A delay in acting on recommendations to address Minnesota’s direct care worker crisis has people with disabilities and their advocates wondering what more they can do to get action. Thousands struggle to find needed support staff.
The report, Recommendations to Expand, Diversify, and Improve Minnesota’s Direct Care and Support Workforce Workplan, was reviewed by the Olmstead Subcabinet in July. It had seven main focus areas, with more than 120 strategies to help address the workforce shortage. The subcabinet, the group overseeing Minnesota’s efforts for full community inclusion for people with disabilities, was to approve report recommendations October 29.
Saying that more time is needed to review the recommendations and their implications, Minnesota Department of Human Service (DHS) Commissioner Emily Johnson Piper called for the delay during a subcabinet meeting October 29. She said the recommendations could be brought back to the subcabinet as soon as its next meeting November 26. That would give state department and agency representatives more time to meet.
Piper said she needs to understand the implication of some of the recommendations for DHS. “I have questions about some of the action items.”
The delay dismayed self-advocates who have worked for many months on the direct care staffing study. They noted that there are more than 10,000 direct care job openings statewide.
Longtime disability community advocate Jeff Bangsberg served on the advisory committee that researched and drafted the report. He asked the subcabinet what more needed to be done. “We were under the impression that people were very pleased with the direction this report took,” he said. “Quite frankly, I’m awed and disappointed.”
“We are in a period of crisis when it comes to finding direct care professionals,” said Bangsberg, who serves as board chairman for the Metropolitan Center for independent Living (MCIL). He pointed out that there hasn’t been a true wage increase for direct support workers for about a decade.
Delays could affect what action items are presented to the 2019 Minnesota Legislature, which gavels into session January 8. It’s likely that several state departments and agencies would be making program or financing recommendations tied to the report.
Another worry is what could happen to the report in the months ahead. Minnesota will have a new governor in 2019, which will mean new state department leaders. Department heads and their designees make up the subcabinet. It remains to be seen how supportive a new governor will be of Olmstead and its goals of inclusion in the community. Regardless of that, a new subcabinet will have a learning curve and will have to get up to speed on issues including the workforce issue and the study.
“I am very concerned that if we table this now, we’ll slow down all of the good work that has been done over the past 18 months,” he said. Bangsberg asked the subcabinet what information it needs to approve the report and act.
Piper said that while the report contains much analysis and many recommendations, she’d like more scrutiny of how to tie everything together. “My concern is not with the work itself,” she said. “It’s not my intent to slow things down.” But she wants to see more details, including delineation of responsibilities, and noted that meeting many of the report’s goals falls on DHS.
Low pay for direct care workers has been debated for years. But the complication for Medicaid-supported workers is that a wage increase would mean asking state lawmakers to pass an increase in the reimbursement rate.
A cross-agency direct care and support workforce shortage working group spent months studying Minnesota’s critical workforce shortage, to develop the report. Since the report was presented to the subcabinet in July, various state department representatives have reviewed the document to determine how they will respond.
Alex Bartolic, who leads disability services for DHS, also cited the urgent need for action on the workforce crisis. One early focus is to be that of educating policymakers. One challenge is that on average a personal care attendant in Minnesota is paid $11.78 per hour. An increase of at least 20 percent is needed to be competitive.
Another need is to look region by region in Minnesota to understand what is happening and what change would cost. Surveys of home and community-based service providers should help DHS get answers.
“This is a big, big issue and a problem in the state,” said Darielle Dannen, government relations director for DEED. She said the review has focused on first steps and what can be done right away. Dannen said conversations about implementing the recommendations will continue.
DEED Commissioner Shawntera Hardy, who chaired the October 29 subcabinet meeting, said her department is enthusiastic about how it can help address the workforce shortage, looking at labor market analyses, doing more training and finding ways to address the gaps in the system.
The need to increase worker wages and/or benefits is a top recommendation in the report. 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 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.
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.
Promoting use of existing training and development options and providing tiered credential options, increasing job satisfaction, enhanced training, promoting direct care careers, service innovations and improved data collection are among other report recommendations.
