Disability Advocates: How much involvement in a political campaign is too much?

This is old news, but I think it is instructive to look back at the 2012 political campaign for Proposal 4, a ballot proposal to amend the Michigan Constitution primarily to assure continued union representation of organized Home Help Care workers by the Service Employees International Union (SEIU). These workers are paid from Medicaid funds that seniors and people with disabilities can use to assist them with  personal care and household chores.

Both Proposal 4 and Proposal 2, another proposal to write collective bargaining rights into the  Michigan Constitution, were defeated. Following their defeat the Michigan lame-duck legislature passed a law that makes Michigan a "Right to Work" state, a devastating blow to labor unions. These controversial union issues became entangled with the Home Help program that almost everyone supports as a way to help seniors and people with disabilities stay in their own homes. The Home Help program has been around for more than 25 years and its continued existence was not threatened by either the passage or defeat of Proposal 4.

[If you want to read more about unions in Michigan, here is a pro-union article, "This is not Wisconsin. It's Worse.", from the American Prospect, 12/10/12, by Rich Yeselson. It covers Michigan labor history, the United Auto Workers, and how unions have in many respects been weakened by past successes.]

The support by seniors and disability advocates for Proposal 4 focused on part of the proposal that would have maintained the MIchigan Quality Community Care Council (MQCCC) under a new name, the Michigan Home Quality Care Council (MHQCC).  The MHQCC, an organization of advocates for seniors and people with disabilities with representation from the MIchigan Department of Community Health (MDCH), would have continued to represent the employers of Home Help workers, seniors and disabled people in the Home Help program, in bargaining with the workers through the SEIU. The MHQCC would also have continued to operate a registry of Home Help workers who had passed background checks and could receive training to improve their job skills. State funding from the MDCH for the MQCCC had been about $1.1 million per year until the legislature defunded the organization in October 2011. Since then it had received help in maintaining the registry from advocacy groups and the SEIU.

Senior and disability advocates were the face of the pro-Proposition 4 campaign. Most, if not all, of the advertising for it emphasized safety through the maintenance of the registry of home help workers. The advertising did not mention, however, that 75% of Home Help workers are family members or friends of the senior or disabled person, unlikely to use the registry, and not subject to background checks. Nor was there much mention of the more controversial union issue.

According to the 12/5/12 updates on the funding of the pro-Proposal 4 campaign called Citizens for Affordable Quality Home Care, funding came almost entirely from Home Care First, Inc. Home Care First got its money, $9,360,000, entirely from SEIU affiliates. The treasurer of Citizens for Affordable Quality Home Care was Dohn Hoyle, the Executive Director of the ARC Michigan. The treasurer of Home Care First, Inc., was Norm Delisle, the Executive Director of the Michigan Disability Rights Coalition.

Here is the campaign statement details for Citizens for Affordable Quality Home Care. This is the campaign statement details for Home Care First, Inc.

The financial stake in the pro-Proposal 4 campaign, was significant: the SEIU collected about $6 million per year in dues and fees from Home Help workers and the Michigan Home Quality Care Council hoped for renewed funding from the state that had been about $1.1 million annually.

One of the primary functions of advocates and their organizations should be to protect the rights of seniors and disabled people and the services they need to survive. To do this successfully, however, they need to maintain their independence and avoid conflicts of interest. In this convoluted campaign to amend the Michigan Constitution, advocates allied themselves with a labor union while simultaneously representing seniors and people with disabilities in collective bargaining with the union. The executive directors of two influential disability organizations were treasurers of the $9.3 million pro-Proposition 4 campaign and the committee that financed it with money entirely from union affilliates.

Seniors and people with disabilities and their advocates played a prominent role in promoting the uncontroversial aspects of the ballot proposal without acknowledging the more controversial union issues. There is a lot to be said for the quality and reliability of unionized workers who are adequately paid and trained and their role in improving the quality of care for people with disabilities, but, as far as I know, these arguments were not made in promoting the ballot proposal. Even if Proposal 4 had passed, the union and the advocacy organization representing seniors and people with disabilities were ultimately limited in their ability to improve the standing of Home Help workers. Although these workers were technically state employees, they received none of the benefits of most state employees and bargaining for better wages depended mostly on convincing legislators to provide adequate funding for the Home Help program.

