Low wages and pandemic staffing support for people with disabilities

Ernestine “Erma” Bryant loves her job, but pay is an issue.

She works in a caregiver role as a “direct support professional” in Tifton, Georgia, helping people with intellectual and developmental disabilities with basic functions such as dressing, bathing and eating.

Bryant said it was a fulfilling job. “You can help people be successful – people who are confined to bed,” she said. “It makes me happy to know that I can help this person get out of the house.”

But she said she was paid less than $ 10 an hour and was trying to find a second job.

In a way, Bryant is an anomaly, having worked for five years as a support professional in the same job in a high turnover field. Even before the pandemic, the country lacked direct support professionals working in private homes, group facilities, day programs and other community settings.

Fears of contracting covid-19 at work have compounded the caregiver problem. Persistent low wages in a tight US labor market make it all the more difficult to attract workers.

Shortages of workers across the spectrum of healthcare – from nurses to lower-level employees – pose an unprecedented challenge for hospitals and other medical organizations. The shortage is at an “epic level,” said Elizabeth Priaulx, a lawyer with the National Disability Rights Network.

People with disabilities who have been approved by state Medicaid programs to receive 40 hours per week in care services often only get 20 hours, Priaulx added. If family members cannot help close the gap, a person may be forced to go to a nursing home, she said.

The Zoller family of Flowery Branch, Georgia, are grappling with this reduction in hours of service.

Katie, 34, has an intellectual disability and lives at home. Her father, John, said instead of the 24/7 care she was previously receiving, she is receiving less than half of it at around 60 hours a week due to the shortage of caregivers. So John, 65, and his wife, Weda, 63, have to fill in the rest. “We have to team up,” he said. The understaffing came after one caregiver for Katie moved and another took a job in a warehouse, each getting higher pay, he said.

Diane Wilush, CEO of Atlanta-based United Cerebral Palsy of Georgia, said her organization has more than 100 vacancies among 358 jobs in 24/7 residential programs. managed by his group, have not been able to offer full services due to a lack of staff.

“We can’t compete with all the retail stores that pay between $ 15 and $ 18 an hour,” Wilush said.

This is because several years ago, the state of Georgia chose a basic Medicaid reimbursement rate for residential service providers of $ 10.63 per hour, although they may pay more for them. caregivers – and sometimes pay less. “It was already an insufficient rate,” Wilush said.

The pressure from an increased workload is having a negative effect on caregivers, said Bryant, Tifton’s caregiver. “When you don’t have enough help, it makes you want to find another job,” she said.

In 2019, before the eruption of covid, the turnover rate of direct support professionals was 43% nationally, according to the collaboration of the national core indicators of public intellectual disability agencies. In a February 2020 vendor survey by the American Network of Community Options and Resources, two-thirds of service providers said they were turning down new referrals. Since staff shortages became a problem, 40% have seen a higher incidence of events that can affect a person’s health or safety.

And a KFF survey released last month found that during the pandemic, two-thirds of responding states reported permanent shutdowns of at least one provider of home and community services covered by Medicaid.

Workers have at times been forced to work 16-hour shifts during the pandemic, said Whitney Fuchs, CEO of InCommunity, an Atlanta-based developmental support and community service provider. “This crisis will erupt into dangerous and unhealthy situations.”

His organization needs to fill 166 out of 490 positions. Before the pandemic, the number of job postings was 80. Even managers, who often cover shifts, are quitting their jobs due to overwork, Fuchs said.

“People are constantly tired,” he said. “This is the life of someone we support. There have been negative outcomes for patients,” like medication errors.

Through the recently passed American Rescue Plan Act, the Biden administration recognized the pay gap for direct care workers by adding more Medicaid funds to help them pay them for their work. The law increases the federal matching rate for state spending on home and community services by 10 percentage points from April 1, 2021 to March 31, 2022.

It requires states to submit spending plans for these funds. Georgia has submitted a plan that contains rate increases, as well as a study of workers’ wages. The proposal is under review by the Centers for Medicare & Medicaid Services, according to Georgia’s Department of Behavioral Health and Developmental Disabilities. Staff said the ministry was “keenly aware” of the shortages.

Federal covid funds have enabled Georgia to grant a 10% pay rise for some vendor services.

Other states are themselves trying to boost workers’ wages. Missouri recently approved $ 56 million to improve its direct support professional crisis.

Parents of people with disabilities, however, are concerned about the future viability of services if the national labor shortage is not addressed.

Bill Clarke and his wife are 80 years old. They have two children with multiple disabilities who receive services in residential homes in the Atlanta area.

“They have physical issues that require 24/7 care,” Clarke said. “There are just not enough people willing to take these lower paying jobs. They are not being paid adequately.”

If these services disappear, Clarke said, “we couldn’t physically manage our two sons.”