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Commentary
PCA Unions Still Not the
Best Option
by Lance Hegland
I’m glad to see
continued dialogue regarding the PCA unionization topic and would
like to explore some additional comments and questions that have
surfaced.
Some union proponents
have offered reassurance that unionization won’t
negatively impact PCA service quality or consumer empowerment because
existing consumer protection and advocacy will continue. At the same
time, last month’s article presented many concerns with the current
system: “extreme chance of consumer abuse due not only to lack
of supervision by the hiring agency but also to the consumer’s
inability to physically be in charge” plus insufficient training,
wages, and benefits for PCAs. Where were the consumer protection and
advocacy organizations when the system began to deteriorate? Where
are they now? Are we saying, “as a disability community, we didn’t
or couldn’t resolve these concerns ourselves, but hopefully the
union can do it for us”? What happened to self-advocacy and empowerment?
What happened to “nothing about us, without us”? I think
we—as a community, and as advocates—have failed to prioritize
and address inadequate training, wages, and benefits for PCAs. If we
continue to shirk our ability to advocate and empower ourselves, perhaps
we do need a third-party like a union to resolve the issue for us.
But, doesn’t that send the message that self-advocacy and empowerment
don’t work?
Next, I doubt unionization
would provide “another layer of consumer
protection and empowerment;” unions exist to provide the best
representation and advocacy possible for members—in this case
PCAs, not consumers.
Third, regarding the
analogies between union PCAs and union employees in other industries,
like construction: when a union carpenter or bridge worker goes
on strike, the house or bridge can wait and doesn’t
collapse; the PCA consumer can’t wait and might collapse.
Fourth, I’m sad to hear the Consortium for Citizens with Disabilities
(CCD) portrayed as being comprised “of individual representatives
of organizations that represent mostly professional advocacy groups,
private for-profit and not-for-profit companies with very little input
from those that are directly affected—direct support professionals
and consumers.” Is that because direct support professionals
and consumers are not providing information — they are not self-advocating?
Or, does CCD have an outside agenda that does not accurately reflect
the needs of the constituents it claims to represent? If CCD truly
is “dedicated to improving the lives of people with disabilities
[by addressing] public policy issues that affect people with disabilities
by collaborating with others, advocating, educating, influencing change
and creating awareness for understanding,” as their mission
statement claims, perhaps the system would not have deteriorated
from the county-administration days? Or, maybe they would have intervened
prior to the threat of unionization? The next few months will tell.
If CCD ignores this potential threat of unionization and fails to
address PCA training, wages, and benefits, the message will be clear.
No matter which group
or community is working on the topic of PCA unionization, an understanding
of the complexities involved with potential cause-and-effect interactions
is critical. For example, last month’s
commentary indicated that unions were one of the reasons competitive
training, wages, and benefits existed during the late-60s through
early-80s and suggested the lack of unions now is one of the reasons
for significantly diminished levels of supervision, training, wages,
and benefits. I think there may be underlying factors that played
a larger role than the lack of unions.
Under the former county-run
system in the 70s, I believe the 87 counties and state had a closer
working relationship than the state and PCA agencies today.
It was a partnership in service delivery, where the state had a
much better idea than it has today of what it cost to provide those
services; they trusted the data provided by counties. If counties
said service costs increased, the state would adjust funding accordingly.
If adequate resources weren’t
allocated to provide training or competitive compensation and service
quality suffered, the county may have been legally liable, which
would eventually cost the state. Both county and state had incentives
to adequately fund services.
Today, the state has
insulated itself from those incentives. There are hundreds of providers
which can be difficult to organize into a unified voice. The relationship
with the state is much more adversarial. When providers inform
the state that service costs have increased, the state indicates
there aren’t funds for matching reimbursements.
The state simply suggests that the industry trim profit margins, cut
costs, and increase efficiency; trying to squeeze blood from a turnip.
The state has granted insignificant annual PCA reimbursement increases
that barely keep pace with cost-of-living. When service quality suffers,
even systemwide, the state simply blames providers; it would be very
difficult to make the case that insufficient reimbursements have created
an environment of poor service. In fact, the longer the state can keep
agencies, PCAs, and consumers blaming and fighting with each other,
the longer it can avoid addressing the issue. How will unions help
by pressuring agencies, who’ve already been begging the state
for increased reimbursements? Such pressure would be as effective as
threatening to invade Mexico if Iran doesn’t submit to nuclear
audits! The state will only increase reimbursements — which providers
can then use to increase supervision, training, wages,
“Who would be held accountable
if a PCA skipped their shift, the homecare agency [could
not] afford to maintain a reliable backup system, and the
consumer ended up in the hospital …?”
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benefits, and
recruitment incentives for competent and quality PCAs; which
in turn will increase quality for consumers—if and only if
consumers, PCAs, families, friends, and advocates work together
to form a unified front from which to push for budgeting and reimbursement
increases.
Finally, I didn’t “incorrectly assume that a company that
hires a PCA is no longer involved and has given up its responsibility
to the consumer and that somehow federal HIPA [sic] and state vulnerability
laws are no longer applicable.” Agencies are generally doing
the best they can with limited resources and difficulty recruiting.
As far as legal remedies, those investigation and enforcement systems
are currently flooded and ineffective—vulnerable adult investigation
units are swamped with cases. Most cases are closed without investigation
unless a busy county attorney feels a case is so outrageous as to almost
guarantee a win. Who would be held accountable if a PCA skipped their
shift, the homecare agency couldn’t afford to maintain a reliable
backup system, and the consumer ended up in the hospital dehydrated,
malnourished, and with post-traumatic anxiety? The PCA may be fired,
but s/he could simply go to the next homecare agency desperate for
workers and be back to work as a PCA the next week.
I firmly believe action initiated in partnership with PCAs, consumers,
families, friends, and providers would be the most healthy solution;
not unions. ![]()
Lance Hegland is a
PCA consumer; supporter of PCAs’ rights
to livable wages, benefits, and working environments; consultant;
and MBA student studying health-care policy and systems.
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