As I started writing this month’s editorial, I knew I wanted to avoid starting out with my continuing concerns about the critical shortage of direct support staff (DSP) personal care attendants (PCAs) in the disability community. I’ll get to that, but lucky for me and you, we have happy news to focus on first: the Charlie Smith award banquet coming up on November 4. That’s always a pleasure to talk about, because the award puts a spotlight on people doing the hard and usually invisible work of advocating for people with disabilities.
Cliff Poetz is the winner of the Charlie Smith award this year. Cliff, a community liaison with the Institute on Community Integration at the University of Minnesota, has been at the center of the disability rights movement in Minnesota for decades. He was one of the first advocates who had himself spent time in Minnesota’s institutions for people with disabilities.
Cliff has spoken out publicly—in the Minnesota Legislature, in the U.S. Senate, and in the Wall Street Journal—to provide first-hand examples of life in an institutional setting. He has helped many understand how degrading and dehumanizing the institutions were. Charlie would be very proud to know that we are bringing Cliff into the fold of Charlie Smith Award winners. Cliff represents exactly what the award is all about, and that is giving voice to those people with disabilities who are not able to speak up for themselves and tell their story to policymakers. Read more about Cliff and this year’s other outstanding nominees in this month’s Access Press.
Reflecting on what life was like in the institutions described by Cliff and many others, I get scared that some of us may have to look at institutionalization as the only option left, considering the lack of caregivers. And that brings me back to my chief topic this year. I’ve been reading about the psychological concepts of classical and operant conditioning in teaching and learning. Operant conditioning was developed by B.F. Skinner who was a professor at the University of Minnesota for many years. (His name is used in “The Simpsons” TV show as Principal Skinner. You know you’ve made it when you’ve been depicted as a character on “The Simpsons.”) It’s a reward-based approach to learning or training, where progress toward the goal is positively reinforced or rewarded.
Most of our careers are reward-based: you work hard, you learn what makes for success, and as you become more competent and efficient, you achieve goals and are rewarded. In most careers the reward is some sort of financial compensation. That doesn’t exist in the PCA program. In the PCA program, you peak at the highest wage within a very short time— and usually not for becoming more skilled, but just for showing up reliably. Too often, after reaching a “peak” wage of maybe $11.50/hour (or $23,000 per year, without sick leave, vacation, or other typical benefits), PCAs leave the field. They look for more rewarding careers with different responsibility, less medical stress, higher pay and a more progressive career path that will continue compensating them for increased skill and experience. The PCA path doesn’t offer any new goals, and it doesn’t offer adequate rewards even for a goal of stability.
Like their PCAs, agencies aren’t rewarded to achieve the state’s goals of providing assistance to the elderly and people with disabilities. An agency receives no financial reward from the state for teaching and nurturing employees in their jobs. When an agency places a newly hired PCA for on-the-job training with another PCA or with a supervising nurse, it can bill the state for only one individual’s work. It takes time, and it costs a lot to teach the appropriate competencies or skills (but most “training” is completed in a shift or two at most). Obviously, it also costs agencies when there is any turnover in staff. In addition, advertising, recruiting and training— even at a minimum level—is very costly. Far too often, agencies can’t afford to follow all the rules. As a result, they often do not train adequately or follow up with a “qualified professional” supervising the PCA at every required task.
Within the PCA program there are two completely different plans: Traditional PCA and PCA Choice. With Traditional PCA, an agency recruits, hires, trains, schedules and terminates—and does all the administrative and financial side of running the plan. In PCA Choice, a client hires, manages and terminates employees as needed, while an agency does all the payroll administration and financial accounting. PCA Choice can often permit a client to offer higher wages and have more choice in choosing employee caregivers. It makes many clients more confident that they are in control and less likely to be institutionalized. For many people with disabilities, however, the number of hours it takes to run a choice program may not leave enough time to work in a chosen career. Many don’t want to have their careers become solely running their own care agencies.
Because in PCA Choice the agency only does the administrative and financial end and the client does the other work, it’s more attractive to the agencies, and there are fewer and fewer agencies that offer Traditional PCA. The definition of choice is: an act of selecting or making a decision when faced with two or more possibilities. It’s becoming harder to find agencies that offer Traditional PCA, which ironically leaves little choice.
I’ve always used Traditional PCA. Next month I will try to find someone who can write more on the positive sides of PCA Choice. Maybe they will enlighten me on which program really offers the best options and the most independence.
Have a good month. September’s beautiful weather is usually a great reward for living in Minnesota!