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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

PHI PolicyWorks has released an updated State Chart Book on Wages for Personal and Home Care Aides (pdf). The chart book tracks wages in all 50 states and the District of Columbia for the period 1999-2008. It shows that nationally, the median real wage (adjusted for inflation) for personal and home care aides has decreased by 3 percent over nine years, from $7.50 to $7.31.

Read the full story

PRESS RELEASE
For immediate release
July 6, 2009

Contact: Alex Olins
PHI Northern New England Director
Phone: (802) 655-4615
Email: aolins@PHInational.org

Rewarding Skill and Improving Care
New initiative provides career advancement opportunities for direct-care workers in Vermont

Burlington, VT — Few issues are more important to people today than health care. Both from a personal and societal perspective, Americans are deeply concerned about what the future holds for them when it comes to health care. In many states, the growing needs of an aging “baby boomer” generation are creating an enormous shortage in qualified direct-care workers, who provide most of the “hands on” home and community-based care that elders and people living with disabilities depend upon. Read the full story