Ways to address Minnesota’s growing direct care worker shortage continue to be scrutinized. Seven main priorities, along with several related recommendations, are under study by Minnesota’s Olmstead Sub-cabinet and a working group.

The report, Recommendations to Expand, Diversify, and Improve Minnesota’s Direct Care and Support Workforce Workplan, was reviewed by the Olmstead Sub-cabinet July 23. A cross-agency direct care and support workforce shortage working group has spent months studying Minnesota’s critical workforce shortage. Several group members presented aspects of the report, which contains more than 120 ideas. The top recommendations and related strategies were reviewed by the sub-cabinet.

Mary Tingerthal, director of the Minnesota Housing Finance Agency and chair of the sub-cabinet, praised the report for its thoroughness. Tingerthal said she was “pretty blown away” by the level of detail on problems and solutions. Other subcabinet members also praised the working group’s efforts and said the work exceeded their expectations.

Working group members said they have not only gathered data from Minnesota and Minnesotans affected by the care crisis, they have also looked to other states. But they and sub-cabinet members noted the challenges going ahead, including the fact that Minnesota will have a new governor and potentially many new House members next year. The change in the governor’s office will mean changes in who leads state agencies, and ultimately, how recommendations and strategies go forward. That’s especially true for the Minnesota Department of Human Services and Department of Employment and Economic Development. Those departments have the most ties to the report’s recommendations and strategies that could come forward during the 2019 legislative session.

Working group members emphasize the urgency of the situation. “We have a significant shortage of workers,” said Linda Wolford. “There are more than 10,000 openings around the state.” Legislators “have failed us” in not addressing the workforce crisis, said Jeff Bangsberg. While the personal care attendant (PCA) programs have been put at greatest risk by the failure to raise wages, all types of direct support staffing have been harmed by low wages.

 

Community members speak out

Community members also spoke to the workforce shortage, the need for increased reimbursements and the urgency of reform. Carla Friese is quadriplegic. She’s been in the state’s Personal Care Attendant (PCA) programs for more than 30 years. “I just want to put another face to the crisis,” she said. The lack of workers means “devastating choices” for people who need care.

Michelle Lacey, who has spent 33 years in the state program, said that as she has needed more and more help, “it has become more and more difficult to fund PCAs to cover my hours. While she has had he help in the past to cover her hours, the friends and family members who pitched in have moved on. It has become a struggle to find workers. “I want to stay in the home I’ve lived in for many years,” Lacey said.

Jane Strauss, the parent of an adult son with disabilities, and Friese also spoke to the difficulties clients face in being labeled as difficult by agencies. Strauss has had an especially difficult time trying to find male workers who can work with and relate to her son. She has hired college students, which is one of many report suggestions, “but they are not reliable, and they are not consistent.”

“You need consistency and you need to have a worker for more than three months,” Strauss said. Her family has also dealt with workers who lack training in such areas as explosive behaviors, and who reinforce negative behaviors through what her family considers to be inappropriate rewards.

Strauss had to quit her job as an attorney in 2004 to help with her son’s care. That has forced her family to live in poverty. She’s 64 years old and facing surgery. “I’m sorry that this was negative,” Strauss said. “But it’s reality. It’s our reality.”

 

Recommendations are reviewed

The need to increase worker wages and/or benefits is a top recommendation. The strategies to do so are led by the need to provide a livable wage to enhance job satisfaction and retention and address statutory limits on reimbursement rates that make it difficult for providers to pay direct care and support staff a livable wage. Another related recommend would require provider reporting of wages paid to track progress toward a livable wage. The need to offer or improve benefits provided to direct care and support professionals, including health coverage, paid time off, and holiday pay is cited. Another strategy is to assess the potential of creating an employee pool group consisting of direct care and support professionals throughout the state to achieve the best possible health coverage at the most affordable price.

A second priority is to expand the worker pool. One way to do this would be to create incentives for high school and college students choosing direct care and support career paths, such as help with tuition. Non-traditional candidates could be recruited to expand the worker pool, including students, people on public assistance and more immigrant Wolford said one benefit that could be cited is the flexibility of direct care schedules, for people who need work hours that mesh with their schedules or who don’t want to work full time.

One barrier in expanding the worker pool is transportation, so the working group has proposed exploring options to address transportation barriers for direct care and support professionals and the people who depend on their services. Another strategy is to provide resources to help organizations utilize recruitment and retention strategies known to increase the quality of candidates hired. Other ideas including developing apprenticeship opportunities for direct care workers and developing a service corps through partnerships with colleges, universities, and/or private partners.

A third recommendation is to improve the workforce by enhancing training for direct care and support professionals. Dena Belisle, a working group member who is a PCA, spoke of the need for improved training. She outlined the importance of developing a training and scholarship program consistent with the Minnesota Department of Employment and Economic Development’s career pathway model.

Promoting use of existing training and development options and providing tiered credential options and career ladders for direct care and support professionals are other strategies. Belisle said direct care work could be a pathway to related work. “Direct care work can be a great starting point for other health and human services careers,” she said.

A fourth recommendation is to increase job satisfaction, including quality of the job. Strategies to accomplish this include ensuring access to effective supervision and recognizing exceptional direct care and support work. Wolford said these steps are needed to avoid losing good workers. A survey of workers would help with retention, to see what ideas they have.

Raising public awareness by promoting direct care and support careers if the fifth recommendation. One strategy is to leverage Minnesota’s career, training and business services to develop a statewide recruitment and promotional plan to attract job-seekers to direct care and support careers. This could include marketing and promoting direct care as a career, through social media and other outreach, said Bangsberg.

It could also include creating a recruitment and retention guide, promotional materials, and public service announcements on direct care and support careers targeted to potential workers. Another idea is to develop an educational awareness plan on direct care and support careers targeted to high school students.

The need to promote service innovation is the sixth key recommendation. Strategies suggested include identifying and promoting the use of technology solutions. “We need to look at how assistive technology could reduce staff time and how can it help meet service needs?” said Belisle.

Another innovation stage suggested is to support the development of service options for shared services and shared living in the most integrated setting. A third is to examine possible policy or regulatory barriers to the employment of potential workers or the accessibility of services by the people who need them.

The seventh recommendation has many strategies is to enhance data collection. Bangsberg said there are gaps in the available data, which need to be filled as work continues. Better data would add to the understanding the direct support worker crisis and ways to address it. One strategy calls for monitoring improvements or worsening of the workforce issues based on baseline data.

One strategy is to gather and report longitudinal direct care and support workforce data across long-term services and supports in Minnesota. Ongoing data needs for monitoring workforce issues is also cited, as is the need to gather and report annual direct care and support workforce data across service types and populations receiving long-term services and supports.

Other strategies are tied to funding, to allow monitoring of the relationship between critical incidents, recidivism of institutionalization, and emergency room visits based on reductions or increases in vacancy and turnover rates, and to conduct a statewide study of emergency rescue personnel who respond to people who fall in their homes or need assistance with toileting or other activities of daily living due to lack of direct care and support staff.

In the September issue of Access Press, newspaper staff will present more information on workforce issues.