Caregiver Registry Trend Raises Unionization, Privacy Concerns

In an effort to ensure home care workers are adequately screened and trained, a growing number of states are rolling out caregiver registries. But depending on the requirements, some worry the registries could do the home care industry more harm than good.

Currently, at least 12 states and the District of Columbia have online training registries that allow employers to verify worker training credentials, according to research from PHI, a worker advocacy organization focused on the direct care workforce.

Registry rules vary from state to state, but generally, agencies and consumers can use the registries to verify caregivers have passed the necessary background checks and training to work in a given market. But some states — such as Massachusetts and California — have been taking the notion of a registry one controversial step further, drawing condemnation from critics as a result.

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“I think privacy is really the primary concern,” Stephen Campbell, data and policy analyst at PHI, told Home Health Care News.

In Massachusetts, for example, caregiver registry legislation makes workers’ contact information publicly available and accessible to anyone. When first introduced, the rules attracted criticism from champions of domestic abuse and undocumented immigrants, as well as industry advocates who worried the requirements could deter prospective caregivers from entering the field.

Among other concerns, critics worried the release of worker contact information could lead to caregivers who are undocumented immigrants being detained or caregivers who are domestic abuse survivors being exposed to their former attackers.

Following the pushback, the state included a way for workers to exempt themselves from the registry.

Meanwhile, different issues persist in California, where labor unions will be able to access caregivers’ information from the state registry starting July 1.

“We were fine with the registry being created [in 2016] so consumers can check to see if caregivers are registered, but we object to that information going to labor unions for organizational reasons,” Dean Chalios, president of the California Association for Health Services at Home (CAHSAH), told HHCN.  

Chalios isn’t the only one.

When the legislation was first introduced, the Home Care Association of America wrote to California Governor Jerry Brown to argue the bill violates the National Labor Relations Act, which only allows unions to access contact information for potential members after 30% show interest in joining the union.

“[The legislation] is clearly just a labor grab and will do nothing more than boost unions’ membership rolls and bottom line at the expense of home care aides and the frail elderly and disabled individuals they serve,” Trevor O’Neil, president of Orange, California-based Colonial Home Care Services and co-chairman of the Home Care Association of America, California chapter, told HHCN in 2017 when the rule was in the works.

And while there is an opt-out option in the California law for caregivers who wish not to be contacted, Chalios believes the rule should work in reverse, requiring caregivers who wish to participate to opt-in.  

“It doesn’t appear to us to be fair to caregivers,” Chalios said, noting that caregivers may be unaware their information will be automatically shared with union groups. “These folks are hardworking people. We don’t think they should have to have their lives interrupted by a union that’s trying to organize them.”  

Historically, unions have not been as prevalent in the home care space as in other industries.

In fact, In Minnesota, thousands of personal care attendants petitioned to have their union decertified, saying that it was created through a fraudulent process after a 2014 law declared them public employees.

Meanwhile, California home care providers in the state view the new rules — along with the registry itself — as extra red tape.

“It’s just something that drags out our process,” Jorge Preciado, who operates a Comfort Keepers franchise in Woodland, California, told HHCN. “We already do our own background checks. We already do our own training. So for us, it’s just a matter of waiting on the state to put this person on a website. … That can take two weeks. That can take three weeks. It’s been a big frustration on the [organization] side of it.”

While Preciado isn’t against caregiver registries, he worries they’re not accomplishing what they were meant to do.

“Since [few consumers are] educated on it, if I’m going to hire a private caregiver, eight times out of 10, I don’t even know to check the registry,” he said.

Still, despite concerns, Campbell believes caregiver registries are good for the home care industry overall.

“If designed well and in a way that protects worker privacy, they can be really effective tools in promoting efficiency and workforce development,” he said.

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