Proposition B seeks variety of home health care changes

An initiative petition put Proposition B on the ballot for the general election. Missouri voters have a chance to vote on the Quality Home Care Act, the official title, on Nov. 3. The act is intended to make it easier for those who need assistance to remain in their homes. It would create a Missouri Quality Homecare Council to investigate the quality, safety and availability of home care services.

The council could also recommend qualifications for personal care attendants, improve the training of those attendants, engage in collective bargaining with them and recommend changes in the attendants wages and benefits to the General Assembly.

The official ballot language states: "Shall Missouri law be amended to enable the elderly and Missourians with disabilities to continue living independently in their homes by creating the Missouri Quality Homecare Council to ensure the availability of quality home care services under the Medicaid program by recruiting, training, and stabilizing the home care workforce?"

A yes vote would create the council, a no vote would not. If it is formed the council is intended to ensure the availability of quality home care services under the Medicaid program.

An exact cost is not available but estimates put the cost at more than $500,000 each year.

Supporters say the initiative will help both home health care workers and the disabled and elderly Missourians who need them to remain independent.

But others are raising concerns that it is a stealth attempt to unionize home health care workers in Missouri.

It would also allow home health care workers to unionize but would ban them from striking. The Service Employees International Union helped fund the petition initiative.

"What this is about is giving consumers a voice in improving home health care,'' said Alphonso Mayfield, executive director of Missourians for Quality Home Care, a coalition that collected more than 200,000 signatures to get the issue on the ballot. ''Ninety-nine percent of it is related to improving home health care. If the workers unionize, that's their choice but it's not the main part of the proposal."

But Mary Schantz, executive director of the Missouri Alliance for Home Care, the state's largest trade association representing home health groups and private duty companies, said the initiative's language is so ambiguous it's hard to know what the impact will be.

''We don't know how the Missouri Quality Homecare Council is going to be implemented or how it's going to impact consumers,'' Schantz said. ''It appears the effort is mostly geared toward unionizing this work force.''

Bob Pund, 40, of Columbia, who was left a quadriplegic after a 1989 car accident, said he's often had problems finding and keeping home health care workers to help him with such basic tasks as getting in and out of bed, showering and eating.

''The pay is very low, there's no benefits, no insurance or workman's comp,'' Pund said. ''And it's physical, hard work. The work force needs to be stabilized. Even people who like the work find they can't support themselves doing it and have to leave.''

He also argued that improving working conditions for home health care workers would save taxpayers money because it costs far less to care for someone at home than in a nursing home or other institution. And the problem will only get worse as baby boomers age, he said.

Schantz said having a statewide list of workers who either are home health care workers or who have expressed an interest in the job could be helpful. But she noted that the state already has a Family Care Safety Registry, which runs background checks on workers in nearly every field that cares for children, elderly or the disabled.

''It's unclear as to what the purpose of (the statewide registry) would be,'' Schantz said. ''My best guess is it may be a union recruitment tool. But again, the ballot language is unclear, so I'm not certain.''