Picket Line Walks the Edge of Change They gathered in late afternoon at the entrance of the Washington Hilton in the nation’s capital - nearly 100 men, women, and children toting hand-lettered picket signs. Some wore white lab coats and carried symbols of their professions - canes, crutches, and walkers. Despite their bold signs - “Inova Cut ... Features
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Features  |   June 01, 2001
Picket Line Walks the Edge of Change
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Swallowing, Dysphagia & Feeding Disorders / Healthcare Settings / Practice Management / Professional Issues & Training / Features
Features   |   June 01, 2001
Picket Line Walks the Edge of Change
The ASHA Leader, June 2001, Vol. 6, 1-15. doi:10.1044/leader.FTR2.06122001.1
The ASHA Leader, June 2001, Vol. 6, 1-15. doi:10.1044/leader.FTR2.06122001.1
They gathered in late afternoon at the entrance of the Washington Hilton in the nation’s capital - nearly 100 men, women, and children toting hand-lettered picket signs. Some wore white lab coats and carried symbols of their professions - canes, crutches, and walkers.
Despite their bold signs - “Inova Cut My Pay 20%” - there was a hint of hesitation as they formed a picket line on the sidewalk, carefully observing the limits imposed by police. The group - rehabilitation therapists belonging to a fledgling union, their families, and friends - had driven from northern Virginia on May 5 to picket the Inova Century Gala, a large-donor fundraiser for Inova Health Systems.
For most, it was their first picketing experience. The orderly demonstration - no chanting or shouting, in keeping with professional decorum - marked another milestone for the Organization of Home Care Professionals (OHCP) in its effort to negotiate a contract with Inova VNA Home Care. With more than 13,000 employees, the parent company - Inova Health Systems - is northern Virginia’s largest employer after the federal government.
In August 2000, Inova imposed a 20% pay cut that affected only the per-visit rates of home care rehabilitation therapists. The company’s approximately 120 physical therapists, occupational therapists, and speech-language pathologists responded by pursuing union recognition by the National Labor Relations Board. Two months after the pay cut took effect, the OHCP won a recognition election by a vote of 83 to 16, becoming the nation’s first union of home care professionals.
The salary cut that triggered the union effort “was a tough decision,” but was justified by financial projections, says Maryanne Boster, Inova’s director of marketing communications.
“Home health has been hard hit by cuts in payments by insurance companies and government programs, and it was important to Inova to continue to provide care while managing our costs,” Boster said.
Corporate changes at Inova, a not-for-profit company, reflect recent trends in home care. Following Medicare budget changes in 1997, the number of home health agencies declined by 25% under an interim prospective payment system (PPS) based on a formula that sharply reduced reimbursement.
But the view has brightened considerably for home health agencies under the final PPS rule, which took effect in October 2000. Under the new PPS, the reimbursement formula was changed, with the result that rehabilitation therapy services generate extra cash for home care agencies.
“For each patient requiring more than 10 therapy visits, under PPS Inova receives an additional $2,000,” said Elisabet Tenenholtz, an SLP and vice president of OHCP. She noted that 80% of the caseload at Inova VNA Home Health are Medicare beneficiaries. “We’ll be bringing revenue into the company, but we’re being paid below market rate in northern Virginia. We have documented this difference through our own market survey.”
For Nicole Cox, an SLP who works PRN for Inova, and who has worked in school and hospital settings, it’s a question of respect.
“We have been very professional about this,” she said. “We have been very respectful and open with the company about the union. But with this pay cut and the lack of serious contract proposals, I feel we’re not being treated with the respect we deserve.”
When negotiations stalled early in the year, OHCP intensified its community and media outreach, creating a speakers’ bureau, leafletting health fairs and job fairs, and organizing picket lines.
Negotiations resumed this month, and the company says it’s committed to gaining a contract. “We’ve reached agreement on a number of issues, and we’ll continue to negotiate until we have all the issues resolved,” Boster said.
Isolation and Risk
The isolation of the home care setting makes it difficult to organize collectively. It also carries unique risks for the clinician. “I’ve worked in a hospital, and I’ m aware of the risk of giving dysphagia treatment in the home,” Cox said. “There are no nurses around, and if you’re concerned about aspiration, you can’t go down the hall to order a chest X-ray.” She added that the paperwork burden was even greater than that of school-based SLPs. “We’re also constantly being asked to see more patients,” she added.
In larger health care companies, home care clinicians rarely get to know their peers in other disciplines, says Maria Robinson, a physical therapist and interim public relations chair for OHCP.
“The company set us up in separate teams, by ZIP code,” Robinson said. “If we communicated at all, it was by voicemail or cell phone. We rarely could put names and faces together.”
But those professional walls tumbled as OTs, PTs, and SLPs met in each other’s homes, organized fundraisers, and created their organization.
“It’s been a remarkable process. We have developed tremendous respect for the different disciplines,” Robinson said. “Now we can refer patients to professionals on other teams who have special expertise. We can mobilize resources that existed but were not accessible to us.”
Professionals in Unions
Recent organizing efforts by health care professionals put as much emphasis on quality of care as on traditional economic issues, according to professor Richard Hurd, who directs labor programs at Cornell University and who specializes in the relationship of professionals and unions. In many cases, quality of care issues play a role in the decision to unionize.
“Many clinicians go into their professions because they love the work, and they want to provide quality care. So there is great frustration,” Hurd said. “If their employer tells them the patient doesn’t need help when the clinician thinks otherwise based on their professional judgment, it causes a serious morale problem.”
But frequently, professionals have negative perceptions of traditional unions. “When they look at unions, they say, That’s not how we operate. We want to be cooperative, not adversarial,’ ” he said.
Upon learning about OHCP, Hurd traveled to Virginia to meet with the group, and has invited Tenenholtz to co-present at an upcoming labor research conference.
In its mission statement, OHCP reflects this equal emphasis on professional and economic concerns. After listing its economic priorities - pay structure, seniority, grievance procedures, and caseloads - the group states that it “is also a professional organization and is working to bring therapists together to continuously improve clinical performance, knowledge, and communication. One of the goals of the OHCP is to demonstrate excellence as home care professionals.”
The OHCP has maintained its autonomy as an independent union, although affiliation with a larger union would bring additional resources.
“We’re not ruling it out, but our autonomy as a professional group has been important to us. It’s a fine line to walk, but we’ve managed so far,” said OHCP president Bill Barrie, a physical therapist.
Tenenholtz agrees. “We want to be not only a union, but a professional organization, promoting quality and standards,” she said. “We haven’t let the pay cut interfere with the quality of service delivery. We are hanging in there and hoping for a brighter day.”
For more information about OHCP, visit www.ohcponline.com. Elisabet Tenenholtz can be reached by email at etenenholtz@hotmail.com.
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June 2001
Volume 6, Issue 12