In Missouri, 12,000 self-employed home care workers will be represented by the Missouri Home Care Union (MHSU), which is affiliated with the Service Employees International Union (SEIU) and the American Federation for State, County, and Municipal Employees (AFSCME).

“Missouri attendants and their consumers have been coming together in Jefferson City to fight against state budget cuts that threaten home care for over 40,000 Missourians,” according to MHSU’s website.

In Wisconsin, 5,000 independent home care workers will be represented by SEIU. “The vote could result in a minimum wage being negotiated” for these workers, reports the Milwaukee Journal Sentinel.

Number of Personal Care Aides Underestimated

In 2008, according to the U.S. Bureau of Labor Statistics (BLS), there were a total of 817,000 personal care aides. “A growing number of direct-care workers work directly for consumers and their families rather than being employed through an agency,” explains PHI FACTS 3: Who Are Direct-Care Workers? (pdf).

The Employment Projections Program estimates that nearly a quarter of these personal care aides were either directly employed by private households or were self-employed, but PHI suggests that these figures significantly underestimate the actual number of home care workers and the proportion that are hired directly by consumers across the country.

As evidence, PHI notes that the count of home care workers who are part of state or county public authorities currently totals over 400,000 and is now even higher with the addition of the workers in Missouri and Wisconsin.

The newly unionized home care workers in Missouri and Wisconsin who work now under the aegis of a home care council are joining their counterparts in five other states: California, Oregon, Washington, Michigan, and Massachusetts.

– by Deane Beebe

Requiring someone to be homebound in order to receive home health services covered by Medicaid violates federal Medicaid law as interpreted by the Olmstead Update #3 (pdf), issued by the federal Medicaid agency after the Supreme Court’s 1999 Olmstead decision.

“We are very pleased that CMS has protected Medicaid recipients by verifying that the more restrictive Medicare homebound requirement does not apply to Medicaid,” said Vicki Gottlich, LLM, JD, senior policy attorney, at the Center for Medicare Advocacy (CMA).

“Their action ensures that people will get the home health services they need,” she said.

In a February 26 letter (pdf) to the state’s social services department’s director, CMS said it will withhold a percentage of Missouri’s federal share of Medicaid dollars unless the state submits a new plan or requests a hearing within 30 days.

Unlike Medicare’s homebound requirement for home health services coverage, Medicaid has never required that someone be homebound to be covered by Medicaid for home health services.

CMA reports that the law regarding Medicare’s homebound classification and the federal agency’s interpretation of it “have been softened to clarify that a person need not lose home health services merely because s/he left home for short periods of time.”

– by Deane Beebe

Missouri home care victory conference - St. Louis, July 24, 2009

Building on Missouri voters’ approval last November of a ballot initiative to create the Missouri Quality Homecare Council, which has authority to negotiate with workers over wages and benefits, Missouri’s in-home care workers have voted by a landslide margin in favor of organizing themselves into the Missouri Home Care Union.

But even before the ballots were fully counted, a Missouri judge temporarily blocked certification of the unionization vote in response to a suit filed by a company to challenge the election process.

The Missouri Department of Labor and Industrial Relations reported on July 22 that the vote, conducted by mail-in ballot, passed 2,729 to 499. The new union, a joint effort by AFSCME and SEIU, will cover about 13,000 workers, making it the largest health care union in the state. It will include workers reimbursed by Medicaid but not those employed by private companies (“Missouri home care workers vote for union bargaining,” AP, July 22).

Threasa Bach, a home care attendant from Salem, said in a press release from the new union, “I’m thrilled. This is fantastic news for Missourians who need home care and for caregivers like me. The next step is to join forces with consumers to make home care better and available to more Missourians.”

Bob Pund, a disability rights activist living in Columbia, told The Columbia Daily Tribune that he was pleased with the election results because he “would like to see better working conditions for the people who do this job because it’s hard to get good employees,” Pund noted high turnover rates among workers due to a lack of benefits such as vacation time and workers’ compensation (“Home health workers hope union will improve care,” July 23).

But the day before the vote total was announced, Cole County Circuit Judge John Beetam issued a restraining order against the State Board of Mediation, which was counting the ballots, in response to a suit filed by Springfield-based Integra Health Care Inc. alleging that the election process had “lacked safeguards to ensure the legitimacy of mail-in ballots and wrongly excluded some eligible voters. The suit also accuses two boards connected to the election of violating state meeting laws” (“Mo. judge blocks certification of union election,” AP, July 23). A hearing date has been scheduled for August 4.

As reported by The Columbia Daily Tribune, “Earlier this month, the Board of Mediation had filed suit against Integra seeking enforcement of a subpoena for a list of workers who would be eligible to participate in the vote. That suit is pending” (“Vote certification for home health union blocked,” July 24).

