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