Human Services Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6486

Title:

AN ACT CONCERNING HOME HEALTH CARE SERVICES AND THE ESTABLISHMENT OF A PERSONAL CARE ATTENDANT WORKFORCE COUNCIL.

Vote Date:

3/17/2011

Vote Action:

Joint Favorable

PH Date:

3/8/2011

File No.:

SPONSORS OF BILL:

Human Services Committee

REASONS FOR BILL:

This bill is meant to establish a Personal Care Attendant Quality Home Care Workforce Council to oversee training and employment for personal care attendants.

RESPONSE FROM ADMINISTRATION/AGENCY:

James McGaughey, Executive Director, Office of Protection and Advocacy for Persons with Disabilities: Mr. McGaughey testified: “One of the big reasons the PCA approach has worked so well is because it allows so much individualization. No two people's needs and preferences are identical, and the roles, tasks and especially the relationships established by people with disabilities and their PCAs can and do vary considerably. Indeed, much of the value of PCA services lie in their highly individualized nature, which is a function of the ongoing management relationship that the person who does the hiring and training – the person with the disability – establishes with the PCA. The person with the disability sets his or her own goals and expectations, chooses who he or she is comfortable working with, trains and directs that person (or persons) in ways that make sense in the context of his or her life.”

“My major concern with this proposal is that it does not reflect an understanding of the essential nature of that individual relationship – the thing that makes the PCA relationship unique. The bill would establish a central structure - the Personal Care Attendant Quality Home Care Workforce Council - which would be charged with tasks, such as training, that properly belong to the person with the disability who employs PCAs. There is a strong likelihood that the type of standardized training which the proposed Council would be charged with developing would undermine the value of the individual training provided by the employer with the disability – individual training that helps establish rapport, and is an indispensible step in defining the way the PCAs relates to the person for whom he or she works. At the very least, standardized training would introduce confusion about who a prospective PCA is actually working for, an effect that would likely be further magnified by the fact that the training is to be ordained by a large statewide power structure - the proposed Council - that would also set policy, bargain with collective bargaining representatives over wages and benefits, and maintain a registry of people working or seeking work as PCAs.”

“History is filled with examples of centralized policy-making authorities that were established with the best of intentions, but which ultimately became the very type of power structure that the first independent living pioneers worked so hard to escape. I urge you to proceed with caution in this area, and not establish an entity that could undermine the inherently individualized nature of PCA services.”

NATURE AND SOURCES OF SUPPORT:

Candace Howes, PhD, Professor of Economics, Connecticut College: Dr. Howes testified: The results of my research suggest that public authorities improve the quality of the jobs and the stability of the workforce:

Personal care assistants in California are demographically similar to PCAs in other parts of the country in terms of age, gender and level of education;

● But, their average wage rate is somewhat higher than the national wage rate for PCAs;

● California IHSS workers are less likely to be on public assistance, they are half as likely to be uninsured, half as likely to be getting public insurance and 50 percent more likely to have employer-based health insurance than PCAs nation-wide;

● Their turnover rate at 25 percent is half the average of homecare workers nation-wide and they are half as likely to be planning to leave the job within 2 years. Other studies have found that about one-third of PCAs intend to leave within one year, and 47 percent within two years, whereas only 6 percent of IHSS workers report such intent;

● Finally, the pool of labor in one county where home care workers were eligible for health insurance, even when they worked as few as 35 hours per week, grew at twice the rate of the labor pool, state-wide; this was because workers in other low wage occupations and family caregivers began to see homecare as a good alternative to their jobs as clerks, factory workers, maids, house-keepers, childcare workers and food service workers;”

Roger Auerbach, Consultant, Auerbach Consulting, Inc.: Mr. Auerbach testified: “Entities such as the proposed Personal Care Attendant Quality Home Care Workforce Council can be a great benefit to a state in many ways. First, it provides a focal point for the State to address a vital issue for its citizens. Individuals needing long-term care support want those services delivered in their homes. This is a well-documented rapidly-growing trend. Almost every survey I have seen shows well over 90% of people wish to receive services at home for as long as they possibly can. Additionally, it is very clear that the cost of services is much less expensive than any other form of long-term care.”

