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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

In a reversal of a 20-year-old decision, the National Labor Relations Board (NLRB) issued a rule on August 26 regarding what constitutes a bargaining unit in nursing homes, rehabilitation centers, and other non-acute health care facilities.

The NLRB decision (pdf) in the Specialty Healthcare and Rehabilitation Center of Mobile and United Steelworkers, District 9 case concluded that the 53 certified nursing assistants (CNAs) employed by this facility had the right to form a bargaining unit that does not include other “nonprofessional” staff such as maintenance workers, cooks, dietary aides, and clerical workers.

New “Community of Interest” Standard Applied

The ruling makes it possible for employees that share a “community of interest,” such as employees with the same job title, to form collective bargaining units, regardless of the size of the unit.

The “community of interest” standard that will now be applied to employees of non-acute health care facilities is the standard used in other workplaces, according to a NLRB press release.

Under the traditional “community of interest standard,” factors such as common supervision, interchange of employees, geography, job classifications, departments, functions, and skills are considered.

Under the new rule, should an employer make the case that “the proposed unit inappropriately excludes certain employees, the employer will be required to prove that the excluded employees share an ‘overwhelming community of interest’ with employees in the proposed unit,” the NLRB release explains.

According to a New York Times article, the lone dissenter on the NLRB “asserted that the new approach would encourage the unionization of units as small as possible, which he said conflicted with the labor act’s aims.”

Majority Calls Precedent “Obsolete”

Referencing the 1991 case that the NLRB reversed, the 3-1 majority opined that “we have concluded that the Park Manor approach to determining if a proposed bargaining unit in a nursing home is an appropriate unit has become obsolete.”

– by Deane Beebe

DOL Secretary Hilda Solis

Seven hundred home care workers; domestic workers; community and faith-based leaders; union representatives; government officials; workforce, aging, and social justice advocates; and consumers of home care services and supports convened in Washington, DC, on July 12 for the inaugural Care Congress, a national town hall meeting on caregiving in America.

A broad coalition of 70 partners, including PHI, came together to begin a national dialogue rooted in values to transform long-term care for older adults and people living with disabilities, paid caregivers, and families.

“Quality care, quality jobs” was echoed throughout the day, which was the kickoff of Caring Across Generations: Changing the Way We Care, a national campaign being spearheaded by the National Domestic Workers Alliance and Jobs with Justice.

As part of the campaign, local Care Congresses are planned for at least 15 cities over the next year.

“Many of our members who began as housekeepers or nannies began asking for training in caring for the aging because their employers were increasingly calling on them to do that work,” said Ai-jen Poo, director of the National Domestic Workers Alliance.

“We realized that domestic workers were helping to fill a gap in care facing hundreds of thousands of families,” she said.

Federal Policy Solution

With the demand for home care growing as baby boomers began turning 65 this year, the coalition is promoting a federal policy solution with five interdependent components — represented by the “Five Fingers of the Caring Hand”:

• Create jobs to meet the growing need for care; explore creative, new funding streams for job creation.
• Transform the quality of current jobs and anticipated jobs by
  • establishing stronger labor standards that protect the health and safety of both workers and consumers;
  • improving job quality, wages, and access to health insurance; and
  • supporting the right to organize and a path to unionization for direct-care workers and domestic workers.
• Provide training and build career ladders to raise the quality of care and prepare workers for quality long-term care jobs; develop certification programs.
• Provide a path to citizenship for immigrant workers who complete training and certification programs to provide care to elders and people with disabilities.
• Support individuals and families by
  • preserving Medicaid, Medicare, Social Security, and the Affordable Care Act;
  • ensuring that improving job quality does not jeopardize access to care for people with low incomes by providing concurrent financial support for families paying out of pocket; and
  • supporting unpaid family caregivers who are taking time from employment with Social Security credits and paid family leave.

Secretary Solis Welcomes FLSA Input

Sen. Al Franken (D-MN)

In her opening remarks at the Care Congress, Department of Labor (DOL) Secretary Hilda Solis told the participants that she welcomed their input on DOL policies — specifically noting the “companionship exemption” in the Fair Labor Standards Act. (Postcards were on hand to write to the Secretary to issue new rules to “narrow the companionship exemption.”)

Solis said that her own mother was a caregiver who “left her family to care for others” — the “hardest work to do.” She explained that her father was a shop steward and that she supported unions so that “voices can be heard” and “people could live better lives.”

Solis also expressed her deep concern about the current state efforts to roll back collective bargaining rights for public employees.

Medicaid Matters Across Generations

About 300 of the Care Congress participants headed over to Capitol Hill for a forum entitled “Medicaid Matters Across Generations,” co-hosted by Senator Jay Rockefeller (D-WV).

White House Senior Advisor Valerie Jarrett

People provided moving testimony about how Medicaid has made it possible for them or a loved one to access desperately needed health care — from home and community-based care to nursing home care.

Senators Al Franken (D-MN), Sheldon Whitehouse (D-RI), and Claire McCaskill (D-MO) expressed their support for the Medicaid program at the event.

Referencing the budget talks and Republican Congress members’ stand on not raising taxes, Whitehouse said, “A deficit doesn’t care if a dollar comes from tax cuts or revenue.”

