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A brief roundup of recent direct-care worker state news:

Court Rules That Missouri Home Care Workers Can Unionize

A state appeals court ruled May 1 that Missouri home care workers can unionize, ending their three-year battle to gain legal recognition as a union in the eyes of the state.

In 2009 and 2010, Missouri’s 13,000 home-care workers voted — by overwhelming margins — in favor of unionization. Both times, however, the votes were thrown out in court after anti-union activists challenged the results, alleging procedural flaws in the voting process.

Last week, however, a Missouri appeals court ruled that the state had to validate the 2010 election, thus clearing a path to the creation of a union for home-care workers.

The newly formed union, Missouri Home Care Union, is a partnership between SEIU and AFSCME.

Minnesota PCAs Temporarily Spared Wage Cuts

Proposed wage cuts to thousands of personal care aides (PCAs) in Minnesota were left out of the state’s latest Health and Human Services (HHS) budget, which Governor Mark Dayton (D) signed into law April 30.

The original HHS budget bill would have reduced state spending on PCAs by nearly $6 million. The cuts would have affected as many as 7,000 family caregivers who serve as PCAs to low-income relatives and receive payment through Medicaid.

The controversial cuts were deemed legal by a district judge in March after being challenged in court by eight Minnesota home care agencies. Despite the judge’s ruling, however, the legislature removed the cuts from the final budget sent to the governor.

Additionally, the budget bill postpones a $20.6 million rate cut to long-term care facilities. The postponement could give Minnesota enough time to negotiate a deal with the federal government, rendering the cut unnecessary.

Alabama Gov. Pushes for More Medicaid Funding

Alabama Governor Robert Bentley (R) vowed on May 2 that he would veto any General Fund budget bill that allots less than $602 million for Medicaid.

The governor’s announcement was a response to an early FY 13 budget proposal from state lawmakers that would have set aside just $400 million in Medicaid spending, 30 percent less than the FY 12 Medicaid allotment.

On May 8, a State Senate committee approved a budget bill that would devote $418 million of the General Fund to Medicaid, with the remaining $184 million to come from a line of credit from a state trust fund.

The credit line can only be created through a constitutional amendment, however. The state legislature is currently considering the amendment; if it passes, it will have to be approved by Alabama voters.

– by Matthew Ozga

Minnesota can enact a proposed 20 percent cut on the wages of paid family caregivers, according to a March 23 ruling by a district judge.

The cuts would lower caregivers’ hourly wages to $9, from approximately $11, and could affect as many as 7,000 family caregivers who serve as personal care assistants (PCAs) to low-income relatives and receive payment through Medicaid.

Originally enacted by the state legislature last year to help close a $5 billion budget gap, the cuts are expected to save the state just $17 million if they take effect.

Last fall, after eight home care agencies filed suit against the state, Ramsey County District Judge Dale Lindman ruled to temporarily block the cuts from taking effect. In his March 23 decision, however, Lindman reversed his own decision, giving the cuts his stamp of approval.

Hope for Delayed Enforcement

Minnesota Governor Mark Dayton (D) has voiced opposition to the wage cuts, and advocates — including many home care agencies — hope he will delay their enforcement until the end of the current legislative session.

Tim Plant, the executive director of Healthstar Home Health in North St. Paul, told the Minnesota Star Tribune, “We disagree with the judge. The law requires unequal pay for equal work, and some of these PCAs are very low-income. They can’t afford the pay cut.”

Lindman, however, said that he agreed with the legislature’s assessment that the PCAs have “moral obligations” to care for their relatives, and would continue to do so despite being paid a lower wage.

The eight home care agencies say they plan to appeal Lindman’s decision.

– by Matthew Ozga

In the last six years, thousands of Minnesotans with criminal records were granted state waivers allowing them to pursue jobs as long-term caregivers, according to a recent article in the Minnesota Star Tribune.

Under Minnesota law, many criminal convictions automatically disqualify job-seekers from employment at nursing homes, home care agencies, assisted living facilities, and group homes.

But the state waived that stipulation for more than 5,000 former criminals seeking caregiving jobs in the last half-dozen years. It is not clear how many of those people went on to obtain jobs in care facilities and at home care agencies.

The Star Tribune also reported that more than 900 aides who got jobs as nursing aides in Minnesota since 2000 despite having a criminal conviction on their record.

Of those 900-plus caregivers, 44 of them — approximately 5 percent — went on to commit another crime.

“Criminal background checks are an appropriate requirement for employment as a direct-care worker, and evidence of serious law breaking should disqualify people from caring for vulnerable Minnesotans,” said PHI Curriculum and Workforce Development National Director Peggy Powell. “But people who have relatively minor misdemeanors on their records should be given a second chance to contribute to society.”

