Service Employees International President Mary Kay Henry envisions a new social compact between home care workers, employers and governments as her union embarks on a massive effort to organize care workers and lobby for the Biden administration’s Build Back Better initiative.

“Ultimately what we are talking about is a system of care that Medicaid has been the major payer for. It’s not like these mom-and-pop [home care agencies] are plowing back their profits to the service of care,” Henry told McKnight’s Home Care Daily in an exclusive interview. “What is the role of our tax dollars in providing elders and people with disabilities and children with care?”

As many home care firms are feeling the pressure from the SEIU, they have been improving the benefits they provide workers. These include offering signing bonuses, better wages and, in some cases, tuition reimbursement and career advancement. That could offset the desire of some employees to unionize.

Still, SEIU has been leading the charge across the nation in support of Build Back Better, which calls for billions of dollars in funding for home-and-community-based services. The additional funding could boost Medicaid reimbursement to states that could increase wages for home care workers. While the administration’s original aim to pump $400 billion into HCBS has reportedly been scaled back by half that amount, Henry said SEIU is pushing Congress hard for at least $250 billion in HCBS funding.

“The biggest number possible allows us a once-in-a-generation chance to meet the moment of crisis that working people are in and invest in the first ever targeted jobs program that puts women of color and all women at the center of recovery where these women have been the hardest hit by the pandemic,” Henry said.

Henry’s other effort, to organize home care workers, could be a larger challenge. SEIU currently represents roughly 750,000 of the nation’s more than 3 million personal care workers. Home care and domestic workers have historically been difficult to organize because they work independently in client homes, and many states haven’t supported efforts by home care workers, who are paid through Medicaid, to bargain collectively.

But Henry thinks the combination of the pandemic, a shortage of care workers and new administrations in Washington and state capitals are changing the calculus of organizing home care workers.

“People decide enough is enough. I deserve better,” she said. “Sometimes a union organizer helps, but a lot of this effort has been because of the political activism of Black and brown women in gubernatorial races who want to change their lives by joining together and bargaining for a better life, for wages and benefits. It’s connected to civic engagement.”

Henry remains steadfast in her belief that the time is right for organizing the home care industry. As the SEIU’s former healthcare industry strategist, she sees a definite parallel between workers in that industry and those in home care.

“Our home care workers see themselves as the backbone of the healthcare system,” said Henry.

Still,  home care is a much more fragmented industry than healthcare. That could present organizational challenges to unions and opportunities for closer engagement between home care agencies and their employees.