In this episode, we examine the crisis in Oregon’s system of long-term care. Demand for long-term care is rising as our population gets older. But the workers who provide this essential care are underpaid, overworked, and leaving the industry. Melissa Unger, Executive Director of SEIU 503, explains the reality endured by long-term care workers. Also, David Madland of the Center for American Progress explains how workforce standards boards could help stabilize workforces in industries such as long-term care.

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Transcript

[We make this transcript available for your convenience and to increase the accessibility of our content. The transcript was generated by software and was slightly edited for clarity. If you are able to, we encourage you to listen to the recording.]

Juan Carlos Ordóñez (host): Oregon’s population is getting older. Since 2023, Oregon has had more elderly people, people over the age of 65, than it has had children under the age of 18, according to a report issued by the Oregon Office of Economic Analysis last May. The state economists said that they expect this trend to accelerate in the years to come, leading to a rapid increase in the demand for elderly care. 

The demographic reality of Oregon’s aging population is on a collision course with the reality of the industry and workforce that cares for elderly Oregonians. There is a huge turnover rate among Oregon’s long-term care workers, the workers who perform the physically and mentally difficult job of caring for seniors and people with disabilities who cannot take care of themselves. This high turnover rate is no great mystery. It’s what happens when a difficult job comes with low pay, poor benefits and tough working conditions.

In the upcoming 2026 Oregon legislative session, the session is set to take place in February, lawmakers are expected to consider legislation that would establish a board that would help set wages and working conditions in the long-term care industry. In this episode of Policy for the People, we replay a conversation from 2023 with Melissa Unger, executive director of SEIU Local 503, which represents many long-term care workers in Oregon.

In that conversation, Melissa described the working conditions and challenges faced by Oregon’s care workers and the policy changes needed to ensure that care workers can also take care of themselves and their families. I began the conversation by asking Melissa what “long-term care” means. 

Melissa: The idea of long-term care is that it is care work for people with physical disabilities that are long-term and are not going to fix themselves, who are seniors or people with developmental disabilities. That we’re the care that they need or the support that they need is not going to change throughout their lives. So it’s going to be long-term work. 

The way that we often are involved is with the group of providers who do that through Medicaid, which is often a federal funding stream that supports long-term care work for people who don’t have the resources otherwise to get the support that they need.

Juan Carlos: And where is this work performed? Is it in the patient’s home? Is it in a facility? Where does it take place?

Melissa:  It can actually happen in all of those places. So one of the key elements of long-term care, and it’s a place where Oregon should be really proud of our work, is to make sure that people have choices. What is the best place for them to get the services they need?

So most of our long-term care workers, our home care workers, and personal support workers provide that support in-home because that is oftentimes people’s preferences. But it can also support facility-based work because we have to be honest that not everyone can make that choice. So long-term care can also be provided in facilities, an assisted living facility, a residential care facility, or a nursing home, which is more usually a short stay. That has to do with acute medical needs, but also gets served through long-term care. 

Juan Carlos: How big is this workforce? I’m wondering how many Oregonians are working in providing long-term care. 

Melissa: We alone represent about 40,000 long-term care workers, and we estimate that that’s not even quite half the workforce. So we think there’s probably in the range of 95 to 120,000 long-term care workers.

And these workers are overwhelmingly women, and disproportionately people of color. Nationally, the majority is people of color. In Oregon, they are not majority people of color, but they are disproportionately people of color and overwhelmingly women. 

Juan Carlos: How would you describe the working conditions of long-term care workers? 

Melissa: You know, when I think about long-term care workers, I often think about the work that home care workers did to organize a union in 2000.  Their whole slogan was “invisible no more”. People who do this work feel invisible. They’re making sure that people can live with dignity in their homes or in a facility, and oftentimes people completely just look them over. There’s a real lack of, I think, view into this workforce in the critical work long-term care workers and overall care providers provide to our communities and to our families.

