This article first appeared in the St. Louis Beacon: October 20, 2008 - Since she became a quadriplegic after a car accident nearly 18 years ago, Kathy Alexander of Bourbon, Mo., has needed a personal attendant at her home.
So far, she says, she's been lucky. The three attendants she needs to get her out of bed, get her ready for work, take her to her data entry job and bring her back home have been with her for a long time. They're reliable, their hours are flexible, and they know how to perform the physically demanding tasks she needs 10 hours each day.
But, she says, other people in her position haven't been so fortunate, and one of her three helpers is at an age where she may not be able to work much longer. Finding qualified replacements isn't easy, but for her, it's vital.
"Once I get an employee trained, I don't want to have to start over," said Alexander, 47.
To find someone new, she said, she'd have to advertise, then conduct interviews.
"In the meantime," Alexander said, "I'd be hoping and praying that I would find someone flexible enough to do what I need done to get me to work every day."
To her, the work her attendants do is more than a job - it's a lifeline.
"If someone doesn't show up at a factory job," Alexander said, "someone else can take their place on the line. For me, if someone doesn't show up, I can't get out of bed. It's a life-saving job."
Recruiting, training and retaining such home health-care workers, and matching them up with the people who need them, is the focus of Proposition B on the Nov. 4 ballot. It would create the Missouri Quality Homecare Council to help elderly and disabled people on Medicaid remain in their homes by getting them the aid they need.
The council would oversee a registry of workers, who would also have the opportunity to form collective bargaining units.
The first part of that description, helping people remain in their homes and get the help they need to perform everyday tasks, has drawn litle opposition. But the creation of the council, and the new ability of workers to forum unions if they want, aren't too popular with some who worry that the proposition's wording is too vague and the changes it would bring would duplicate services already provided by the state.
FOUR-PRONGED APPROACH
Under the proposition, which requires a simple majority for passage, the governor would appoint an 11-member council: six who have received or are now receiving personal care assistance; two representatives of Missouri Centers for Independent Living; and one each to represent the state Department of Health and Senior Services, the Governor's Council on Disabilities and the Governor's Advisory Council on Aging.
Among the council's duties would be to conduct an assessment of the current and future needs of the home-care workforce in the state; encourage eligible individuals to serve as personal-care attendants; provide training and recommend minimum qualifications; establish and maintain a statewide list of eligible, available attendants and provide referrals; and recommend wages and benefits for attendants.
Further, the proposal would allow personal-care attendants to join a collective bargaining unit if 10 percent of them say they want such representation. They would not be allowed to strike.
The cost of the proposition to the state is estimated to exceed $510,560 a year.
For Krissi Jimroglou of Missourians for Quality Home Care, which represents those in favor of Proposition B, the new approach would make life easier for those who need home health care in four ways:
* Helping workers and those who need them find each other
* Providing a backup system when an attendant is needed in an emergency
* Recruiting workers in a field that will grow as baby boomers age
* Ensuring a better qualify of life for workers who now earn an average of $8.93 an hour with no benefits.
Jimroglou notes that between the years 2000 and 2030, the elderly population in Missouri is expected to increase by 72 percent, at a time that the pool of potential home-care workers will be shrinking.
Similar councils have been created in other states including California, Oregon, Washington, Michigan, Wisconsin and Massachusetts. Jimroglou's group says a study in parts of California found that worker turnover fell 57 percent over five years, while the supply of workers rose by 54 percent.
She defends the 10 percent trigger for a vote on collective bargaining -- down from the long-time threshold of 30 percent -- by saying that home health-care workers have different needs from workers who traditionally have made up a unionized labor force.
"In home care and in other fields like child care, where you have an isolated, dispersed workforce, these people don't know each other," Jimroglou said. "The kinds of connections and relations presumed in rule of 30 percent don't exist anymore."
VAGUE LANGUAGE, UNNEEDED DUPLICATION
But opponents of Proposition B think the unionization provision is just one of its flaws. They note that in the ballot language that voters will see on Nov. 4, the union issue isn't even mentioned, giving a false view of what the proposal would really accomplish. And they say that the language of the proposal itself is vague enough that no one can really tell how it will work.
"It's only fair that when voters go to vote, they have an understanding of what they are voting for," said Trey Davis, vice president of governmental affairs for the Missouri Chamber of Commerce and Industry.
"Does this create a slippery slope in Missouri, not only in the health-care industry but beyond into the business community? We need to make sure that our voting public knows what they are voting about. Do they want to be voting on increasing the unionizing ability of the people who will be affected?"
Mary Schantz, executive director of the Missouri Alliance for Home Care, another opponent of the proposition, has other worries about the ballot language.
"The way it reads on the ballot, it's certainly an appealing thing to vote for," Schantz said. "But voters will see less than 100 words on the ballot.
"What is on the ballot implies that without establishing the council, people with disabilities will no longer be able to stay in their homes. That's not true."
She notes that the council will take over oversight of a program now being run by the state Department of Health and Senior Services, and she sees no need for the change.
"I don't see any reason for taking one small part of Medicaid and putting it into a quasi-governmental body that would have regulatory control."
Brenda Campbell, director of Missouri's division of senior and disability services, doesn't share all the concerns of Proposition B's opponents. But she feels the ballot language may give voters the wrong impression.
"I'm not so sure it replaces any state function," she said. "Nothing in the proposition creates anything new that can't already be done in the state of Missouri."
"This is just creating a new entity within the system, but it's not going to take away any rights Missourians hold dear now - to be able to live in their home, receive care at home and direct that care.
"I'm not sure of the benefit of having the council. It just doesn't jump off the page at me. The state and the vendors and the consumers already do what the council will do."
Full text of the proposition