Home health care council on ballot
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Home health care council on ballot

Date: October 8, 2008
By: Emily Coleman
State Capitol Bureau
Links: Full text of Proposition B

JEFFERSON CITY - Proposition B on Missouri's November ballot would establish a council on home care quality.  But critics charge it is just a unionization attempt.

The proposition is sponsored by Missourians for Quality Home Care. The Disabled Citizens Alliance for Independence is also in favor of the proposition.

The proposal would establish the Missouri Quality Homecare Council with authority to recommend standards and wage rates for home-care workers and to recruit more people to become workers.

"There are about 50,000 Missourians who qualify for in-Home Services, which addresses the needs of residents and allows them to stay in their home," Brian Hauswirth, the communications director of the Department of Social Services, wrote in an email.  "Assistance in provided in areas such as cleaning, toileting and meals."

However, the provision that has generated the controversy involves unionization of home-care workers.  Under that provision, a statewide sole bargaining agent for all home-care workers would be created by a majority vote of home-care workers.  The vote would be required if requested by at least 10 percent of the workers.

"This is a union attempt to unionization, which is not in the ballot language," Mary Schantz, executive director of the Missouri Alliance for Home Care. "It's misleading."

Schantz said she is concerned that Missouri voters will not know what they're voting for.  Everyone wants quality home care, she said, but the proposition does more than that.

"The point is to have someone to bargain with the state," said Richard Blakley, the executive director of Disabled Citizens Alliance for Independence. "We're looking for a mechanism to help get higher wages."

While there are about 8,000 attendants in the state of Missouri, there are not enough attendants, Blakley said.

"We want to do this so you can do this as a living," Blakley said.

Higher wages and benefits may be able to draw more people into the field and keep them there, he said.

But Schantz argues the language of the proposal is unclear.

"The entire language is ambiguous," Schantz said.  "We're taking a group of people and turning them over to a private group. It's bad business."

Schantz said she would not be in favor of the proposition even if the unionization and language problems were removed.

"The council itself is a bit alarming," Schantz said.  "It's a quasi-government group, and it has no oversight."

The eleven-member council would be give wide range of responsibilities involving non-medical workers who help with daily living for the elderly, disabled and others who qualify for home care.  The council would be given authority to make referrals of personal care attendants and recommend wage rates.

"I'm equally as concerned about a council where supervision can only occur on budgeting and reporting matters," Schantz said.

Since the council is funded by taxpayers, Schantz said there should be a route for taxpayers to express their concerns about policy decisions like there is for public officials.  "The privatizing of this program is not the way we should be going," she said.

Currently, Missouri monitors home health care through two state agencies, the Health Department and the state's Medicaid unit, MO HealthNet, in the Social Services Department.

The Health Department sets standards for state licensing of private home-health care agencies. 

"There's not a single county that doesn't have at least two providers," Coots said.

Proposition B would  not affect those regulations governing medically-skilled professionals, said Lisa Coots, the administrator of the Health Department's Home Care and Rehabilitative Standards Unit. It may affect the consumer directed services and the public who hire through this service.

"This type of home care (through the consumer directed services) is primarily personal care and chore care, not skilled care provided by nurses and therapist as seen with the services rendered by the home health agencies," Coots said.