Cuts Threaten Oregon's Pioneering Homecare System

By Ethan Lindsey | Feb. 17, 2009 9:22 a.m. | Updated: June 16, 2010 11:59 p.m. | Bend, OR

The stimulus bill is going to be law. President Obama says he will sign off on the $790-billion package, and now the states are trying to figure out what that means for them.It looks like Oregon could get close to $2-billion for education, shovel ready jobs, and health care.Eight-hundred-thirty-thousand dollars will boost the state’s Medicaid funding.We asked Central Oregon correspondent Ethan Lindsey to find out how that money will reach the trenches.He sent us back this report on how it could help reduce cuts in the state’s unique home care system.Forty-five-year-old Christopher Brown points out photos of his four brothers displayed all over the walls in his small motor home.Brown’s younger brother Rusty was severely disabled in a fall when he was a teen. Today, Rusty is considered 100-percent disabled and is unable to hold down a job.Medicaid pays for his prescription drugs and for the care provided by his brother Chris.This scene in Oregon is like many around the country and the world. A younger family member takes in, or cares for an ailing relative in their home.The difference in Oregon?At the end of the month, Christopher Brown will get a check, from the state, for his work.In the early 1980s, Oregon became the first state to use Medicaid money to pay in-home care workers. Often, they are relatives of people who need care.Christoper Brown: “I just have job, okay, I’m a lackey like you, you know.  So, technically, your brother’s your boss. You work for him./Right, right I do. But then you also have the brother relationship./Do you go on strike? Do you say, I’m not working today!/Sometimes, you know. All I ask for is sometime to go to the gym, or go to the rifle range, or hang out. We still try to live like we were kids.”Since the program began, many states have followed Oregon’s lead.Cheryl Sanders is the executive director of the Oregon Home Care CommissionCheryl Sanders: “So, the home care worker can’t go chop wood for example. That’s not a Medicaid-authorized service. But assisting someone with their activities of daily living, helping them with medication management, or shopping, those are the type of tasks a home care workers provides for a consumer-employer in their own home.”When the program first started, caregivers received low wages and no benefits.That led to high turnover and poor care.In response, in the year 2000, 60 percent of Oregonians voted to allow home care workers to unionize. Researchers say the quality of care improved.Workers are eligible for health care benefits, workers’ compensation and professional development classes.One winter weekend, twenty homecare workers cram into a small hotel conference room in Portland.But the classes are a bit unusual.The discussions revolve around personal, family, and relationship issues.William Douglas teaches some of the classes.William Douglas: “One of our core classes, is what they call, ‘keeping it professional.’ And that is a fun class to teach and we talk about boundary issues and those are things that someone if they were working for a G-M, or Ford, or even McDonald’s, they’re going to get on the job training – and then continuing education. And this helps people advance their profession.”Oregon’s 10-thousand homecare workers are independent contractors.And, before the Oregon law, they didn’t get anything like benefits or professional development. But just like a private employer in this economy, the homecare system faces cutbacks. The state of Oregon confronts a billion-dollar budget shortfall. One proposal to save money could cut as many as half of the home care jobs.Karla Spence is a field organizer with Service Employees Union International.She says the cuts don’t make sense – because as it is now the system actually saves the state money.Karla Spence: “This is a win-win situation, for the people who need long term care and to live as independently as possible as long as possible. And with the aging of our baby boom generation, we have to invest in this system, otherwise we’re going to have more of our population going into more expensive nursing homes.”Christopher Brown, back at his mobile home, says he embraces his work.Christopher Brown: “Sometimes, its pretty slacker. But sometimes it’s not, too. My other brothers all have kids and families and wives and all that. I sacrificed that to take care of him. I don’t even have a girlfriend, I don’t have children or anything like that. This is a job that doesn’t get easier as you get older.”Brown doesn’t want to lose his home care job. He says if that happened, he’d still care for Rusty, but he’d have to find another paying gig.And that, he says, would affect more than himself. It’d hurt his brother’s quality of life, and everyone else in the same situation.

© 2009 OPB

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