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Winning Dignity for Caregivers

The Missouri Home Care Union was built on the belief that, working together, 13,000 independent providers could win improved care for the elderly and disabled—and a better life for themselves.

The Missouri Home Care Union was built on the belief that, working together, 13,000 independent providers could win improved care for the elderly and disabled—and a better life for themselves.

By Clyde Weiss

Marilyn and Linda Kelley

Independent home care provider Linda Kelley and her mother, Marilyn, helped build a union for 13,000 Missouri providers. Photo: Virginia Lee Hunter


A knock on the door one day last year brought independent home care provider Linda Kelley face to face with the woman she now calls her “angel.”

Standing on the doorstep of Kelley’s home in Springfield was Sylvia Grass. Once a caregiver at a privately run in-home care agency in Independence, Grass was on a mission to build support for what today is called the Missouri Home Care Union, an affiliate of AFSCME Council 72.

The union serves as the collective voice of 13,000 personal care attendants like Kelley who make it possible for the elderly and disabled to live with dignity in their own homes—or sometimes, the homes of the providers themselves. But the prospect of their own union was just a dream on the day that Grass showed up at Kelley’s home.

Her message: With a union, Kelley and other independent providers in Missouri “could have a voice—and she wouldn’t stand alone.”

“I started crying,” says Kelley. “I told her I’m in the hole very bad. I was scraping for food.”

To get by, Kelley depends on her own disability benefits and the little she earns as a provider through the state’s Medicaid-funded, consumer-directed home care program. But her 65-year-old mother, Marilyn, for whom she cares, is allowed to pay for no more than three hours a day of support.

Recently, when Marilyn’s emphysema and chronic pulmonary disease grew worse, Kelley took her into her own home. “I cook her meals, bathe her, distribute her medicine, help get her in and out of her wheelchair—it’s a never-ending situation, 24-7,” she says.

Kelley’s pay—$8.50 an hour, with no health insurance benefits, sick days or vacation time—leaves her with little to make ends meet. Yet she does her job willingly because the alternative, she says, is unthinkable. “God knows I don’t want to die in a nursing home,” she explains. “They’ve got 150 patients with maybe two nurses on the floor.”

Grass, who understands the financial despair and isolation felt by many independent providers, offered Kelley a ray of hope. Through a union, she told her, “you can make a change.”
“Please,” implored Kelley, “tell me how.”

A First Step

Arthricia Temes

St. Louis resident Arthricia Temes, a consumer of the services offered by independent home care providers, says caregivers should be able to earn a decent living so they can go on helping the elderly and disabled live their lives outside a nursing home. Photo: Lloyd Grotjan

Before building their union, the independent providers—who are employed directly by the “consumers” of their services—needed an official “employer of record” with whom they could negotiate for improvements in their program. That was the purpose of the Missouri Quality Home Care Act, also called Proposition B.

The goal of the 2008 ballot measure: establish the Missouri Quality Home Care Council, an 11-member panel appointed by the governor that could improve services and negotiate with a union. To build support for its passage, AFSCME formed alliances with various groups, most importantly the Disabled Citizens Alliance for Independence (DCAI), headed by Richard Blakely. Council 72 worked with DCAI in the last five legislative sessions to improve funding for these programs, and both understood the need for a coalition effort.

Council 72 also mobilized dozens of volunteer member organizers (VMOs). Among them was Threasa Bach, a certified nursing assistant employed at a veterans’ home in St. James. Bach had never volunteered for anything like this before, but as vice president of Local 2093 (Council 72), she knew the vital role of a union in building dignity and respect for its members.

Bach and her husband, John, traveled around the state once they received their VMO training. “We talked to a lot of people about the home care campaign, about Proposition B and about getting people signed up for the union,” she says. “We told them what we could accomplish for our clients—that if we got what they needed, we’d get what we needed, too.”

One of those clients was Arthricia Temes. Partially paralyzed and reliant on her caregiver to live an independent life at home, the 62-year-old St. Louis resident joined AFSCME’s campaign and spoke at rallies about “how I felt as a consumer” regarding the caregivers’ vital services.

Temes says many providers willingly “work for nothing because they know their patients’ needs. But we should pay them what they deserve, because they are very, very important to us. You’ve got to have somebody who cares.”

The voters overwhelmingly agreed that the providers deserved to have their own union. In November 2008, Proposition B passed by a 75 percent margin.

Union Yes!

Thresasa Bach

Certified nursing assistant Threasa Bach became a volunteer member organizer to help Missouri’s independent home care providers win their own union. Photo: Virginia Lee Hunter

The next steps were critical. First, AFSCME needed to win the support of enough providers to qualify for a certification election for the Missouri Home Care Union. That’s what brought Grass to Kelley’s doorstep.

Would she join their campaign to build support for the union?

“I jumped on it,” says Kelley. “I was ready for my voice to be heard.”

Although they couldn’t go door-knocking like Grass and the Bachs, Kelley and Marilyn told their story to state lawmakers and their aides. They also spoke at press conferences and were interviewed by a St. Louis radio station.

Then, in an effort to ensure the providers had all the support they needed, the AFSCME home care campaign joined forces in March with the Service Employees International Union (SEIU). Now armed with the signatures of thousands of providers, the newly reconstituted Missouri Home Care Union quickly petitioned to hold a mail-in ballot election of providers throughout the state.

In July, the efforts of Kelley, the VMOs and other supporters of the union campaign were rewarded when an overwhelming 85 percent of the providers who cast ballots voted for the union.

Sadly, the sunshine over the providers’ victory celebration was clouded by a circuit court judge who temporarily blocked certification of the union pending a ruling on a lawsuit filed by a private home health care company. The providers hope that the lawsuit will soon be dismissed.

Another hurdle was the refusal by the Republican-led Legislature to fund the Missouri Quality Home Care Council, thwarting the will of the voters who approved Proposition B. That situation remained unchanged as AFSCME WORKS went to press.

Yet, armed with hope, grit and the support of their new union, the providers intend to carry on their fight for dignity. Vows Kelley: “I’m not about to stop now. We just started to get our voices heard. I want to get a contract for the union!”

Including the newly organized Missouri independent home care providers, AFSCME represents approximately 95,000 independent providers nationwide. Most of them are in California, Iowa and Maryland.

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