Over the last decade, despite longstanding status as quintessential lowwage work, in-home direct care workers have generated significant and inspiring innovations to improve job quality. Unionization of home health has provided some of the labor movement’s most significant membership increases in recent years, delivering substantial wage and benefits improvements for more than 300,000 workers. Coop models have emerged for direct care work, proving that better wages and working conditions are possible in these positions. And advocacy campaigns for home health workers have increased awareness of these jobs and won significant policy victories to help promote the interests of the workers doing them. This paper sheds light on the issues facing this workforce; offers data on the in-home care workforce, wages and benefits in the jobs; and discusses issues related to working conditions and labor law. We focus on in-home workers not only because they face some of the worst wages and working conditions in the direct care workforce, but also because they represent the fastest growing segment of it, and organizing by these workers has generated important improvements in job quality.