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Connecticut State Capitol building in Hartford

The Connecticut House approved a bill on April 20 that would give collective bargaining rights to a newly formed union of personal care attendants (PCAs).

The union, which formed last month, is comprised of PCAs who provide Medicaid-funded services and supports to elders and people with disabilities. The PCAs are employed by individual consumers but are paid by the state.

The bargaining-rights legislation passed the House by a vote of 84 to 57 as an amendment to a broader labor bill. If passed by the State Senate, it is expected to be signed by Governor Dannel Malloy (D), a vocal supporter of collective bargaining rights for PCAs.

Currently, the PCA union only has “meet and confer” status, meaning its members can meet with a newly formed Workforce Council to discuss ways to improve working conditions in Connecticut’s home care programs.

Bargaining Would Give Common Voice to PCAs

Collective bargaining would be a huge step forward for PCAs, supporters of the House bill say.

Marjorie Davis, a PCA from Hartford, told the Connecticut Mirror that PCAs are “a very discounted group of workers,” and that the ability to collectively bargain would represent “cohesion [through] a common voice.”

Supporters also said that collective bargaining rights are essential to help PCAs fight for better wages and adequate benefits — which, in turn, will result in better care for elders and people with disabilities in Connecticut.

“Granting workers a voice will, in the long run, improve their lives and the lives of the people they serve,” said State Representative Zeke Zalaski (D), the co-sponsor of the bargaining-rights bill, shortly before the House voted on it.

– by Matthew Ozga

Connecticut Gov. Dannel Malloy (D)

Connecticut Governor Dannel Malloy (D) has proposed that home health aides and agency-based personal care attendants (PCAs) in the state should be trained to administer medication to consumers.

Currently, only nurses are permitted to administer medication to consumers receiving care in the home. Nurse visits cost an average of $54 each last fiscal year, for a total cost to the state of nearly $130 million.

The Malloy administration says that the plan would save the state more than $28 million a year, once fully implemented.

It would also help thousands of elders and people with disabilities to remain in their homes — rather than enter nursing homes or other long-term care facilities — by ensuring that the cost of home care is as low as possible, administration officials say.

Nurses and many home care agencies say they oppose the idea, arguing that medication is more safely administered by highly trained nurses.

Malloy’s plan comes as part of a set of proposed adjustments to the state budget, which will go to the legislature for approval.

Details of Plan

Malloy’s plan would allow home health aides to administer oral medicine, topical medications, and eye drops, so long as they are trained and certified to do so.

The plan would also permit agency-based PCAs to administer medication. Currently, only independent PCAs who have been trained by their clients can legally give out medicine.

“Allowing home health aides and agency-based PCAs to administer medication is a positive step for Connecticut’s home care industry,” said PHI National Director of Curriculum and Workforce Development Peggy Powell.

“However, it is extremely important that these direct-care workers are properly trained in handling and administering medication in order to keep their clients as safe as possible,” Powell added.

Additionally, the Malloy administration’s proposal would reduce by 10 percent the rates paid to nurses administering medication. It would also allow certain medicine-related assisted technologies — such as medication reminders and automatic pill dispensers — to be covered under Medicaid.

– by Matthew Ozga

A five-member working group met in Connecticut on Jan. 10 to determine whether personal care attendants (PCAs) employed through the state’s Medicaid waiver program should be given the opportunity to join a union.

Gov. Dannel Malloy (D) opened the door to PCA unionization through an executive order issued in September. Prior to the executive order, PCAs were not legally allowed to organize because they do not share the same employer.

In Connecticut, people with Medicaid hire PCAs through a registry maintained by the state Department of Social Services. Although all PCAs receive their wages through the state, they are individually employed by the Medicaid recipients who hire them.

The five-member Personal Care Attendant Working Group met twice in December to discuss the viability of unionization for PCAs.

It plans to meet two more times in January before submitting its report to the state. That report is due February 1.

If the group finds providing PCAs with the opportunity to join a union to be appropriate, Connecticut’s PCAs will hold a vote. The Service Employees International Union (SEIU) is seeking to represent the Connecticut PCAs for collective-bargaining purposes.

Julie Popper, an SEIU communications coordinator, told the Hartford Courant in December that her organization wants to “make home care a viable, stable, professional option, and it’s not going to be if qualified, skilled workers are attracted to working in nursing homes instead.”

The September executive order also established a 13-member Personal Care Attendant Workforce Council, responsible for studying issues related to PCA recruitment, retention, and training.

– by Matthew Ozga

Connecticut Gov. Dannel Malloy (D)

Personal care attendants (PCAs) who are employed through Connecticut’s Medicaid waiver program now have the option of joining a union, following an executive order issued by Gov. Dannel Malloy (D) in September.

Through the PCA Waiver program, elders and adults with disabilities can direct their own care, hiring and training PCAs as they see fit. The PCAs’ wages, however, are paid by the state.

The executive order says that worker representatives elected by PCAs can engage in non-binding discussions with state officials over issues such as wages, benefits, and collective bargaining rights. The governor can then address those and other workplace issues based on the discussions.

“No one should be surprised that I believe people who care for others need to earn decent wages and earn respectable benefits,” said Malloy, whose mother worked for years as a public health nurse.

A related executive order, signed by Malloy on the same day, grants unionization rights to day care workers employed by the state-run Care 4 Kids program.

