couldn’t provide a replacement. Had she had access to something like this, this worker-client platform, she could have possibly been connected and done it on her own.”
For her part, Sherwood believes the board’s training recommendations are particularly important and that the board should continue to push measures to ensure new direct care workers are prepared for the job. “There was one person that really stood out to me,” she recalls from the hearings. “My heart went out to her, it really did. She stood up and she was telling about how she was assigned a person to take care of, and she went into the home, and the caregiving facility had not explained to her correctly the condition that the patient was in and the type of care that the person needed. But the person was able to tell her the things that she needed to do and she was able to do them.”
In direct care as in the wider economy, there are few opportunities for workers to tell employers and policymakers directly about their working conditions or to sit in government bodies that might do something about them. Industry standards boards give workers the chance to do both, though any recommendations or policies ultimately have to be negotiated with employer representatives. Even with that limitation, though, boards have been able to give workers a rare seat at the table where decisions about working conditions are made.
“When I first went in, I didn’t know what was going to happen — if they were going to stand up and walk out the door laughing, and do me like all the employers that I’ve had for the last 40-plus years,” Sherwood says. “Or if they were really going to listen to me or not. And it was nice. It was a really nice surprise. It made me feel like I wasn’t wasting my time.”
Even at their most empowered, standards boards obviously can’t do many things unions can and must. It remains essential for workers to have the right to win binding, employer-specific agreements through collective bargaining. Such agreements can improve wages and conditions above and beyond the minimums an industry standards board might recommend or mandate.
But establishing those minimums through boards in more sectors could be transformative for labor rights in America, most especially in sectors, like direct care, that are structurally difficult to unionize. And industry standards boards could even help facilitate union organizing — by bringing workers together in venues like hearings or by pushing for measures that could make organizing easier.
“Workers in this industry were the ones who pushed for this legislation because they do see this as an opportunity,” Felix-Sowy says. “And we have been very clear and transparent about that — that the end goal has always been to organize this workforce. And if this board and these recommendations help both lift standards in the industry as well as help workers build their power together, then that is a good thing.”