Fortunately, the Home Help program is still intact and available for those who qualify for it. Beyond that, the chief beneficiaries of the ill-fated Proposal 4 campaign were the PR firms and the media outlets that ran advertising for it. Seniors and people with disabilities are probably no worse off, but advocates who were so intimately involved in this political campaign seemed unable to draw the line between themselves and outside interests and they probably undermined their credibility as advocates.

More on Proposition 4 from the DD News Blog

Election 2012: Michigan's Proposal 4 and Home Help Services

Proposal 4 is a controversial ballot proposal that takes a non-controversial Medicaid-funded service for people who need help to remain in their own homes and places it at the center of a debate over left-right politics, public employee unions, the role of advocates for seniors and people with disabilities, and a formerly state-funded organization - the MQC3 - that may or may not disappear unless Proposal 4 passes.
 
Whether or not Proposal 4 passes, Home Help Services will continue to be provided for people on Medicaid. The Home Help Services program has been around for over 25 years. If you are on Medicaid, you are entitled to these services based on your need for them.

The following is the wording for Prop 4: 

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PROPOSAL 12-4
A PROPOSAL TO AMEND THE STATE CONSTITUTION TO ESTABLISH THE MICHIGAN QUALITY HOME CARE COUNCIL AND PROVIDE COLLECTIVE BARGAINING FOR IN-HOME CARE WORKERS

This proposal would:

• Allow in-home care workers to bargain collectively with the Michigan Quality Home Care Council (MQHCC). Continue the current exclusive representative of in-home care workers until modified in accordance with labor laws.
• Require MQHCC to provide training for in-home care workers, create a registry of workers who pass background checks, and provide financial services to patients to manage the cost of in-home care.
• Preserve patients’ rights to hire in-home care workers who are not referred from the MQHCC registry who are bargaining unit members.
• Authorize the MQHCC to set minimum compensation standards and terms and conditions of employment.

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Background Information and Analysis of Prop 4

To understand proposal 4, the best place to go for an objective analysis of the issues is to a report from the Michigan Senate Fiscal Agency (SFA) that provides background information on the proposal and explains the ramifications of a "yes" or "no" vote.

The Introduction to the SFA report lays out the issues involved in this proposal:

"Proposal 12-4 relates to workers who provide in-home care to Medicaid-eligible recipients of services under an existing State program called Home Help Services. These workers, who are hired by the recipients and paid by the State, are often relatives or friends of the recipients. The workers belong to a labor union, SEIU [Service Employees International Union] Healthcare Michigan. For this purpose, the workers are considered public employees of an entity called the Michigan Quality Community Care Council.

"In April 2012, legislation was enacted to prevent these workers from being considered public employees, and to prevent SEIU Healthcare Michigan from being recognized as their bargaining representative. A Federal lawsuit was filed to challenge that law. In June, the judge issued a preliminary injunction, preventing the law from taking effect for the time being. The Attorney General has filed a motion to appeal."

The Home Help Services Program is administered by the Michigan Department of Human Services and is paid for with state and federal Medicaid funds. The program supports services to seniors and people with disabilities on Medicaid who need assistance with personal care activities and household chores. For more information, see The DD News Blog.  According to the SFA report, Proposal 4 reflects current practice with regard to recipients being allowed to hire and direct individual providers paid for by the state. Proposal 4 would not change this program.

The Michigan Quality Home Care Council (MQHCC) would replace the Michigan Quality Community Care Council (MQC3) and do what the MQC3 was doing, at least while it had funding: provide training for in-home care workers, create a registry of workers who pass background checks, and provide financial services to patients to manage the cost of in-home care. The MQC3 Board is made up of advocates for seniors and people with disabilities including Dohn Hoyle, the Executive Director of the ARC Michigan, who was the first Chair of the Board of Directors for MQC3. Here is a link to the MQC3 Web site.

According to the SFA, the MQHC "would set compensation standards, subject to appropriations by the legislature, and other terms of employment for the providers by program participants." Participant-employed providers would have the right to collectively bargain as public employees who do not belong to the civil service. "The providers would not be considered public or State employees for any other purpose, and would not have the right to strike," according to the SFA report.