Program Highlights Recruitment Challenges

“Minnesota’s waiver program demonstrates the challenges we face — both here in Minnesota and on a national level — recruiting the best, brightest, and most highly skilled people to do this important work,” said Amy Hewitt, a senior research associate at the University of Minnesota’s Institute on Community Integration.

“Unfortunately, articles such as the Star Tribune’s contribute to the widespread perception that direct support positions are staffed primarily by criminals — which is emphatically not true,” Hewitt continued.

“Until we recognize the value of the direct support workforce by offering robust training and credentialing programs, living wages, and access to benefits, employers and individuals will continue to have difficulty attracting top talent to these jobs,” she concluded.

Concern for Elders

Martin Kennedy, director of the Division of Continuing Care Providers with the federal Centers for Medicare and Medicaid Services (CMS), told the Star Tribune, “There are a lot of criminals who end up trying to go to work in long-term care, and that places those residents at risk.”

Studies show that approximately 14 percent of elders are abused each year. A Government Accountability Office report issued last March, however, determined that this figure almost certainly underestimates the extent of yearly elder abuse in the U.S., since the vast majority of elder abuse goes unreported.

A 2005 report (pdf) by the National Center on Elder Abuse, a government agency, found that elder abuse does take place in long-term care settings. Nevertheless, “the great majority of abusers are family members, most often an adult child or spouse,” not direct-care workers, the report stated.

In 2009, the National Criminal Justice Reference Service, another government agency, issued a report (7 MB pdf) showing that more than three-fourths (76 percent) of physical elder abuse was perpetrated by someone related to the abused elder.

A CMS-endorsed training curriculum designed to prevent elder abuse and neglect is available as a free download at the PHI website.

– by Matthew Ozga

Minnesota’s budget gap forced the state government to shut down on July 1.

Governor Mark Dayton (D) is at an impasse with the Republican-controlled legislature over its unwillingness to approve a budget that is adequate to cover state services, as well as its refusal to help close the funding gap by increasing the income tax rates for millionaires.

While state parks, rest stops, licensing, and other services are closed, thousands of low-income elders and people with disabilities with Medicaid — known in Minnesota as Medical Assistance — are still receiving care in nursing homes and veteran homes, the Wall Street Journal reports.

However, according to the Star Tribune, all Minnesotans who depend on long-term services and supports are beginning to feel the pinch.

Hiring on Hold

The state’s background check office is closed and not processing the more than 400 criminal checks that it usually handles each week for nursing homes and assisted living facilities that want to hire new employees.

The two nursing home associations in the state and Gov. Dayton are asking a “master” appointed by the court to reopen the background check office.

Additionally, state inspections and oversight of nursing homes and home care agencies, along with building repairs to state nursing facilities, are all on hold during the shutdown.

Unwilling to concede to Republican demands for no new taxes, Dayton told reporters, “I cannot accept a Minnesota where elderly widows are denied the at-home services that permit them to remain healthy and able to live in their own homes…so that millionaires do not have to pay one more dollar in taxes.”

Dayton refused to sign the $34 billion budget proposed by the legislature. State economists say that $39 billion is needed to maintain current state services, according to the Star Tribune.

– by Deane Beebe

Neil Johnson, Executive Director, MN HomeCare Association

Neil Johnson, executive director of the Minnesota HomeCare Association, writes about the need to invest in our home care workforce. Read the full story

Are rising gas prices making it harder for you to deliver or receive care? Add your comments at the end of this post. 

We all feel the pinch from high gas prices, but for home care workers it’s more of a punch. As PHI President Steven Dawson puts it: “The doubling of gas prices over the past few years has been like a pay cut for many home care workers — particularly those serving clients in rural areas.

“Policy makers like to believe that home care is cheaper than nursing homes, but that’s only true because home care workers are paid less than nursing home workers, often without health benefits,” adds Dawson. “There’s not much good to say about higher gas prices, except perhaps that they will now force policy makers to look more closely at the real costs of shifting toward home-based care, and in response create realistic reimbursement policies that will offer home care workers a true livable wage and benefits.”

When PHI’s Michigan State Director Hollis Turnham wrote about the home care gas crisis in our blog in June, talking about the problems she was already hearing about, anticipating others, and asking what other people were experiencing, the response was swift and impassioned. An employer called rising gas prices “the 500 lb gorilla in the room for home care agencies.” A home care worker talked about seeing turnover increase and “looking for something closer to home myself.” The head of a home care and hospice aide recruitment agency said he planned to do “something very tangible to address this issue,” though he wasn’t ready yet to say just what. 

Read the full story