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In Supreme Court’s Harris v. Quinn Case, PHI Supports Illinois’ Right to Engage in Cooperative Labor Management Solutions for State-Employed Home Care Workers

January 21, 2014

Bronx, NY — Today, the Supreme Court heard arguments in Harris vs. Quinn, a case that challenges the right of states to offer collective bargaining to their publicly funded workforces, including personal care aides who serve Medicaid beneficiaries in consumer-directed programs.

PHI submitted an amicus brief (pdf) in support of the state of Illinois' right to determine how it provides state-funded long-term services and supports and sets employment conditions for this essential public workforce.

"The PHI 'Brandeis brief' provides important background information for the Court's consideration, conveying sound empirical evidence and social science information about the labor market for home care workers," said Jodi M. Sturgeon, president, PHI, the nation's leading authority on the direct-care workforce.

"The state has an overriding interest in developing a sufficiently large, skilled, and stable workforce to meet the needs of beneficiaries enrolled in the state's Medicaid-funded home and community-based services programs. State policymakers need flexibility to creatively address this challenge."

Petitioners Are State Employees

The petitioners in Harris vs. Quinn are personal care aides (PCAs) in the state's consumer-directed Medicaid programs. In these programs, individual beneficiaries share employer responsibilities with the state. Thus, in Illinois, the petitioners are hired directly by the beneficiaries for whom they provide care. But the state retains critical functions as an employer, setting parameters for job responsibilities and qualifications for applicants, determining wages and benefits, and directly paying the workers.

As the brief states, it is "the state's right to run a publicly funded program in the manner that the state reasonably believes allows that program to best accomplish its objectives." Allowing beneficiaries a greater degree of control over whom they choose to hire does not change the fact that the petitioners are employed by the state, and are free to offer their services in other parts of the home care industry where the state does not operate a personnel system.

Dispersed Workforce

Consumer-directed programs, by their very nature, rely on workers who are dispersed among thousands of households. For these programs to meet the burgeoning need for services, the state needs to take an active role in building an adequate and committed workforce available to work in such programs.

In several states (e.g., California, Oregon, Washington, Illinois, and Massachusetts), collective bargaining has been an effective tool for serving these workforce-stability and quality interests. Unionization can provide a structure for communicating with worker representatives in order to understand the needs and concerns of this workforce, leading to improvements not just in wages and benefits but also recruitment and training opportunities, all of which are of key concern to state policymakers.

Challenges of Maintaining Sufficient and Qualified Workforce

There is a clear need to find innovative, creative strategies to build, strengthen, and stabilize the state's workforce that provides Medicaid-funded home and community-based services to elders and people living with disabilities. According to the National Association of States United for Aging and Disabilities, 84 percent of states report serious concerns about the lack of sufficient direct-care workers to meet beneficiaries' demand.

In no other area of the economy is the demand for new workers growing faster than in the home care sector. For example, in Illinois, demand for personal care and home health aide jobs is growing at 33 percent and 42 percent respectively, much faster than the projected 9 percent increase for all jobs in the state.

Though plenty of home care jobs are being created, recruiting, training, and retaining an adequate and stable workforce is a constant challenge that limits the effectiveness of the state-run and -funded programs. Recruitment and retention are problematic for two reasons: the traditional labor pool for these jobs (women aged 25-54) is stagnant and the quality of jobs is generally poor (something that state policymakers have not typically tried to address).

Not only are wages low, but the jobs are often part-time, physically and mentally challenging, and result in high rates of injury. Because individuals find the work is more difficult than expected, annual rates of turnover surpass 50 percent and compromise continuity and quality of care. In addition, worker replacement costs add significantly to the cost of providing services.

To address these challenges, the state of Illinois turned to a strategy that has been successful in other areas of the country — establishing a cooperative labor-management partnership through which the state could better assess workers' needs and the opportunities to improve working conditions.

"It is important that the state retain the right to make policy judgments about how best to strengthen its Medicaid-funded home and community-based service and supports programs and make them more successful and effective," Sturgeon said.

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PHI, the Paraprofessional Healthcare Institute, works to transform eldercare and disability services, fostering dignity, respect, and independence — for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality care.

Deane Beebe, PHI Media Relations Director, 718-928-2033, 646-285-1039 (cell),

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