The Supreme Court is deliberating in a case that will decide whether in-home personal care and home health aides are allowed to unionize and bargain agreements with government agencies. The case will also decide whether their contracts can require every aide who benefits from the collective bargaining agreement to pay her fair share in agency fees (or dues, if she is a union member). These collective bargaining agreements have made a huge difference in the lives of the overwhelmingly female and disproportionately minority workforce that cares for the sick and disabled, the frail elderly and small children in their homes or in the homes of the customers.

Until the 1990’s, when states and counties across the nation began creating public entities to act as employers and bargain collectively with the workers’ unions, the in-home care workers rarely were paid more than the minimum wage, they had no coverage for health or dental insurance and no pension or retirement plan. Even today, after almost two decades of progress, half of these workers have incomes less than twice the poverty level and they earn far less than workers in other occupations – even after taking into account gender, age, race, education, and geography.

But where in-home aides have been permitted to unionize and bargain collectively they have improved pay and benefits, training, retention, and the safety of clients and workers alike. In Illinois, where the Supreme Court case challenging unionization arose, the latest contract includes $13.00 an hour pay, health and dental insurance, a grievance procedure, and paid training hours – a huge improvement over what was formerly minimum wage work with no benefits and no respect.

That is what is at stake in Harris v. Quinn: whether a workforce of 2 million women who are vital to the care of our aging society, vital to the cost-effective care of the disabled (in-home care generally is half as expensive as institutionalization), vital also to the development of small children and infants whose parents work, will have an effective voice to transform their undervalued profession into one that can attract and retain workers. History shows us that without unionization, these jobs will continue to be undervalued and the workers treated with disrespect. Without the collective power and the voice a union provides, in-home care will once again be too poorly paid to support a decent standard of living and will be outsourced to temporary immigrant workers in a process that will create a downward spiral of wages and working conditions.

Out of 818 occupations, the Bureau of Labor Statistics projects that personal care aides will be number one in growth over the next 10 years, both in terms of growth rate and sheer numbers. Home health aides are projected to be the fourth fastest growing occupation. Harris v. Quinn will decide whether the gradual, ongoing improvement in the quality and desirability of these jobs continues or the clock is turned back.