I
have many concerns about PCAs being unionized. Certain groups (e.g.
Service Employees International Union) are interested in organizing
personal care assistants (PCAs) employed in the home health care service
industry. Granted, the stated mission is noble: to support the proper
training, wages, and benefits for PCAs and thereby improve consumer-directed
services. However, unionization would expose consumers and vital community
support systems to serious risks. Furthermore, there are a number of unexplored
opportunities that could achieve the same objective with much less potential
for harm.
I’m unsure how historical union activities and models, plus
union visions and goals, will be able to ensure quality and stability
for workers and consumers. For example, how does a union model work
in a consumer-directed residential environment? Will union practices
jeopardize consumer freedom, direction, choice, privacy, quality, and
safety? Will a union model make it difficult to avoid inappropriate
workers who may pose risk to consumers’ physical and emotional
health and safety? Who will be responsible for documenting behaviors
that negatively impact quality-of-life? Will poor-performing workers
shirk their responsibilities citing union protection? Who will be responsible
for providing individual consumer advocacy and management training?
Who will be responsible for collectively bargaining with unions: consumers,
personal care provider agencies (PCPOs), or the Department of Human
Services (DHS), which controls resources available for compensation
and benefits? Will consumers and PCPOs become strategic negotiation
pawns? Will strikes, walkouts, and picketing be used? Where will picket
lines be drawn? At DHS, PCPO offices, or consumers’ homes?
Who will be responsible for funding these additional administrative
tasks? Will gains in PCA wages be consumed by mandatory union dues?
Unionization seems like an inefficient solution.
I fully understand and
appreciate the frustration of PCAs, consumers, PCPOs, and community
members because of low wages and poor working conditions often
experienced by home health care workers. A 2006 study comparing
average wages for PCAs providing services to Minnesota Medicaid
consumers with wages in similar occupations discovered that between
50% and 80% of non-PCA occupations are paid higher than the maximum
possible for Medicaid-funded PCAs. June’s
Supreme Court decision denying overtime for home health care workers
reflects severe misunderstanding and lack of appreciation for industry
workers. Since PCAs often lack basic benefits, such as medical, dental,
vision, life and disability insurance, retirement, and paid travel
between job sites, it is obvious why Minnesota Medicaid consumers
and providers struggle to offer competitive jobs. Unfortunately,
consumers and provider agencies are helpless to improve the situation;
funding for PCA services is set by the Minnesota State Legislature
and regulated by DHS. The state, in turn, receives much of its funding
for these services from the federal government.
I think an efficient answer is NOT unionization, but rather a unified
public awareness and advocacy campaign by consumers, families, PCAs,
and provider agencies targeting elected state and federal officials
plus mainstream media. I strongly encourage the Minnesota Consortium
for Citizens with Disabilities, Minnesota Association of Centers for
Independent Living, Direct Support Professional Association of Minnesota,
Minnesota HomeCare Association, and their national counterparts to
begin examining these issues and working toward alternative solutions
to rebuild and maintain community-based support systems protecting
consumer-direction as well as providing competitive and livable wages
and benefits. However, if these stakeholders do not act, then I would
support unionization for the advantages it may provide. ![]()
The author can be reached at lhhegland@precisainc.com
