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, 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.