Home-care reform plan, I-775, is union-made

Fed up with a Legislature unwilling to pay in-home care providers more money and a state bureaucracy often ineffective in ensuring care standards, these folks have turned to a new ally: a union.

A union-funded measure on the statewide ballot Nov. 6 aims to ensure better in-home care for the elderly and disabled by setting up a new client-driven agency. Initiative 775 would create an authority to oversee the recruitment, training and performance standards of the thousands of home assistants who contract with the state. They would also establish a registry of approved assistants so the clients wouldn't have to search the newspapers with their fingers crossed.

Moreover, the measure authorizes the board to negotiate new employment terms with those home-care providers -- currently paid less than $8 an hour with no benefits -- who would be in a statewide union.

Even if voters approve the measure -- there has been no organized opposition -- there's no guarantee the state would follow the intent of I-775. The Legislature would still have to provide funding for the board and approve -- and pay for -- any contract it negotiates, including the pay and benefit improvements for which the initiative's backers hope.

But it's a big start for two classes of people hoping to take over the state's performance as middleman: the clients and the caregivers.

"They don't have a job without us, and we don't have a life without them," said Katrinka Gentile, a client of in-home care and a longtime activist for the disabled. The collective strength of collective bargaining cuts both ways, she said, and I-775 would empower the clients, too.

The measure does have its opponents. Some advocacy groups claim that the new level of bureaucracy would be a waste of money that could better go to care.

But it's the unionization provision -- which some fear could infringe on the rights of the clients it's meant to protect -- that has become the hottest topic of debate among some groups that advocate for the elderly or disabled -- groups that are generally on the same side.

Virtually all of the $650,000 in cash the measure's sponsors have raised came from the Service Employees of International Union. I-775 is similar to measures recently adopted in California and Oregon, which were also supported that union.

Two of the state's largest advocacy groups, the AARP of Washington and Arc of Washington, have decided to sit this one out. They've remained neutral on the measure, even though it addresses a top priority of both groups.

"It's not clear that 775 addresses the balance between the needs of consumers for high quality, affordable care and the needs of providers," said Jo Senters, state director of AARP, who declined to elaborate. "We are reviewing the initiative."

Gov. Gary Locke has not taken a position on the measure but said that he has "serious misgivings." Particularly, he worries that it increases the state's legal liabilities.

The state has already gotten into plenty of trouble thanks to the program that serves low-income elderly and disabled people. Poor pay, high employee turnover and repeated high-profile tragedies have brought the program that serves the state's most vulnerable under increasing public and political scrutiny.

Last summer, the state agreed to pay $8.8 million to settle a $55 million lawsuit brought by one of its clients, Linda David. David was beaten into disability on a filthy sailboat in Snohomish County while under the state-paid care of her husband. And last fall, a Vancouver, Wash., assistant was accused of fatally shooting her disabled client in what has been described as a mercy killing.

The state pays independent providers to give in-home care to about 34,000 elderly and disabled clients, said Kathy Leitch, a state Department of Social and Health Services official. Caregivers help clients at their homes, allowing them to complete everyday tasks from meal preparation to bathing and using the bathroom. They are often relatives of the client, paid $7.68 an hour by the state.

Such assistants must complete 22 hours of training and pass a criminal background check. But it is up to the elderly or disabled client to recruit and hire the provider.

"Putting ads in the paper and interviewing (candidates) yourself is very costly," Gentile said. "These people are on limited income."

Instead, the board created by I-775 would act as a clearinghouse to connect clients with providers who also provide additional training and recruit low-income workers.

Some opponents of the measure complain that it puts too much distance between clients and their providers. Under collective bargaining, the board and the union would negotiate standards for pay, work environment and employment.

"The people who think they're the employers are left out of the process," said Mark Stroh, director of the Washington Protection and Advocacy System, a federally funded legal and political advocacy group. "They're not even at the table."

According to the initiative, the governor would appoint the nine members of the board. They must include five current or former clients of long-term, in-home care services and one person with a developmental disability. The other four members would represent the state Developmental Disabilities Planning Council, the Governor's Committee on Disability Issues and Employment, the State Council on Aging and the state Association of Area Agencies on Aging.

That's not the same as clients choosing their own representatives, Stroh said.

Opponents such as Stroh also worry that any union contract might infringe on clients' rights to fire caregivers at will, or may not prevent a provider walk out.

"I have a fear that there's going to be too much union control," said Joan Coffin, a client and a Yakima-area activist for the disabled. "My fear, personally, is their control in the situation and who's going to be making the decisions."

Clients would retain the right to recruit, hire, supervise and fire providers, according to an explanatory statement written by the state Attorney General's Office. And the providers would be prohibited from striking.

"For someone who lives at home ... one of the most important rights is to determine who comes into their home and does things such a as bathing, feeding, dressing," said David Rolf, Northwest regional director of SEIU, the union that now represents 2,000 home-care givers contracted with Catholic Community Services.

Rolf said his union would never infringe on those rights, and that the clients would retain a right to terminate providers at will.

Gentile, the 22-year activist, added, "any of the (independent providers) can walk out any day (while) working for us. That's one of the reasons -- collectively -- we want to join together and get a better quality of people."

Still, opponents are not satisfied that there won't be unforeseen consequences. And they say the money it would cost to create another agency would be better spent in direct care. The state budget office estimates that implementing the measure would cost $3.7 million next year and $6.8 million over the 2003-2005 fiscal biennium.

Deana Knutsen, a sponsor of the measure and member of a local hospital board, says that opposition to the initiative stems from misunderstanding.

"A lot of the concern revolves around unionized workers and what does that mean," said Knutsen, who has a son with disabilities and a deceased sister who had disabilities. Knutsen argues that the measure and the new board would create safeguards where few exist.

"There's no safeguards there in the system as it is," said Knutsen, whose deceased father was also a client of the program. "This gives a place where people can get together and work out some of the difficulties within the system."

"If the initiative passes, the people are saying this is something we believe strongly we need to have," Knutsen said. "The way the system sits right now, people are much more vulnerable and things happen. And it costs more money to clean up messes than to do the prior work."