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Columbia Missourian

Proposition B creates argument over home health care standards, union

October 26, 2008 | 8:30 p.m. CDT
Tonja Fix, a home health care worker, helps her client of six years, Jeff VanDyke, shave at his home. Both are unsure of Proposition B because it may lead home health care workers to unionize, which could increase costs. This could lead to a reduction of in-home hours for clients.

COLUMBIA — Tonja Fix doesn't get much time for vacation.

As a home health worker, she said she works 13-hour days and cares for four clients throughout the week. She works every day, including the weekends, but she gets no paid vacation. She earns $9 an hour and, despite her profession, has no health insurance.

"It would be great to have higher wages,” said Fix, 38. “It would be great to have health insurance. It would be great to have all the perks that go along with everyone else's job in the world."

Proposition B, one of several issues that Missouri voters will find on their Nov. 4 general election ballot, looks to address the economic challenges of home health care workers. The initiative would establish a council on home care quality. Critics, however, say it’s a veiled attempt to unionize home health care workers.

The proposition would establish the Missouri Quality Home Care Council, which would have the authority to recommend standards and wage rates for home care workers and recruit more peoplefor the job. The council also would keep a statewide list of available home care attendants in an attempt to make it easier for consumers who need home services to find attendants quickly.

“There are about 50,000 Missourians who qualify for in-home services, which addresses the needs of residents and allows them to stay in their home," Brian Hauswirth, spokesman for the Missouri Department of Social Services, wrote in an e-mail. "Assistance is provided in areas such as cleaning, toileting and meals."

Fix's clients suffer from a multitude of ailments. One was born with spinal muscular atrophy, a form of muscular dystrophy, and another must deal with diabetes, rheumatoid arthritis and lupus. She said the care is more complex than cooking and cleaning. Her client with muscular dystrophy needs her help just to get out of bed and get dressed, she said. She insists that attendants must understand all their clients’ needs and illnesses.

In her six years as a home attendant, Fix has become especially attached to the people she cares for.

"I love them to death," she said. "It definitely goes beyond an employee-employer relationship. I love them like family."

Opponents of Proposition B have not questioned the enthusiasm or capabilities of home care attendants, but they are challenging the politics behind the measure. The proposition, if passed, would amend Missouri law to allow home care attendants who serve Medicaid patients to collectively bargain but not strike.

If Proposition B passes, a statewide sole bargaining agent for home care workers could be proposed if 10 percent of eligible workers vote in favor of it. That 10 percent can force a second vote to create a union, which requires a majority of workers to approve unionization. 

The proposition would affect about 8,000 attendants who serve clients who use Medicaid, said Krissi Jimroglou, spokeswoman for Missourians for Quality Home Care, which is sponsoring the proposition. The Disabled Citizens Alliance for Independence also favors the proposition.

Mary Schantz is executive director of the Missouri Alliance for Home Care, a group that opposes Proposition B. "This is a union attempt to unionization, which is not in the ballot language," Schantz said. "It's misleading."

Schantz worries that Missourians won’t know what they’re voting on.

Everyone wants quality home care, Schantz said, but the proposition does more than that.

"The entire language is ambiguous," Schantz said. "We're taking a group of people and turning them over to a private group. It's bad business."

But Richard Blakley, executive director of the Disabled Citizens Alliance for Independence, said “the point is to have someone to bargain with the state. We're looking for a mechanism to help get higher wages."

Blakley added that there are not enough attendants in Missouri and that higher wages and benefits might attract more people into the field and keep them there.

"We want to do this so you can do this as a living,” he said.

The Service Employees International Union also supports the proposition's passage and has financially backed Missourians for Quality Home Care. Jimroglou, the spokeswoman for Missourians for Quality Home Care, said she is a paid employee of that union.

"I know critics out there say, 'Oh, this is another tool to get the union more workers.' Like I said, this is about improving the quality of home health care in the state of Missouri," said John Cross, political director of Service Employees Union International Local 2000 in St. Louis. "If the workers want to unionize, that's up to them, but that's not the main part of this proposal."

Cross said that he didn’t know how much money the union has contributed to the Missourians for Quality Home Care campaign but that it could not have been much because the union doesn't "have the money like other corporations, like the gambling folks."

According to campaign finance reports on file with the Missouri Ethics Commission, however, the union has contributed more than $1.1 million in cash and in-kind services to Missourians for Quality Home Care’s campaign committee since it was established in January. The union is the only donor listed on its reports.

Schantz said she would not favor the proposition even if the collective bargaining and language issues were removed.

"The council itself is a bit alarming," Schantz said. "It's a quasi-government group, and it has no oversight."

The 11-member council would be given a wide range of responsibilities over non-medical workers who help with daily living for the elderly, disabled people and others who qualify for home care. The council also would have the authority to make referrals of personal care attendants and to provide voluntary training.

"I'm equally as concerned about a council where supervision can only occur on budgeting and reporting matters," Schantz said.

Since the council is funded by taxpayers, Schantz said there should be a route for taxpayers to express their concerns about policy decisions.

"The privatizing of this program is not the way we should be going," she said.

Missouri monitors home health care through two state agencies, the Department of Health and Senior Services and the state's Medicaid unit, MO HealthNet, which is part of the Department of Social Services. The health department sets standards for state licensing of private home health care agencies.

Proposition B would not affect regulations governing medically skilled professionals, said Lisa Coots, administrator of the health department's Home Care and Rehabilitative Standards Unit. It may affect consumer-directed services and members of the public who hire through this service.

Fix, as a provider under consumer-directed services, is ambivalent about the proposition.

"Most of us workers are all aiming for the same thing: benefits and higher wages,” she said. “And I would feel that because I work so much I don't have time to fight for what my beliefs are, so that would be handy, I suppose, to be able to have somebody to step in where I can't."

On the other hand, Fix worries that if the proposition passes and takes effect on Jan. 31, it could have a negative impact on her and her clients.

"I haven't heard anything negative about it, but, just like everything else in the political field, those things won't come to light until after it gets put in," she said. "That's my biggest fear."

A portion of this article was originally reported on Missouri Digital News.

Official Ballot Language

Shall Missouri law be amended to enable the elderly and Missourians with disabilities to continue living independently in their homes by creating the Missouri Quality Homecare Council to ensure the availability of quality home care services under the Medicaid program by recruiting, training and stabilizing the home care workforce?

The exact cost of this proposal to state governmental entities is unknown, but is estimated to exceed $510,560 annually. Additional costs for training are possible. Matching federal funds, if available, could reduce state costs. It is estimated there would be no costs or savings to local governmental entities.

Proposed fair ballot language for Proposition B:

A “yes” vote will amend Missouri law to enable the elderly and Missourians with disabilities to continue living independently in their homes by creating the Missouri Quality Homecare Council. If formed, this council will ensure the availability of quality home care services under the Medicaid program by recruiting, training and stabilizing the home care workforce.

A “no” vote means the Missouri Quality Homecare Council will not be created.

This measure will have no impact on taxes.

For the full text of Proposition B, go to the Missouri secretary of state Web site.