In the 1930s, when workers were allowed to organize, care work was not included in that. And that’s because oftentimes these workers are immigrants, they’re black and they’re women. And so they’ve been excluded from many of the protections that other workers have had. And so as that has evolved over the years, it means that they’re underpaid. 

When home care workers first organized in our union, they were paid less than $2.50 an hour. They had no taxes taken out of their paychecks, and they did not have health care. 

Juan Carlos: I imagine that the work of caring for an older person or someone with a disability comes with a fair amount of physical and emotional demands. I mean, it’s pretty challenging work, I imagine. 

Melissa:  It is. It’s oftentimes lifting, it’s helping bathe someone. It’s helping someone go to the bathroom. It’s helping move someone in and out of doctors appointments. Oftentimes, if it’s in a facility, it’s helping people in and out of beds. And so it’s very physical work. But I think that the thing I hear from our workers the most often is just the emotional piece of it.

They care so much for their consumers. And on a regular basis, consumers pass away. Or they can have behavioral health challenges that can cause them to have outbursts. And so there’s a constant emotional toll. And one of the things I think a lot about is like when a home care worker loses a consumer, someone that they’re caring for in that person’s home, sometimes that can be a relationship that’s lasted for years and they die.

They don’t get a paid day off after that. They don’t get any support. There’s no system set up to make sure that that person’s job continues 

Juan Carlos:  I want to go back to something you mentioned earlier, which is the wages of workers in this sector. I’m wondering if you can tell us what the latest numbers show in terms of what long-term care workers get paid?

Melissa: You know, it is a range. And I will say, we’ve been able to make real progress for unionized caregivers in the last couple of years, but it’s still very low. So home care workers wages are now at $17. 77 an hour. And, to put that in context, they’re doing this very hard work, where I think Target might now have a starting wage of $24.

But at the same time, they often don’t have full time work. And so most home care and personal support workers often find themselves making less than $20,000 a year, because they don’t have full time work and they have to piece together all of these consumers to be able to even create full time work.

So oftentimes people are working 10, 15 hours a week.  For nursing home workers, it’s definitely a range. But just for a CNA who has to get training, pass a test and have a license, their wages will often range, at a unionized facility, between $20 and $27. And that is after massive work during the pandemic to increase wages.

And I think that while that is progress, it’s clearly not enough. And it does not represent the difficulty of their work and doesn’t represent really the reliance we have on our society for them doing their work. And I think the other thing I would highlight is that it’s not just about wages, it’s also about access to benefits and health care. And so we’ve been working very hard to create an accessible health care plan.

But just one example is, in a nursing home that we represent, we just got a new health care plan and worked really hard, both with the state to help support health care for essential long-term care workers and with employers. But there was a member that we had that was paying $800 a month for their premium share for themselves, their, their spouse and their child.

And that is not uncommon. And then the health care they had, had an $18,000, out-of-pocket maximum. So the reality is that health care was not accessible and affordable. It was only for emergencies. The idea that people whose whole job is keeping other people healthy and they don’t have health care is a huge problem.

Juan Carlos: What have you heard from long-term care workers in terms of their ability to make ends meet, in terms of their ability to take care of themselves and their families? 

Melissa: Well, I’ll just tell you a story I heard yesterday. I was with long-term care workers in Salem telling their stories. And one of our workers shared with a legislator that she had a consumer, a client that she was working with, and for some reaso, that work ended. She immediately was left with no work, and there’s no system to help find another consumer. So in that gap, she lost her place to live. And now she has a new consumer a couple weeks later, but she now no longer is able to stay because she wasn’t able to pay rent. And she now has to have first and last month’s rent to be able to find some place to live. But she hasn’t been able to work long enough to be able to actually pay that first and last month’s rent. 

That is an indication of how on the edge every one of these workers is working. In that same meeting I heard about two other caregivers who are living in a trailer or living in a car, because they can’t afford to rent in the communities they live in and in the communities they care in. If someone is caring for someone to make sure another family can function, they should be able to provide for themselves. And what I hear every day is that’s not true. 

