Granny Snatching: Home Health Care, Unionized or Independent?

By the first of November a new government agency is slated to be in place in Hartford, tasked with overseeing home health care aides, resulting from Gov. Dannel Malloy issuing Executive Order 10.

The order calls for the establishment of a Personal Care Attendant Quality Home Care Workforce Council, which appears to be modeled on a similar program that has been in place in Massachusetts. It requires documentation of “approved” home health care aides, and provides for unionization of those aides.

The order comes at a time when elder care advocates are attempting to move some 5,000 elderly and disabled residents out of nursing homes and back into community or home-based care. With the cost of nursing homes in Connecticut often exceeding $12,000 per month, paid mostly through Medicare and Medicaid, a return to home-based care would create enormous savings for both the state and federal budgets, which are running astronomical deficits.

Currently there are both independent workers as well as private agencies which provide services such as visiting nurses, occupational and physical therapists and home care aides who help with daily activities ranging from personal hygiene to medical help. Some insurance programs including Medicare pay the cost of such services, but only if certain conditions are met. Otherwise, the cost is borne either by the patient or their caregivers.

Statewide unionization of home care attendants would obviously add greatly to the cost of those services.

According to Malloy’s Executive Order 10 the council is to work with the Department of Social Services to begin a study of “issues relating to the recruitment and retention of personal care attendants,” and further to develop a plan to improve the quality, stability and availability of personal care attendants.

In the “Whereas” section of the order it states that personal care attendants “typically earn low wages, no benefits, no paid time off and receive no standardized training … as a result the pool of personal care attendants in this state suffers from high turnover and inconsistent quality.”

I don’t think there is anything wrong with providing training and establishing competency requirements for home care attendants, but the part of the executive order that has people shaking their heads, especially since a similar effort died in the last session of the legislature, outlines the creation of union representation.

First the Commissioner of Social Services and the Commissioner of Developmental Services are to compile a list of all Personal Care Attendants who have been paid through a state waiver program in the previous six months. Under that program the consumer hires and trains the PCA. The consumer fills out a time sheet and submits it to the state.

The state issues a check to the attendant and mails it to the consumer. Under the PCA waiver, a fiscal contractor handles the employer tax responsibilities, so the consumer doesn’t have to file employer related tax forms.

That list of names is to be updated at least every six months. But the order also calls for designation of a “Majority Representative” or union, and the only entities eligible to select a Majority Representative are a state-wide unit of “all personal care attendants” or state-wide units of attendants who provide services under programs administered by the DSS or DDS.

The lists of Personal Care Attendants are to be provided to the unit that wants to be the Majority Representatives “for the purposes of conducting an election or verifying the majority of signed authorization cards.”

As I mentioned above, I don’t have a problem with setting qualifications or standards to deliver home care to the elderly or disabled. But I don’t see how the state needs to be involved in creating union bargaining units to achieve that goal.

Apparently so many state representatives and senators felt the same way last spring that an effort to do what the Governor has done by executive decree failed for lack of support.

We obviously are still a long way from implementation of this order, but it is in place, and time will pass.

Among the many questions I have is whether personal care attendants who operate independently and don’t take money from the state will be required to provide their personal information to the state lists and if they will be required to join a union. The order calls for union elections if only 20 percent of the PCAs on the state list indicate they want one.

That means a very small minority can set the rules for what happens to the majority.

This bears watching.

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