By Dave Ranney, KHI News Service, September 21, 2009
TOPEKA — For years, advocates for the disabled and the frail elderly have warned legislators that attendant care workers are woefully underpaid for the work they do.
"It’s a huge problem," said Jim Beckwith, executive director at the Hiawatha-based Northeast Kansas Area Agency on Aging.
People don’t like to hear me say this, but it’s true,” he said. "In America, we do not respect those who care for the very young and the very old. We say we do, but we don’t."
Attendant care works help the frail elderly and people with disabilities bathe, get dressed, fix meals, do laundry, take their medications, and maintain their homes or apartments.
These services allow recipients to avoid expensive, Medicaid-funded moves to nursing homes.
"As the population keeps getting older and the demand for in-home services keeps going up, it’s going to be harder and harder to recruit and retain a reliable workforce," Beckwith said. "In a lot of ways, we’re already there."
In Kansas, the average care worker’s wage hovers around $8.85 an hour. No retirement plan. No health insurance. In many cases, no reimbursed mileage expenses.
In Kansas, a person earning $8.85 an hour probably is eligible for food stamps. There’s a good chance their children are eligible for HealthWave, the state’s health insurance program for needy families.
Most attendant care workers start out at closer to $7.50 an hour.
Union effort
Last month, the Service Employees International Union (SEIU) Healthcare Kansas filed an open records request, asking the Kansas Department on Aging and the Kansas Department of Social and Rehabilitation Services for the names, addresses, telephone numbers, and e-mail addresses for the 6,000 to 8,000 attendant care workers whose services are underwritten by Medicaid.
Neither SRS not KDoA had the information because the workers, generally, are hired by the people they care for and are paid by contractors who, in turn, bill the state.
Rather than deny SEIU’s request, SRS and KDoA sent a letter to more than 1,000 contractors asking them to compile the information.
The letter triggered protests from key Republican legislators.
"The state ought not to be doing their (the union’s) legwork," said House Majority Leader Ray Merrick, R-Stillwell. "If they want to come in and do it themselves, fine, more power to them. But the state shouldn’t be doing it for them. That’s just common sense."
State associations representing programs and services for the developmentally disabled, physically disabled and frail elderly lodged protests, too.
"I don’t have a problem with unions — that’s not the issue," said Cindy Luxem, executive director of the Kansas Health Care Association. "The issue is whether it’s appropriate for the state to tell private entities they have to provide names, addresses and phone numbers of their employees because some of what they do is paid for by the state. It’s just not right. This isn’t the place or the way for (SEIU) to gain this kind information."
Luxem’s group represents many of the state’s for-profit nursing homes, some of which provide in-home services and employ attendant care workers.
"None of my members responded to the request," Luxem said.
On Thursday, SRS and KDoA drafted letters rescinding the request and letting providers know that any information they had submitted had not been shared with the union.
But in the drafts, the respective department secretaries ask the contractors to share the information about SEIU with their workers:
"It is the State’s practice to make information regarding labor organizations available to its employees. I request that you also provide these attendants with information about labor organizations that are available to them."
Whether the letters are approved by the departments’ respective secretaries remains to be seen. A decision is expected as early as Monday.
"Our position is that workers should have information," said Michelle Ponce, a spokeswoman for SRS. "Beyond that, we’re very neutral. Whatever they decide to do is up to them."
Contacted by KHI News Service, SEIU Healthcare representative Sadie Kliner declined on-the-record comment.
SEIU has had an organizer in Kansas for about two years.
Wage issue unsettled
Though spiking the SEIU’s request for attendant care workers’ contact information may slow the union’s recruitment efforts, it does little to address the larger workforce issues and is unlikely to stop the union’s efforts to enroll workers.
"I can’t say that the Legislature has done much," said Mike Oxford, executive director at the Topeka Independent Living Resource Center (TILRC) and an in-state organizer for ADAPT, a national disability rights organization.
"For years, we’ve heard about the benefits of preferring home and community based services over institutional care and how much money it saves," he said. "But then we turn around and build the system on the backs of low-wage workers. Then, anytime you try to raise wages there’s all kinds of opposition because it costs so much because labor is by far the biggest cost center."
"This one of those areas that the more you get into it, the less sense it makes," Oxford said.
In 2008, TILRC helped introduce Senate Bill 566 directing SRS to figure out how much attendant care workers ought to be paid and how to come up with the money.
The bill passed the Senate but died in the House. It was not re-introduced this year.
"The message, I guess, is that it’s OK to pay attendant care workers the same as a 16-year-old kid working at Arby’s," Oxford said.
Link pay to quality
Advocates for the frail elderly have proposed raising attendant workers’ wages by linking them to higher standards of care.
"I’m all for raising wages, but raising wages doesn’t raise quality," said Jan White, who oversees in-home services at the Community Memorial Healthcare Home Health in Marysville.
All six of the program’s home health aides are certified both as nursing assistants and home health aides.
"To be a certified nursing assistant you have to have 90 hours of education and clinical training," White said, "and to be a certified home health aide takes 20 more hours and you have to take a state exam."
Trained workers, she said, tend to earn higher wages.
"The argument can be made that qualified workers ought to be paid more," White said. "It’s hard to argue for paying unqualified workers more."
White noted that because Community Memorial Healthcare Home Health is a part of the local hospital, its workers receive the standard benefits package.
"You absolutely have to have health insurance," she said.
Four of the program’s six workers have been named Home Health Aide of the Year by the Kansas Home Care Association.
"We value our workers and we let them know they’re valued," White said.
She proposed two more strategies: "We need to change the public’s attitude toward this kind of work, and the elderly need to stand up and say it’s something they require."
In Kansas, attendant care workers are not licensed; certification is voluntary.
"You don’t have to know First Aid, you don’t have to know CPR, you don’t have to be med certified," said Beckwith at Northeast Kansas Area Agency on Aging.
The standards are low, he said, because those receiving services get to hire their workers. Oftentimes, these workers are friends or family members who may or may not be qualified.
"The idea is to let them hire someone they’re comfortable with and who will be dependable," Beckwith said.
How to pay for it?
Rep. Bob Bethell, R-Alden, is chairman of the House Aging and Long Term Care Committee.
"The issue really comes down to rates SRS and Aging pay the providers, which pretty much defines what the providers can pay the workers," Bethell said. "As everybody knows by now, those rates don’t cover the actual costs of the services. So the key, I think, is to come up with a way to say ‘Here’s how much is needed to make things better,’ and then ‘Here’s how we’re going to pay for it.'"
Bethell said he would have preferred that some of this year’s federal stimulus money had been used to shore up attendant care worker wages.
"But that didn’t happen," he said.
Bethell said his committee will hold hearings on workforce issues next year.
"It's definitely on the radar," he said.
House Majority Leader Merrick said he’s all for attendant care workers earning more, but he’s not convinced that it’s government role to make it happen.
"I agree that $8 an hour is a crummy wage," he said, "but it’s an open market and if people are willing to work for that, well, that’s what the market is. Now, I may not agree with it, but that’s how it works. That’s the free-market system we live with every day."
—Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128
Read more about this issue at: The attendant care worker’s job and Union also active in other states.