Juan Carlos: Yeah. It seems that for workers who are providing care to others, to our loved ones, to ourselves, we want them to be able to take care of themselves as well. For their own physical and mental well-being, if they’re better off in that respect, so are we.

Melissa:  We as families and as communities could not function without the support of care workers. And yet they are often some of the most underpaid workers in our economy. And I don’t think that that can be divorced from the fact that they are women and women of color. And we have to really readjust to the role they play in our communities and our families and respect that role.

And understand that if we don’t, people will not continue to do this work. There is a huge workforce shortage, and yet we still haven’t figured out that some of this is about respect, valuing the work and doing that by giving workers the same protections and the same rights that workers throughout our industry have. And I think I would be remiss to not highlight that government is the major funder of long-term care work when it comes to Medicaid.

And yet government is making a decision many times to make this a system of low wages. Employers are a part of that, too. I do not want to let employers off the hook. They’re making decisions and often making profit by underpaying folks. But government also has the control to change this dynamic. And so we really think it’s a key element to figuring out how to make progress for care workers as employers, workers and government coming together in deciding what kind of state do we want to be, where we’re lifting up this work and celebrating this work.

I often think about the fact that we have done that in a lot of ways around construction trades. The government sets a wage standard through a prevailing wage for government construction workers who are oftentimes men, overwhelmingly men. And they have that system where they don’t give employer’s choice. They have to pay a certain rate if they’re going to get government dollars.

Yet when it comes to care work, which is as equally and maybe even more government supported, they have none of those same standards. And I think that we should really be asking government why there’s different standards for these different types of work that government supports and pays for. 

Juan Carlos: You mentioned the high turnover in the industry, which is perhaps not surprising given that it’s very demanding work and not paid very well. And I’m wondering what this high turnover rate means for clients, for the workers, for the industry as a whole. 

Melissa: You know, one of our members tells a story a lot about a consumer who has gotten long-term care supports for a very long time and can’t really get out of bed without a care provider. So, 24 hours a day. They have caregivers who come support them. And they talk about how this one time, an agency that was helping provide home care work, for this consumer, subbed out a worker without any notification to the consumer because the worker quit their job. And so that person was in bed. Someone they did not know walked into their home and came to help get them out of bed and bathe them.

Someone they’ve never met and they didn’t even know it wasn’t going to be the person they were expecting. And I think that story really highlights to me the impact on consumers when there is high turnover. And also just like the everyday relationship that’s built between a caregiver and a consumer. And so the high turnover has real impact.

If you’re training someone on how your oven works, about what type of food you like, about how you like to be bathed, about how you like to be supported, to get in and out of bed or use the toile, and that person is changing on a daily basis or on a weekly or monthly basis, it’s traumatic in some ways. 

So that’s one example of how high turnover impacts consumers. But another example is that many consumers just can’t find a worker because there’s not enough workers. And then the last example is in facilities. Our members who work in facilities right now are often completely short staffed, and they find themselves in a situation where they are running all day long to try to get to somebody when they ring their bell.

And, you know, the consumer has every right to be upset that it takes an hour and a half for someone to get there. But then they will often learn that there’s only two people on shift because there’s not enough people to fill the shifts. And that is oftentimes a choice that employers are making at their understaffing facilities. But right now, it’s really indicative of the workforce crisis that’s impacting this entire industry, where they cannot hire people because if you’re paying $21, to help someone go to the bathroom and bathe them and deal all the emotional work it takes, and that same person can make $21 across the street at a Target. It’s a real hard case to make that this is the right job for them. 

Juan Carlos: And it would seem that the demand for long-term care workers is only going to grow in the years and decades to come, because our population is aging. So there’s going to be more people needing care. I’m wondering if you’ve seen any data on that point.

