Proposition B addresses home health work conditions

Thursday, October 2, 2008 | 2:36 p.m. CDT; updated 5:09 p.m. CDT, Thursday, October 2, 2008

KANSAS CITY — Supporters say an initiative on November's ballot will help both home health care workers and disabled and elderly Missourians who need those workers to remain independent.

But others are raising concerns that the initiative — Proposition B on the ballot — is a stealth attempt to unionize home health care workers in Missouri.

The proposition would create the Missouri Quality Homecare Council, with duties that would include recruiting home health care workers, recommending wages and economic benefits rates to the Legislature and maintaining a statewide registry of personal care attendants.

It would also allow home health care workers to unionize but would ban them from striking. The Service Employees International Union helped fund the petition initiative.

"What this is about is giving consumers a voice in improving home health care," said Alphonso Mayfield, executive director of Missourians for Quality Home Care, a coalition that collected more than 200,000 signatures to get the issue on the ballot. "Ninety-nine percent of it is related to improving home health care. If the workers unionize, that's their choice, but it's not the main part of the proposal."

Many disabled and elderly Missourians who are eligible for Medicaid hire and train their own home care workers through Consumer Directed Services, a personal assistance program that emphasizes consumer control and keeping the elderly and disabled in their homes.

Others turn to various private home care companies and agencies that do the hiring and training of workers.

Mayfield said the proposition would affect only people hiring workers through CDS and would have no impact on the private home care industry.

But Mary Schantz, executive director of the Missouri Alliance for Home Care, the state's largest trade association representing home health groups and private duty companies, said the initiative's language is so ambiguous it's hard to know what the impact will be.

"We don't know how the Missouri Quality Homecare Council is going to be implemented or how it's going to impact consumers," Schantz said. "It appears the effort is mostly geared toward unionizing this work force."

The Missouri Chamber of Commerce and Industry also has questioned the initiative, although it said it is still evaluating how to respond to it. The chamber said in a statement that the proposal would allow unionization if 10 percent of the workers expressed a desire to organize, well below the 30 percent generally required to vote on unionizing.

The chamber said it wants voters to be aware that "a seemingly innocent November ballot initiative contains potentially harmful language that could greatly increase health care costs for the state and private providers."

The Homecare Council would have 11 members appointed by the governor, with six being people who have used home health care services through Consumer Directed Services. The other five members would be from the Missouri Department of Health and Senior Services, the Missouri Centers for Independent Living and the governor's advisory councils on aging and disabilities.

A ballot summary says the council would cost the state at least $510,560 a year, although matching federal funds could reduce that amount.

Few dispute that home health care workers have a difficult, physically demanding job that pays little and offers few benefits, causing a high turnover rate.

Bob Pund, 40, of Columbia, who was left a quadriplegic after a 1989 car accident, said he's often had problems finding and keeping home health care workers to help him with such basic tasks as getting in and out of bed, showering and eating.

"The pay is very low, there's no benefits, no insurance or workman's comp," Pund said. "And it's physical, hard work. The work force needs to be stabilized. Even people who like the work find they can't support themselves doing it and have to leave."

He also argued that improving working conditions for home health care workers would save taxpayers money because it costs far less to care for someone at home than in a nursing home or other institution. And the problem will only get worse as baby boomers age, he said.

Schantz agreed that the wages, benefits and working conditions of home health care workers could be improved, but she said the industry is often caught between paying an attractive salary and keeping rates reasonable for consumers.

"Nobody wants their loved ones put at risk. We'd all like for them to be able to stay in their homes" she said. "We all have the goal of quality workers and good training. Most home care agencies try to pay workers and provide some benefits. Everyone wants to find good workers and keep them."

Pund and Mayfield said keeping a statewide registry of workers would be an important part of the initiative because it is often difficult to quickly find a replacement through the Consumers Directed Services when a worker quits.

"If there's a statewide registry, I could call somebody else or even have a backup ready," Pund said. "Otherwise you may do without any service. In my situation, when I can't get out of bed, that's a bad situation."

Schantz said having a statewide list of workers who either are home health care workers or who have expressed an interest in the job could be helpful. But she noted that the state already has a Family Care Safety Registry, which runs background checks on workers in nearly every field that cares for children, elderly or the disabled.

"It's unclear as to what the purpose of (the statewide registry) would be," Schantz said. "My best guess is it may be a union recruitment tool. But again, the ballot language is unclear, so I'm not certain."

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