Dear Governor Dayton,

I hope your hip surgeries were successful. I haven’t heard much more about it or your rehabilitation in the news, so I am assuming it all went well without any resulting restrictions on your movement. I also hope you aren’t living with a lot of residual pain. On top of all that, you live daily with the stress of leading government in Minnesota, and I thank you for that.

As someone who’s had surgeries and long-term injuries more often than I want to think about, I always look forward when I’m recovering to the simple pleasure of walks and playtime with my dog, a sweet Doberman Pinscher. Having your surgeries must’ve slowed down your time with your own dogs. The companionship of having dogs is a wonderful way to help with anxiety and stress, and coming home to pets who are nothing but loving, loyal, and always happy to see you is a great relief at the end of the day. Hope you and your two German Shepherd Dogs are running together again soon.

I recently met with Lauren Gilchrist, your senior policy advisor, but want also to share with you directly the urgent concerns of the disability community about home care—especially as you yourself have just experienced some level of need for physical care.

I explained to Lauren the crisis we are in, and she understands the danger that is looming right over our heads, as far as personal home care services go. For several years, policy experts and the media have been warning about an impending care gap. It’s here. In addition to your hip surgeries, I think you’ve had other stays in the hospital over your lifetime, so you can relate to the need for personal care attendants in our homes in order not to be confined to a nursing home or rehab facility for recovery or long-term care. Whether we lead a state or a small business or a household, we all want to maintain our independence and our health.

As you well know, the demographics of Minnesota are changing as people grow older, live longer and healthcare expertise improves. Still, the aging process brings many disabilities, as much as we don’t want to accept it: trouble with our hearts, trouble breathing, walking, bathing, hearing, seeing, general mobility. Some think that family members should be the home care solution, that children should look after their disabled parents, parents their disabled children, or any adult their disabled siblings. But those kinds of arrangements cause disruptions in families, and frequently impoverish and exhaust them. Can you imagine one of your sons giving up his career to take an $11 per hour job to stay home and take care of you or their mother? Or you having to step down from your governorship because one of your sons needs your help at home because of a disabling accident? The whole state would lose. Disability and severe injury can be devastating to a family and can also restricts the growth of the state.

But there’s another important reason why family care cannot provide the full solution. Many children or adults with disabling conditions require complex care. The necessary tasks sometimes involve complicated medical duties. The caregivers of higher-need Minnesotans should be trained and compensated adequately to fulfill these complex professional tasks.

By 2024, the home care industry is projected to grow by 30 percent in Minnesota, with an additional 16,000 new jobs. DEED ranks the current demand for home health workers at 21st in the state, but over 10 years the industry’s projected growth rate is third-highest in Minnesota. If we don’t do something soon, what will become of Minnesota’s elderly and disabled? Many of us with disabilities can’t find reliable, well-trained employees now. How will these projections affect millions of your Minnesota constituents?

The elderly and people with disabilities choose to live outside of institutions and nursing homes. These choices are not just preferences; they are rights. Government must fulfill promises made by the Americans with Disabilities Act over 25 years ago and, in Minnesota, by the Olmstead Plan in 2015. I’m sure you’re aware that the Americans with Disabilities Act and the Olmstead Act have explicitly stated that people with any disability should be living in the least restrictive environment of their choice.

So providing home health assistance is a matter of human and civil rights. But it’s also a matter of good economic sense for the State of Minnesota. Many studies across the U.S. have found that home health support is cheaper and generally provides a higher quality of life than institutions. So instead of focusing on whether we can afford to fund these needed services, we need to ask whether we can afford not to fund them, and whether we can afford not to abide by the federal statutes. And what is our moral and ethical responsibility? I think we both know the answer to that last question.

There are people in the disability community now experiencing disruptions in care on a weekly basis. PCAs are leaving the job because they’re afraid to come into work because there’ll be no one to relieve them after an eight-hour shift. Home care providers are struggling to cover the hours and are often struggling just to keep their PCAs from working beyond 16 hour days. This is the home care service crisis that is upon us. Far too frequently, PCAs are working more than 40 hours a week, but there is no overtime reimbursement for those hours from the government.

The turnover rate for PCAs is 40 percent to 60 percent across the country and the median wage is a little over $10 an hour. Can you imagine running a business where the turnover rate is 50 percent, and you get no reimbursement for training employees to do medical tasks (many of them required by state law), or for a qualified professional to certify the PCA? Did you realize that 28 percent of PCAs/CNAs/Direct Support Professionals rely on Medicaid for their personal health insurance? About half of this workforce receives public assistance with annual incomes below the federal poverty line.

But I’ve gone on too long in what was meant to be a friendly letter. This is where we need our pets, to calm ourselves after days of high-pressure work. I know you are besieged by so many asking for government funds from the state budget. I wish you some good fall evenings with your dogs, and hope that as election day draws near you will find some time just to think about this issue. I believe in your compassionate views, and look forward to seeing what you will do with a new House and Senate in the coming year.

Yours truly, Tim.