Melissa: It’s one of the fastest growing industries in Oregon. It’s expected to increase by 24% between 2020 and 2030. And I can tell you from working with over 40,000 workers in this industry and also just being with the employers and on the ground with government as they’re trying to deal with this, our state is completely unprepared for the increase. And the impact will be people going without care or going with inadequate care.

Juan Carlos: I want to switch gears here and talk about what can be done at the policy level to improve working conditions for long-term care workers, and you’ve already begun to describe some of the things that could be done. You reference establishing a board that sets standards. What would you like to see the Oregon Legislature do in this regard?

Melissa: I feel like there has to be a real focus on this industry and on these workers. You know, we often try to recruit jobs to Oregon. These are jobs that are here and are going to only grow. So what is the legislature’s responsibility to lean in and focus on these jobs? Especially because these are jobs that government actually funds.

So one thing I want them to do is have a more robust, stronger conversation about this industry, this work, the fact that Oregonians rely on it so much and they support it. And so how do we get them to just really engage like they do on many other workforce issues? So that’s one piece, but two, I do really believe, at the core, that they should figure out what is their role in setting standards.

So, you know, we introduced a bill this legislative session called Senate Bill 602. That bill is really about how do you get together government workers, employers, and consumers and really say, what is needed in this industry?  What is needed in terms of wages, what is needed in terms of benefits, what is needed in terms of workforce enhancements? So that we can make sure as a state, we have a plan. 

Juan Carlos: As I understand it, Senate Bill 602 that you referenced is not moving forward this session. I’m wondering if you can talk about the legislature’s decision not to advance it. It seems like a missed opportunity. And what the way forward may be in the years to come, in terms of advancing this idea.

Melissa: The reality is that new ideas like this often take time. This is just a moment. We got to introduce the idea. We got to hear people’s support for the idea and also people’s opposition to it. And think about how we come back and continue to make this case. I really do believe that we’ll be back next session and in the session after that, to get the government to really think about their role in this. I think that we made progress. 

Juan Carlos: Melissa, as we wrap up, let me ask you, are there any final thoughts regarding long-term care workers that you would like to share with us?

Melissa: I believe long-term care workers are the backbone of our economy in many ways, just like childcare workers. I mean, caregivers really make sure that our economy works.

They make sure that people can go to work. When I had kids, I was able to go to work because someone was able to watch them. And that’s the same as people who are caring for aging parents or people who have a child with a developmental disability. And so the fact that they aren’t honored in the way that they should be and respected in the way they should be underestimates that they are the fundamental foundation of how our economy functions every day.

So I just hope that we can start to give them the respect they deserve for the fact that they make our entire system work well. 

Juan Carlos:  That was Melissa Unger, executive director of SEIU 503, speaking in 2023 about the working conditions and challenges faced by Oregon’s long-term care workers.

I recently sent a note to Melissa asking for an update, asking where things stand right now. This is what she said in a written response:

“The need to improve the wages and working conditions of long-term care workers has not gone away. In fact, it’s become more urgent, as we continue to see high turnover in the workforce, as well as growing demand for long-term care due to the aging of our population. States like Minnesota and Nevada have shown that establishing a statewide workforce standards board to set minimum pay and working conditions in the industry can help end the care staffing crisis. It’s time for Oregon to do the same.”

So what exactly is a workforce standards board that Melissa refers to? 

A few months ago, I spoke with David Madland, an expert on the topic of Workforce Standards Boards. David, a Senior Fellow at the Center for American Progress, explained the growing interest in Workforce Standards Boards as a way to improve pay and working conditions across entire industries. Here are excerpts from that conversation.

So, David, in recent years, we’ve seen growing interest in workforce standards boards. And these are sometimes called wage boards or industry boards. Can you explain to us what these boards are and what problem they are trying to solve?

David Madland: So these boards, as you mentioned, have passed now in about six states and three different cities. And what they do is they bring together representatives of workers, representatives of companies and representatives of the government to sit on a board or a panel to set standards for an entire industry. So things like wages and training standards. 