PHI spoke to SEIU spokesperson Krissi Jimroglou in St. Louis to find out further details of the situation. “This was a democratic vote,” she said, “and to be included in it, Integra needed to supply that list. They denied first a request and then a subpoena. So they disenfranchised their own employees from a democratic process, and with their lawsuit they have delayed what all Missourians are pushing for, which is improving home and community-based health care services.”

She also told PHI that the passage of last November’s ballot initiative demonstrated that “there’s a hunger for improvement in home care in Missouri. Both home care attendants and the public realize that Missouri has a long way to go to ensure there’s a stable, professional workforce in place, and that’s why these workers, who make about $9 per hour, have no benefits, and have largely been relegated to the shadows, are so excited to step up to the plate and make their voices heard.”

She said a large victory rally was held by consumers and workers at a St. Louis senior center on Friday, July 24.

The Missouri Capitol Building in Jefferson City

PHI reported last fall (“Missouri Passes Quality Home Care Act,” November 6, 2008) that Missouri voters had overwhelmingly passed a measure to create a Quality Home Care Council, which would run a statewide registry of home care workers, coordinate backup services, offer training, and negotiate with workers over wages and benefits if they chose to form a union.

Now the AP reports (“Missouri unions seek to organize in-home care,” April 12) that Missouri’s Republican-led legislature is refusing to fund the council as SEIU, having teamed up with the American Federation of State, County and Municipal Employees (AFSCME), proceeds with efforts to organize Missouri’s 16,300 personal care attendants.

SEIU and AFSCME have jointly formed the new Missouri Home Care Union, which submitted a petition in March to become the state’s official representative of personal care attendants.

In what appears to be a direct response to the unions’ organizing campaign, Missouri’s House and Senate both refused to include funds for the Quality Home Care Council in the new state budget. Democratic Gov. Jay Nixon had recommended including $360,000 to pay for hiring and office expenses.

The Missouri Alliance for Home Care, the state trade association, opposed the ballot measure because they perceived it as a union measure, according to the organization’s executive director, Mary Schantz. “This ballot measure doesn’t have anything to do with helping people get home service,” she said. “It was an initiative of the SEIU to unionize the work force.”

Though Schantz expressed fear that a union could hurt those in need of personal care attendants by driving up costs, the home care authority model has been successful in several states in improving both the quality of jobs and quality of care.

In California, where consumers and labor worked together to establish the first public authorities for the In-Home Supportive Services program, unionization has increased wages and benefits for workers. Consumers, who hold the majority of seats on the authorities’ governing boards, have supported these wage and benefit increases because they have led to a far more stable and committed workforce.

Other states have followed this example, including Oregon, Washington, Michigan, and Massachusetts.

The measure (see our Oct. 23 story) passed with 75 percent of the vote and was led by Missourians for Quality Home Care. SEIU Healthcare worked in coalition with consumers, disability and senior advocates, and grassroots organizations to collect the signatures needed to get the proposition on the ballot.

“I’m thrilled. This is fantastic news for Missourians who need long term care and for caregivers like me,” said St. Louis home care attendant Tasha McGhee. “The next step is to work together to improve our jobs and the services we provide.”

The act creates a Quality Home Care Council that would run a statewide registry, coordinate backup services, offer trainings, and negotiate with workers over wages and benefits–if they choose to form a union. Similar councils exist in Oregon, Washington, Massachusetts, Michigan, Wisconsin, and California.

Here is an example of an video used in support of the proposition:

Aaron Toleos, Online Communications Director
atoleos@phinational.org

Following our story last week on Washington State’s ballot initiative, we were contacted about a ballot initiative in Missouri that also deals with long-term care workers.

The ballot question called Proposition B would create a Quality Home Care Council that would run a statewide registry, coordinate backup services, offer trainings, and negotiate with workers over wages and benefits–if they choose to form a union. Similar councils exist in Oregon, Washington, Massachusetts, Michigan, Wisconsin, and California.

According to the Missourians Quality Home Care Campaign, a consumer-led council in California can be credited with helping to achieve the following:

• Workforce turnover fell 57 percent over a five-year period.
• The supply of workers increased by 54 percent.
• Consumers reported greater satisfaction with services following the wage and benefit improvements.

Krissi Jimroglou contacted us from SEIU Healthcare, (Service Employees International Union) in St. Louis. Jimroglou told us that her group has been working in coalition with consumers, disability and senior advocates, and grassroots organizations to collect the signatures needed to get Prop B on the November ballot.

“We’ve got attendants in motion around the state in TV ads and at town hall meetings, talking about what Prop B would do,” said Jimroglou.

For more on the merits of the proposition, read the endorsements by the St. Louis Post-Dispatch and the Kansas City Star.

Aaron Toleos, Online Communications Director
atoleos@phinational.org