Reliance on Public Assistance to Supplement Low Wages

PCAs in Connecticut earned an average of just $10.37 an hour in 2010, and the current pay ceiling for the state’s PCA Waiver program is a little more than $13 an hour.

Earlier this year — during public testimony offered in support for a bill that would have given them collective bargaining rights — several PCAs told the Connecticut legislature that they had to use food stamps and other public-assistance programs to make ends meet. (The bill was ultimately never brought to the floor for a vote.)

A PHI analysis found that two out of five direct-care workers in New England relied on public assistance programs, such as food stamps and Medicaid, during the period 2007 to 2009.

– by Matthew Ozga

As President Obama and Congress continue to wrestle over a budget plan to reduce the federal deficit, a small group of bipartisan senators known as the “Gang of Six” put forth a proposal which, if enacted, would cut Medicare, Medicaid, and Social Security, and repeal the Community Living Assistance Services and Supports (CLASS) Act.

The CLASS Act, a provision in the health care reform law passed in March 2010, establishes a voluntary, federal insurance plan designed to help people purchase long-term services and supports.

Details of the CLASS Act — including the monthly premiums and the cash benefit to purchase these services and supports — have yet to be worked out. However, according to the law, the Secretary of the Department of Health and Human Services (HHS) has until October 2012 to do so.

HHS Secretary Kathleen Sebelius has said that she is developing a plan that would make the voluntary, long-term insurance plan solvent, as required by the health reform law.

The sustainability of the CLASS Act has been called into question by some Republican lawmakers, prompting a March 11 hearing. Assistant Secretary for Aging Kathy Greenlee, who is the administrator of the CLASS Office, testified that the program would remain fiscally sound even when elders and people living with disabilities begin to make claims.

The CLASS Act would lower the cost of Medicaid, which pays for 62 percent of the nation’s long-term services and supports costs (pdf), say supporters of the program.

“What’s strange to me is that this started out as a cost-saver, and now it’s being targeted in the name of cost savings,” Judy Feder, a professor at the Georgetown Public Policy Institute and fellow at the Urban Institute, told Politco. “The people who are saying it will cost us money say that that’s a challenge that cannot be met, but I believe it can.”

Personal Care Attendants Workforce Advisory Panel

Less well-known is that the CLASS Office is also charged with managing a Personal Care Attendant (PCA) Workforce Advisory Panel.

While HHS has accepted nominations to the panel, which were to be announced last fall, to date there has been no such announcement.

The panel is responsible for examining the adequacy of the number of personal care aides, their wages and benefits, and access to their services, as well as advising Congress.

Personal Care Aides are projected to be the fourth fastest-growing occupation in the country between 2008 and 2018, increasing by 46 percent, according to a PHI analysis available in PHI FACTS 3: Who Are Direct Care Workers? (pdf).

– by Deane Beebe

Health Action 2011 logo

Consumer advocates’ interest in long-term services and supports is growing, as evidenced by several workshops at Health Action 2011, Families USA‘s annual consumer action conference.

Workshops ranged from “New Options for Home and Community-Based Services” to “Dual Eligibles: New Opportunities, New Challenges.” The latter is about people enrolled in both Medicare and Medicaid (pdf).

I was asked to co-present a workshop entitled “The CLASS Program and Building the Workforce to Deliver Services” (pdf) to help advocates better understand the new CLASS (Community Living Assistance Services and Support) program.

Critical Connection Between CLASS and the Workforce

This workshop stressed the critical connection between the need to invest in and support a quality direct-care workforce, on the one hand, and the new CLASS program, which will offer participating consumers who pay into the program the ability to purchase in-home services and supports.

Carol Regan, PHI Government Affairs Director

It is surprising to many that there are more direct-care workers in this country than nurses, and that it is the direct-care worker that will be relied on to meet the needs of CLASS beneficiaries — not nurses.

More than 3.2 million workers are employed in the eldercare disability services field today, and another 1.2 million are anticipated by 2018 (pdf).

Because of concern regarding the additional workers that will be required to provide long-term services and supports when the CLASS program begins in five years, the Affordable Care Act (ACA) included the creation of the Personal Care Attendant (PCA) Workforce Advisory Panel.

Its members are charged with advising the Health and Human Services (HHS) Secretary and Congress on the adequacy of the size of the workforce, wages and benefits, and access to PCA services.

CLASS Details in Development

Connie Garner, the lead staff person on long-term care from the late Senator Ted Kennedy‘s office, provided the workshop participants with information on what this program will do for millions of Americans. Garner now leads Advance CLASS, a new organization established to ensure the successful implementation of the CLASS program.

The CLASS program is a voluntary, federally administered, consumer-financed long-term care insurance plan. It, too, became law when President Obama signed the ACA. The CLASS plan will provide a cash benefit to participating consumers to help them pay for needed assistance, including home care, nursing home care, and assisted living, if they become functionally limited.

Before people can enroll, the HHS Secretary must design and implement the program. The law requires the Secretary to release the details of the plan no later than October 1, 2012, with sign up beginning later in 2012 or 2013.

PHI is looking forward to the announcement of the appointees to the PCA Panel so that the panel can get started on developing recommendations on what is needed to improve direct care jobs in order to provide quality services. PHI is a member of Advance CLASS.

– by Carol Regan, Director of PHI Government Affairs Office