And the reason that they’re important is, I think, for a couple of things. They bring together the people who are most directly affected by standards and give them a voice, especially in industries where those workers would have a really hard time expressing their voice. But they also give the opportunity for employers to similarly have a voice and speak to the challenges that they’re facing. 

Juan Carlos: And who creates these workforce standards boards. How did they come into existence? 

David: Well, the legislature passes a law, then the governor signs. Or if it’s a city, the city council passes and the mayor signs, creating these bodies that gives them some authority to set some standards and outline the kinds of people who will represent the workers and represent the employers on the board. 

Juan Carlos: What is the need for these workforce standards boards? What problem there is solving the traditional workplace organizing hasn’t been able to. 

David: So these boards are solving for a lot of simultaneous problems. So one you mentioned is worker organizing. Trying to form a union and then collectively bargaining at an individual worksite is very challenging under our current laws. And in certain kinds of industries, especially what we consider sort of heavily fissured industries that are spread out and disaggregated (because of layers of contracting and the like) are very hard for workers to come together, and form a union and then be able to negotiate.

And even if they somehow succeed in winning a union, which is almost impossible, the firms that they negotiate with would have a difficult time raising the standards, because they’re just a one little small player and their direct competitor would have much lower labor costs. So these boards help address those issues by bringing all the players together, giving the workers some sort of an actual seat at the table, and ensuring the standards are going to be equal across the entire industry, so that all employers compete on a level playing field.

And I think that’s the major thing that they are addressing, but they are also addressing some other challenges. A lot of times certain industries, like the care industries, have issues with recruitment and retention of staff. And so they need to not only raise wages, but they need to find ways to approve and increase the training there.

And so these boards allow you to address multiple interrelated issues and have the voices of the most directly affected people involved and at the table. When I’ve spoken to workers who are participating in these boards, they really appreciate the voice. And sometimes that’s the voice that they heard, the worker who actually is on the board. But other times, even just the people who can participate, they say, yes, I had the opportunity to speak at this hearing and talk about the challenges that we face. And so that I felt heard and empowered. 

Juan Carlos: Are there benefits to businesses in the industry as well? 

David: Yes, there definitely are. I have spoken to a number of businesses who are on these boards and one that stands out was an employer who said something like, ‘I know my business much better than any legislator or politician does. And so the fact that I am here and can help set the standards is and, and negotiate and talk to that directly with the workers and come to a compromise is a much better way than just having the legislators in the capital make some decisions.’ Others will say, you know, at least I’m competing on a fair playing field. Whereas if I was forced to have higher wages than my competitor, that wouldn’t be the right situation. Instead, we can compete fairly and I can show that I run my business better. And then the last thing is, some employers appreciate the ability to solve these collective challenges that go across their entire industry, and they wouldn’t have a vehicle for doing so.

As I mentioned, in certain kinds of industries, especially care industries, there’s significant worker shortages. So for example, nursing homes are short staffed and they could make more money if they could hire more staff because they can take care of more residents, but they can’t do that. They need this body to help them set the standards that are going to enable them to hire more workers.

Juan Carlos: Are workforce standards boards a relatively new idea, or does it have, a longer history?

David:  It has a very long history. So it’s more new and old. In the early 1900s, what we call the Progressive Era in the United States, many states, in fact most states, had something akin to these sectoral standards bodies where workers and employers and the government would set minimum standards.

Since 2018, there’s been a rebirth of this idea. Probably the most well known is in California for fast food workers. It’s created a standards board, and they have successfully raised a significant, quite high minimum wage for these workers, just in the first year of its operation. But also, in Nevada home care workers have boards. Minnesota has nursing homes. Then we have agriculture boards in Colorado and New York. And my view is that we will continue to see this trend spreading, because of the success that this new wave of  standards board has created.

Juan Carlos: That’s it for today’s show. Thanks for listening. And we will see you next time.