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Kasich Administration’s Rate “Modernization” and End of Collective Bargaining Threaten Consumers & Home Care Workers

While the administration has declared its intention to expand the choice of self-direction to all disabled Ohioans (see other article), their actions toward home care workers – rate “modernization” and ending collective bargaining rights – appear to undermine the promise of self-direction for consumers.

Ohio Consumer Voice for Integrated Care (OCVIC, led by UHCAN Ohio), is extremely concerned about adequate pay for home care workers because inadequate pay leads to worker turnover and poor quality services. The House version of the budget bill, HB 64, added a  pay raise to home care workers (it’s uncertain whether the Senate will retain it, and the Governor could veto it). But during May, the administration dealt a double whammy against home health aides.

Rate “Modernization”: On May 15, 2015, the Ohio Department of Medicaid held an administrative hearing on a proposed set of rules to “modernize the way Ohio Medicaid pays for nursing and aide services.” Although ODM claims that most provider types will see gains in certain circumstances, everyone speaking at the hearing – including Cathy Levine and John Lepley from OCVIC – decried the proposed cuts in pay for home health care workers, both those working for agencies and independent providers.

Several home health aides spoke of their commitment to their clients. One frail, elderly woman shuffled to the podium, leaning heavily on her walker, to tell the hearing officer that she would probably be dead if it weren’t for her home health aide. When she said the aide is like a daughter to her, the aide teared up – as did most people in the room. Every aide who spoke talked about the struggle to make ends meet on their current $9.00 an hour pay. One IP has to work over 70 hours a week to afford her prescription drugs.

Home health aides – whether working for agencies or as independent providers – are woefully underpaid.  Advocates for home care workers support a living wage for IPs – $15 an hour. If that seems like high pay for someone without a nursing degree, let’s consider what a home health aide does for frail older adults and other people with disabilities. Let’s also consider the value of their work – i.e., what benefit and savings do they provide?

Home health aides assist clients with personal activities of daily living, including dressing, bathing, eating, and toileting. It requires great skill to lift, assist, and move another adult without inflicting pain, humiliation, or injury. Trained home health aides prevent falls and pressure sores (“bed sores”), complications that lead to hospitalizations and further disability or death. (“Superman” star Christopher Reeves died from an infection stemming from a bed sore.) Home health aides prevent very expensive hospitalizations, surgery, rehab, and confinement to nursing homes. They are essential to reducing avoidable, undesirable spending for Ohio’s highest cost patients. Thus, IPs produce the highest-quality care at a comparatively modest cost. If you consider the cost of nursing home care, the state can afford to raise home health workers’ pay to $15/hour.

ODM developed the new formula with an actuary and “stakeholder” input (from nurses, for whom the rule addresses current concerns about overpayment for short visits). But it is not clear whether home health workers will fare better or worse.

Stripping Away Collective Bargaining: This rate process demonstrates why all home health aides need an organization that represents their interests. However, they are farther than ever from having representation. On Friday, May 22, 2015 (Memorial Day weekend), the Governor rescinded an Executive Order issued in 2007 by former Governor Strickland that gave  home health aides the right to organize and bargain collectively (negotiate) for their wages and working conditions. With Governor Strickland’s departure, a sunset of provisions giving the union bargaining power took effect, but the union (SEIU 1199) continued to negotiate a contract and provide healthcare (a much needed and rarely available benefit for this group of workers) – until the Governor’s action last week.  (Ironically, the Governor justified his action on the basis that IPs can now get their health care through the Marketplace – a shaky notion until we know the outcome of King v. Burwell – see other article).

To its credit, the Governor’s Office of Health Transformation preaches (correctly) the need to move Ohio from paying for volume of health care to value-based care.  However, efforts to restrict the ability of home care workers to bargain collectively for pay and working conditions and the confusing new rate structure call into question whether, in this case, they are practicing what they preach.

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