Other pertinent facts are: 

• The MQC3 was created in 2004 to coordinate personal assistance services provided by Home Help Services and to create a registry of providers. 
• An election to organize Home Help Workers was held in 2005 with ballots sent out to 43,000 providers. Only about 8500 of them voted, with "yes" votes winning about 7 to 1 over "no" votes. 
• According to a report from the Anderson Economic Group on "The Role of MQC3 and Home Help" from 2011, about 75% of the total number of home help workers are family members or friends of seniors or people with disabilities and 80% have only one client. 
• In 2010 there were 53,516 consumers of home help services;  In 2008, there were on average 44,000 home help providers each month. 
• MQC3 had an annual budget of about $1.1 million from the Michigan Department of Community Health. Its registry contains the names of about 900 providers.

Objections to the organizing of home help workers have come from many of those who are family members or friends of the person they are caring for in their own homes who do not consider themselves State employees. Others object to paying 2.75% of their meager wages (about $8 per hour) in union dues. They may opt out of belonging to the union but they still pay a fee to the union for representation.  As I understand it, the Michigan Department of Community Health deducts union dues and fees from Home Help workers pay checks, which are then sent through the MQC3 to SEIU Healthcare Michigan.

Others believe that the legislature, by passing Public Act 76 in April 2012 that amends Michigan's Public Employment Relations Act, has undermined collective bargaining rights and that a constitutional amendment is necessary to protect these rights.  The law excludes people who receive government subsidies for their work from the definition of "public employee" and prohibits recognition of bargaining units made up of non-public employees. A Federal lawsuit challenged the law and an injunction has prevented it from going into effect.

The MQC3 has been defunded by the legislature and passing proposal 4 will put it back on its feet as the MQHCC. The organization's training programs and the registry of providers seem to be helpful, but whether it needs to be part of the Michigan Constitution is up to the voters.

One question that I have that I have not seen anyone address has to do with the MQC3 (and potentially the MQHCC) representing the "employers" of home help workers, seniors and people with disabilities who generate the Medicaid funding to pay for services.  Were these "employers" ever asked if they approved of the MQC3 representing them or if they wanted such representation? It appears that the State assigned the MQC3 to represent seniors and people with disabilities without their knowledge or participation.  

For Pro and Con views on Proposition 4, see opinion pieces in the Detroit Free Press from October 19, 2012:

Prop 4: Proposal assures higher standards for home caregivers, greater safety for patients by Dohn Hoyle

and

Prop 4: Family and loved ones providing home health care shouldn't be forced to pay union dues by Robert and Patricia Haynes

There will be a live chat on Proposal 4 at noon on Tuesday, October 23, 2012, sponsored by the Detroit Free Press. Go to the Web site  to submit questions in advance.

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I will be the first to admit that I am not an expert on many of these issues. I am just doing the best I can to piece together the information available to me. If you have  questions, corrections, or comments on this blog post, please say so in the comments on my blog. I will publish them as long as they are civil and coherent. A diversity of views and opinions on this issue are welcome.
 

Fraud and abuse in home healthcare for the elderly and disabled

The Boston Globe reports that the Massachusetts Medicaid program has significantly increased spending on home healthcare in the last decade, while reports of fraud, abuse, and neglect have tripled. This raises new concerns about the lack of training, certification, and criminal background checks for personal care attendants as well as minimal oversight for the low-paid healthcare workers.

Federal investigators from the Government Accountability Office have also found rampant abuse in the Medicare home healthcare program for the elderly, including $200 million paid for care that was never provided. Between 2002 and 2006, spending for the program increased 44%, while the number of patients rose by only 17%.

The union representing personal care attendants, the director of the state's Medicaid program, and the Director of the Boston Center for Independent Living defend the program as meeting the demands of consumers who are elderly and disabled as well as being cost efficient.

Bill Henning, from the Boston CIL says,

"This is a program with inherent risks, and we would be happy to overhaul it in a lot of ways. But there's a lot of turnover in this field, and there's a real concern that we could choke off the supply of attendants."

Tom Dehner, the director of the state Medicaid program, is reluctant to increase regulation:

"We believe that consumer control of this program and service is intensely personal...We think consumers are in the best position to direct when and how to receive these services and train people and supervise them."

A woman with severe spastic cerebral palsy who has been bullied, threatened, and intimidated by personal care attendants (she has hired and fired scores of them), thinks otherwise:

"You can never be sure who you hire, and I check all their references...It would be nice, at the least, for the state to allow us to do a free criminal background check."