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Home Care Bargaining Certified

Home care providers win rights in Iowa.

By Clyde Weiss


Caring for her mother-in-law, who has dementia, is an around-the-clock job for Marjory Stubberud, a former certified nurse aide who works at her home in Waterloo. An independent contractor with the state-run Consumer-Directed Attendant Care (CDAC) program, she is paid to provide this necessary service. But her income — about $11,000 last year before taxes — falls far short of fulfilling her needs.

"I have no retirement savings," laments the 52-year-old Stubberud, who also lacks health insurance coverage and vacation leave. She therefore jumped at the chance to help build a union with AFSCME.

A majority of her colleagues signed cards asking the state to recognize Council 61 as their union, and AFSCME was certified last July as the exclusive representative for the state's 2,500 home care providers. This great achievement began with a simple but hard-fought demand for justice.

BELOW THE RADAR. CDAC providers perform the same tasks as their colleagues employed at nursing homes: They bathe, dress, groom, lift and offer other essential personal services to their patients. Some are qualified to give medications, tube feedings, injections and other health care. But working at home, they're less visible and far less powerful as a group.

Home care providers are poorly compensated for the difficult work they do. In Iowa last year, they earned a mean hourly wage of $9.05. Even if they work full time, which many are unable to do, that's just $18,830 a year. Nationally, nearly one in five lived below the federal poverty level in 2001, the most recent year for which data are available. The demand for their services is increasing rapidly as the population ages, and as more seniors choose to remain in their own homes rather than reside in costly nursing homes.

Unlike employees who operate from a central location, these personal caregivers work out of their patients' homes (sometimes their own), and the patient, or client, is legally their employer. Consequently, they don't congregate in places where they can discuss their mutual needs and concerns, which makes organizing difficult — and especially important.

AFSCME represents 175,000 workers in long-term care settings. The total includes 75,000 home care workers in public and private facilities as well as independent providers in nearly a dozen states. Sixty thousand are represented by United Domestic Workers of America-NUHHCE, an affiliate in California. Organizing drives are under way in that state and Iowa, along with Maryland and Missouri, plus several other places across the country.

The campaign by Iowa's home care providers to join AFSCME was launched in April 2004 when Council 61 sent a mail survey to question them about their concerns. The key to the campaign was direct contacts. About 20 members of the union — known as volunteer member organizers (VMOs) — visited the providers at their homes, even taking vacation time and weekends to do so.

Rx: MOVE THYSELVES. These outreach efforts helped Council 61 approach the providers and listen to their concerns, and also demonstrated to them that they could do something to improve their situation. "Providers needed to understand that we had to move our own organizing campaign — and to reach out to other home care workers," says Jennifer Andrews, a CDAC provider. "It was up to us."

The message got through. As CDAC provider Deborah Stine of Des Moines puts it: "You can't make changes unless you are willing to get involved. That's the reason I decided to join in the union effort."

As the November 2004 elections approached, the providers mounted their own nonpartisan get-out-the-vote drive. Afterward, they wrote and collected thousands of postcards that called on the governor to grant them basic benefits. They also sought the creation of an independent organization that would champion CDAC providers and act as an employer of record — a legal framework for union representation.

The following month, dozens of providers and their clients took another bold step: They rallied and marched — television cameras rolling — to the Department of Human Services (DHS) in Des Moines, where they demanded to speak to its director about consistently late paychecks. "They didn't want to pay me on time," says David Elmore of Prescott, who waited up to nine weeks between checks. Although the director wasn't in at the time, the providers got their meeting 10 days later, as well as a promise that the company responsible for the late-payment fiasco would be replaced (see Public Employee, March/April 2005, Page 31).

In March, some 50 providers from throughout the state took their concerns to the legislature, joining Council 61's Lobby Day at the statehouse. Besides learning how to work together on a campaign for respect, the providers gained another bonus: Their efforts raised public awareness of consumer-directed care as a choice in addition to care offered by a state agency or private nursing home.

INDEPENDENCE DAY. The providers' quest for union representation achieved its ultimate success on July 4. In a ceremony at the state capitol, Gov. Thomas Vilsack (D) signed an executive order that granted them the right to bargain collectively through a "meet and confer" process: Providers will impress on DHS the need to improve the CDAC program for themselves and their patients.

Next, on July 15, the Iowa Mediation Service certified Council 61 as the exclusive representative for 2,500 CDAC providers. Two months later, a team of 17 providers from 15 counties — representing all parts of the state — met for the first time to discuss what they wanted to achieve at their bargaining sessions. They hope to have a statewide agreement by year's end.

"We need to be compensated for the knowledge and skills we have," says Danny Dunn, a provider in Dallas Center, a town of some 1,500 about 20 miles west of Des Moines. "We need to strengthen the system. Joining the union was the first step." 

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