Home care behind Proposition B

Proposition B, which is on Tuesday’s ballot, seeks to establish the Missouri Quality Homecare Council to ensure the availability of home care services under Medicaid, but critics say it is a unionization effort that could increase overall health care costs.

The council would serve under the Department of Health and Senior Services. It would be responsible for assessing home care quality, recruiting people to be personal-care providers, and training and recommending minimum qualifications for home care workers.

The proposal is expected to annually cost $510,560 from the state government’s general revenue.
Supporters say the initiative will stabilize the home care work force and allow people who need care to stay in their homes rather than moving to nursing homes.

Krissi Jimroglou, with Missourians for Quality Home Care, said making home care a viable career will benefit home care workers and consumers alike.

“Consumers will benefit because when workers have better wages and benefits, there is going to be lower turnover,” Jimroglou said.

The council would create a statewide registry of home care workers. Jimroglou said this would address several problems in the home care system. Home care workers are not paid when their clients stay in the hospital overnight, threatening their ability to work in the home care industry full time. The ballot measure would also create a backup for consumers by providing them with a registry to call for assistance if their attendants are unavailable.

“Right now the system is pretty haphazard,” Jimroglou said.

The Missouri Alliance for Home Care, a trade association representing home health care companies and hospices, opposes Proposition B. Mary Schantz, executive director of the alliance, said the language on the ballot does not accurately reflect the issue.

“What voters see on the ballot is not actually what they’re getting,” Schantz said. “In fact it’s pretty far from what they are getting.”

Schantz said Missourians with disabilities will still be able to live independently if this initiative fails, contrary to the phrasing of the question on the ballot. The real issue is whether to unionize home care workers, she said.

“This council is the collective bargaining unit for workers,” Schantz said. “It is a unionization effort. It was funded by (Service Employees International Union).”

The SEIU is the primary sponsor of the measure, contributing $936,250 to support the initiative, according to the National Institute on Money in State Politics.

Schantz also said the establishment of the council is a step toward privatization, which could lead to higher health care costs.

Jimroglou argued that giving people a choice and stabilizing the home care work force would make it cheaper to continue living at home.
“The notion that Proposition B will raise health care costs is fundamentally wrong,” Jimroglou said.

Schantz said privatizing would change the bureaucratic organization of state health care regulation. She said that although the council would be under the authority of the Health and Senior Services Department, it would independently authorize rule changes and lobby Missouri’s General Assembly for wage increases.

“The council can issue rules, which is interesting because usually rules only come out of the department,” Schantz said.

Richard Blakley, executive director of the Disabled Citizens Alliance for Independence, said passing the proposition should not change the operations of the home health care industry aside from attracting better workers. The alliance, a community-based center for independent living that works to protect disabled residents’ ability to live in their homes, supports Proposition B.

Blakley said the council would allow home care consumers to control changes in the industry. He said the ability for attendants to collectively bargain for higher wages and benefits would only improve the care disabled citizens receive.

“If it doesn’t pass, the quality of the care would not be as high,” Blakley said. “Higher wages tend to attract higher-quality workers.”