“Next, these Councils have provided support systems for both consumers and workers to make it easier for consumers to hire qualified workers and direct their own care. As I explain below, Councils have created worker registries which consumers can access to find a qualified worker who has been screened in many ways such as with criminal background checks, work status, personal references and skills training. In addition, many Councils also coordinate administrative functions such as processing payroll and benefits.”

“Finally, Councils have served as an employer of record for purposes of collective bargaining and many independent provider workers have chosen to organize themselves and have successfully bargained for higher wages and new health and worker's compensation benefits. While home care is still a low-wage occupation, increased wages made this more attractive work and the addition of health benefits specifically have been shown to be a positive factor in people coming to work as home care workers and staying with this profession.”

Deborah Chernoff, Communications Director, District 1199, SEIU: “This legislation is a critical step towards giving people the kinds of services they need, in the setting they prefer, at a cost the state can sustain.”

“Connecticut's rapidly aging population means that more and more of the state's residents will need long term care. Unfortunately, experts project that the demographic group that makes up the caregiver workforce will shrink. Low wages and benefits drive current caregivers from the workforce at a turnover rate that the Connecticut Long Term Needs Assessment found is nearly 100% annually. As demand for services at home increases, we must take action to improve PCA recruitment and retention. That means creating more PCA jobs and offering wages, benefits, and training that keep will workers in this critical field.”

Dejourn Shields, Personal Care Assistant: Mr. Shields testified: “I like my PCA work, but it's barely even making ends meet. I'm a college graduate looking for something good for my future and while I like this work, it doesn't give me the benefits or pay that I'm looking for. Plus there's no room for advancement.”

“If the state wants to keep workers like me in the home care field, the first step would be passing this workforce council. PCAs need access to benefits, training, and a sense of career. Without making these improvements, the PCAs who can will just move on to something else. It doesn't matter how much you care about your clients—you have to take care of your own future and your own responsibilities too.”

Sherika Knighton, Sandra Prince, Patricia Haugabook, Olga Carrera, Luis Acosta, Elizabeth Tilman, Cynthia Barrett, Eliane Essue, Tanya Meneses, Takelia Baldwin, Sasha Commodore, and Belinda Jordan, all personal care assistants, submitted similar testimony in support of this bill.

Dan Ludington, Home Care Client: Mr. Ludington testified: “I'm disabled and I've had to use the home care system because I can't do anything else. The system seems to want to keep me at a certain level of care or quality of life, giving me just enough hours for the basics but not enough hours to be able to really thrive. We can't better our lives at this level.”

“The biggest way I can sum it up is the system is broken. There's no way for disabled or handicapped to have anything to say in it. If something is wrong, what do we do? There's no direction for us. We get care but we don't seem to have any say for what goes on in it. The idea of home care is good but our system is not done. We need to get it to work, getting the right people, getting them to stay.”

“That's why I'm calling for this commission to be created. With the commission, consumers like me can have a say and can start fixing the system so it works. We know what's wrong with the system better than anyone else does. I'm excited to have someone use my experiences with what's wrong in order to make things better.”

Margie Santana and Tyree Winfrey, both home care clients, submitted similar testimony in support of this bill.

Bette Marafino, Vice President, CT Alliance for Retired Americans: Ms. Marafino testified: “The Board of the Alliance endorses the Quality Workforce Council.”

“A priority of the Alliance for Retired Americans is to foster quality care for seniors in CT. This April we are holding a forum called, “Aging with Dignity, A Continuum of Care”. We know that nursing home care is very expensive for both the state and individuals and that any time we can provide alternative care is a benefit to the state and to the elderly.”

“It is way past time for the legislature to form a Workforce Council that will provide a comprehensive approach to home care along with providing qualified, well- paid home care providers. Thank you for your attention to this matter.”

NATURE AND SOURCES OF OPPOSITION:

Representative Christopher Coutu: Representative Coutu testified: “From 2002-2004, I worked for a disabled individual as an Aide. My capacity was similar to that of a PCA, supporting normal every day duties for a gentleman who was fully dependent on his PCA's or Aide. During this time, I became very aware of the savings to the state from direct PCA or Aide contracting, versus the previously used third party management model. I learned that a third party only increases cost, not quality. In the case of Aide's, an administrative cost of up to 100%. Further, that no standard training would assist all clients. Some have brain injury, others are confined to a wheel chair, or others suffer personal challenges.”

