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SCOTUS Decision Will Hinder State’s Ability to Provide Quality Home Care Services

June 30, 2014

Bronx, NY — Today, the U.S. Supreme Court rendered a historic majority opinion in the case of Harris v. Quinn that, unfortunately, will hinder the state's ability to ensure a sufficient and stable home care workforce for providing essential publicly funded long-term services and supports to people in their homes.

The Court, in determining that consumer-directed home care workers are "partial public employees," demonstrates a fundamental misunderstanding of the state's role in determining the conditions of employment for home care workers paid with public monies, and fails to recognize the critical interest of the state in ensuring quality of care for its elders and citizens with disabilities.

As argued in PHI's amicus brief (pdf), the state of Illinois is responsible for ensuring that individuals can receive high-quality publicly funded long-term services and supports in the least restrictive settings — the home and community. To meet this obligation, the state must guarantee the availability of skilled home care aides statewide. The state has several mechanisms for overseeing employment conditions and improving the quality of home care jobs, one of which is designating a common employer for home care workers — usually dispersed working in private homes — so that they can form a collective-bargaining unit.

"Most home and community-based services are paid for by the state's Medicaid program, so the state clearly has a compelling interest in developing and supporting the workforce that provides those services," said Jodi Sturgeon, president of PHI, the nation's leading authority on the direct-care workforce.

"States need to develop public policies that support good home care jobs and ensure quality care for consumers," Sturgeon continued. "Collective bargaining for the workforce has been important for addressing both these issues. Illinois aides in the consumer-directed programs have seen their wages double as a result of collective bargaining. The quality of care is inextricably linked to quality of home care jobs — these better wages help ensure a stable workforce that can provide the consistent and continuous service elders and people with disabilities want and deserve."

State's Employment Responsibilities

In today's opinion, the majority accepted the petitioners' claim that personal care aides (PCAs) hired directly by beneficiaries in the state's Medicaid program are not fully public employees. In doing so, the justices misconstrued the state's critical functions as an employer. While beneficiaries in consumer-directed programs are in charge of the day-to-day oversight of service provision, as noted by Justice Kagan in her dissent, the state maintains many key employment functions including: setting parameters for job responsibilities and qualifications for applicants, determining wages and benefits, and paying workers directly.

Dispersed Workforce

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

In several states (e.g., California, Oregon, Washington, Illinois, and Massachusetts), collective bargaining has been an effective tool for serving these interests. Unionization has provided 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. Together, these improvements support the states' interest, namely, providing quality home care to its citizens.

Challenges of Maintaining Sufficient and Qualified Workforce

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 growth of the traditional labor pool for these jobs (women aged 25-54) is stagnant and the quality of jobs is generally poor.

Not only are wages low, but the jobs are often part-time, physically and mentally challenging, and result in high rates of injury. All of these factors contribute to annual rates of turnover in excess of 50 percent, which compromises 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 proven 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.

"In short, the Court's decision limits the State's ability to determine how best to strengthen its Medicaid home and community-based services by building a sustainable qualified workforce," Sturgeon said. "And unfortunately, Illinois citizens who need long-term care, their families, and the underpaid workers who provide their care will bear the brunt of this decision."

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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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