Earlier in the day, Valerie Jarrett, a senior advisor and assistant to President Obama, told the Care Congress participants that the President understands that Medicare and Medicaid are more than numbers — they are “about people.”

– by Deane Beebe

“PHI supports the right of workers to organize and bargain collectively; PHI never participates in specific union organizing drives — either to bring a union into an organization, or to keep one out.”

Steven L. Dawson, PHI President

The political clashes in Wisconsin, Ohio, and elsewhere — to end collective bargaining rights for publicly funded employees — should force an “adult conversation” about unions within the eldercare/disability care system. For this is not an abstraction: lost in the national media coverage of the Wisconsin legislation is the reality that 9,000 nurses and nursing home staff, along with about 5,000 home care workers, are at risk of losing their rights to fully represent their interests. These are the very types of workers — home care and nursing home front-line workers — whom PHI is pledged to support and defend, so that they in turn may best serve their clients who are elderly or disabled.

Since its inception in 1991, PHI has consistently held the policy position stated at the lead of this editorial: We support the rights of all workers to organize; we don’t participate in organizing drives. Yet because the eldercare/disability industry is so often deeply divided on the question of unionization, the first half of that sentence has, for some in the industry, obscured the second.

So, I want to take this important moment in our country’s political debate to contribute to a more thoughtful conversation. First, let me share PHI’s actual experience, for PHI is a rather complex nonprofit that plays an active role in both policy and practice, at both the national and state levels.

Working with a Range of Stakeholders

Within the policy portion of our role, we work with a range of stakeholders — employers, consumers, labor, and government. Specific to labor organizations, we work with both the Service Employees International Union (SEIU) and the American Federation of State, County and Municipal Employees (AFSCME) on several public policy initiatives to improve jobs for all workers. For example, at the national level, we are engaged in coalitional efforts with SEIU and AFSCME to extend “fair labor” minimum wage and overtime rights to home care workers; in New York State, we are currently advocating with both SEIU and high-road employers for wage parity between home health aides and personal care aides.

Yet at the same time, PHI co-convenes with the American Geriatrics Society and the Eldercare Workforce Alliance. The Alliance is a national coalition representing consumers, employers, family caregivers, the direct-care workforce, and health care professionals — which to date organized labor has chosen not to join — advocating on a range of federal eldercare initiatives. We also participate in many other coalitional initiatives — such as promoting the CLASS Act — in which employers, consumers and organized labor are working, in concert, to advance their shared interests.

Within the practice portion of our role, PHI provides consulting assistance to more than 20 eldercare and disability employers across the country. Many are unionized; many are not. In fact PHI is itself, essentially, an employer, being the primary sponsor of two home care cooperatives: Cooperative Home Care Associates in the South Bronx and Home Care Associates in Philadelphia. The first is unionized; the second is not. In the New York instance, the union made a compelling case to the workers that they would be stronger if unionized, and the workers voted accordingly; in the Pennsylvania case, no union has made an equally compelling case to the workers, and the cooperative remains nonunion. This is as it should be — up to employees to decide.

Finally, PHI also provides consulting assistance to a range of training programs across the country. Many of these programs are unionized; many are not. It is in this role that PHI most often plays a direct, contractual role with organized labor. We are proud that we have helped unions in New York, California and Washington State design and strengthen their direct-care curricula, teaching capacity, and training programs. Still, a financial analysis of PHI’s income over the past 20 years would disclose that less than 1 percent of our total revenue has been paid for by organized labor.

Of Value to All Stakeholder Groups

In fact, what we are most proud of is that, over the past 20 years, PHI has become a trusted partner to all the key stakeholder groups within the eldercare/disability services system — employers, labor, consumers, and government. We work very hard to be “of value to each; in the pocket of none.” We work hard to gain the full trust of our clients and partners, no matter which stakeholder they represent. We work hard to be of such clear value that all can be assured that PHI remains consistently true to its mission — to support and advocate for the intertwined interests of direct-care workers and the consumers they serve — unbeholden to any one stakeholder group.

The larger political context here is that, within the eldercare/disability field, there will always be bad actors, but there is no such thing as a “bad stakeholder.” For each of the key stakeholders is essential, and the “high road” leaders of each — labor, consumers, employers, and government — have all played critical roles in improving the quality of direct-care jobs and the quality of care. Therefore, every stakeholder has earned the right to sit at the table, however they might wish to be represented. Responsible people may disagree about the actions, and even the roles, of each stakeholder, but that should never extend to denying the right of any stakeholder group to organize on their own behalf.

And that is why PHI believes it centrally important, given the events in Wisconsin and other states, to reiterate publicly our support for the rights of all working people to bargain collectively — particularly if they are primarily low-income workers providing essential services to primarily low-income clients. We will, as always, refrain from engaging in specific union organizing drives. Yet in this critical moment in our nation’s political history, we are compelled to stand with direct-care workers and other health care staff, in defense of their unbounded right to democratic representation.

Steven L. Dawson
President, PHI

Independent home care workers who provide services to Medicaid-eligible consumers voted to unionize in Missouri and Wisconsin on May 5 and 6, respectively, totaling 17,000 workers who will be represented there. Read the full story