“As someone who recognizes that most who will be affected by this legislation, like my friend and client, are more then competent to recruit, hire, train and employ PCA's directly, I ask the committee put these citizens individual rights ahead of the financial and longevity interests of any union.”

Representative Michael Molgano: Representative Molgano submitted testimony opposing the bill: “The relationship between consumer and PCA oftentimes becomes one of family, and instituting a workforce council as arbitrator can cause an unhealthy tension to such a relationship. Although a consumer or surrogate shall have the right to hire, supervise, direct, and terminate employment, a decision made by the council could jeopardize an accord between employer and employee. All employment-related covenants should be and must only be between the consumer, or surrogate, and the personal care attendant. There cannot be any other party involved.”

“Although I do not receive services from a state-funded program, I am dependent on assistance from personal care attendants and know firsthand the importance of a low turnover rate. A person who is accustomed to my routine will take between one and one-half to two hours in the morning and the same in the evening to perform the care activities I require. When training a new attendant, this time increases 100%, or more, for an average duration of two months. It not only extends the time needed to perform my care routine, it presents an extreme demand on the time I need to perform my duties. Such an impediment affects every aspect of my life, including my office as a Connecticut State Representative.”

Sheila Mulvey of Plantsville, Connecticut: Ms. Mulvey testified: “All comments made are directed in respect to the DDS programs of individual and family support waiver services and the comprehensive waiver program specifically to the self directed funding program, presently an effective cost-saving program of which I am most familiar. There are approximately 800 individuals and families participating in this program.”

“In regards to the aforementioned DDS programs affected by HR6486 I find this bill to be: redundant of sound and successful practices already in place ( lines 58 – 76 and lines 85-91); written with little or no understanding of how these DDS programs are designed and implemented (lines 58-76 and lines 85-91); teetering on the edge of breaching privacy and confidentiality of the consumers and families involved (lines 99-113 and lines 114-129); conceptualized and written with no apparent involvement, consideration or understanding of the lives of the people who receive these services and run their individual programs as “employers” in contract with state and federal governments and unjustly excludes them from negotiating on anything that they already do for their employees ( lines 135-line 210); and, excludes DDS from modifying or rejecting recommendations made by the council ( lines 82-84.)”

Connecticut Association for Home Care & Hospice (CAHCH): CAHCH submitted testimony stating: “The proposed bill speaks to the establishment of a Personal Care Attendant (PCA) Workforce Council for the purpose of collective bargaining. While establishing a statewide registry for PCA referrals may simplify the hiring process for consumers and enhance the staffing of the state waiver programs, Connecticut's home care industry needs to remain the source of quality care provided safely in the patient's home.” CAHCH also included with its testimony tools it feels should be referenced in considering the development of a council.

Catherine Ludlum, Manchester, Connecticut: Ms. Ludlum testified: “I have 22 years of experience as an employer of personal care attendants, and I am a participant in the Personal Care Assistance Waiver. There are many reasons why I think the Council and the personal assistants union that will follow will be harmful both to PCAs and to their employers with disabilities.”

“At a time when Connecticut is closing some agencies and consolidating others because we can no longer afford an enormous bureaucratic structure, how can we even consider creating a new State agency that will duplicate what already exists?”

Mary-Ann Langton, West Hartford, Connecticut: Ms. Langton testified: “A Personal Care Attendant Quality Workforce Council would corrupt a system that is going well. New requirements and regulations would cause more barriers to people with disabilities. Higher wages for the personal assistants would mean less hours for people with disabilities because employees are paid by Medicaid Waivers with financial caps. Workforce will shrink because personal assistants do not want to pay into an union.”

Claude Holcomb of Hartford, Juliet Meyer of Hartford, Donald James of Manchester, Stan Kosloski, Executive Director of CT Disability Advocacy Collaborative, Stephen Mendelsohn of New Britain, Michelle Tyler, a personal care attendant from Tolland, and Jack and Claire Langton of West Hartford all submitted testimony in opposition to this bill.

Reported by: Samantha M. Odyniec

Date: March 18, 2011