{"id":23059,"date":"2022-05-20T11:02:44","date_gmt":"2022-05-20T16:02:44","guid":{"rendered":"https:\/\/arknews.org\/?p=23059"},"modified":"2022-05-24T13:12:47","modified_gmt":"2022-05-24T18:12:47","slug":"home-aide-shortage-threatens-care-for-developmentally-disabled-arkansans","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2022\/05\/20\/home-aide-shortage-threatens-care-for-developmentally-disabled-arkansans\/","title":{"rendered":"Home aide shortage threatens care for developmentally disabled Arkansans"},"content":{"rendered":"

In December, Governor Asa Hutchinson <\/span>announced a plan<\/span><\/a> to bring relief to thousands of families stuck on a waiting list for Medicaid-funded services for people with intellectual and developmental disabilities.<\/span><\/p>\n

Under the governor\u2019s plan, Arkansas will spend an additional $37.6 million each year to expand a program that pays for direct care workers and other services that help developmentally disabled people stay in their homes or in a community-based setting, as an alternative to institutionalization. These home and community-based services are sometimes called \u201cwaiver\u201d services because they are funded through a waiver agreement between federal Medicaid authorities and the state. <\/span>About 5,000 clients are now on the Arkansas waiver program<\/span><\/a>.<\/span><\/p>\n

The governor has said all of the roughly 3,200 families now on the waitlist \u2014 some of whom have been waiting for more than a decade \u2014 should be served by June 2025. Yet the plan may run into a problem. Arkansas, like many states, is facing a shortage of direct care workers<\/a>, the frontline staff who help disabled, elderly and other clients with daily activities like eating, bathing, getting dressed and using the bathroom.<\/span><\/p>\n

Teresa Dodson, 49, is the primary caregiver for her 22-year-old son, Nathan, who has autism and requires around-the-clock supervision.\u00a0<\/span><\/p>\n

\u201cThe governor has been releasing more of the waitlist people to start receiving coverage services,\u201d she said. \u201cThat's fabulous. It's not going to help us families if they can't find staff. And the more people we release off of that waiver waiting list, the more people that need staff.\u201d<\/span><\/p>\n

From 2017 to 2020, the number of nursing assistants, home health aides and personal care aides in Arkansas <\/span>dropped slightly, from about 41,000 to about 39,000<\/span><\/a>, according to PHI, a national nonprofit that advocates for direct care workers. The workforce likely decreased further over the past two years, fueled by the COVID-19 pandemic and high demand for low-wage workers in other sectors.<\/span><\/p>\n

Direct care workers are typically paid minimum wage \u2014 or close to it \u2014 to perform physically and emotionally demanding work. Arkansas\u2019s minimum wage is $11 an hour.<\/span><\/p>\n

Leaders of home and community-based service providers say finding workers has become much harder over the last year and a half. In January 2021, Easterseals Arkansas had about 14 openings for direct care workers, according to Ron Ekstrand, the CEO of the Little Rock-based provider. By April of this year, it had 52 openings. (Easterseals employs about 250 direct care workers total.)<\/span><\/p>\n

\u201cThere\u2019s something wrong with a system in which we can\u2019t find enough people,\u201d Ekstrand said.<\/span><\/p>\n

\"\"
Easterseals Arkansas CEO Ron Ekstrand (Credit: Brian Chilson)<\/figcaption><\/figure>\n

Some help is on the way. In February, the Arkansas Department of Human Services (DHS) <\/span>announced<\/span><\/a> a $112 million \u201cworkforce stabilization incentive\u201d for providers of home and community-based services. Organizations serving developmentally disabled Arkansans will receive about $52 million for worker retention and recruitment, according to DHS spokesman Gavin Lesnick. The remaining $60 million has gone to providers that serve elderly people.<\/span><\/p>\n

The funding is part of the American Rescue Plan, the federal pandemic relief package signed by President Biden in 2021. <\/span>The bill provides<\/span><\/a> another $12 million for technology initiatives and $27 million for renovation and construction projects for both groups of Arkansas providers, to be disbursed later this year.<\/span><\/p>\n

Providers say the one-time money is desperately needed, but it won\u2019t solve their long-term workforce problems. And with the state opening up new waiver slots, families who have been waitlisted for years may still find themselves waiting for services.<\/span><\/p>\n

Syard Evans is the CEO of Arkansas Support Network, a provider with offices in Springdale, Fort Smith, Camden and Jonesboro. Currently, the organization \u201cdoes not have the necessary resources to support the clearing of the waiver waiting list,\u201d she said.<\/span><\/p>\n

As of mid-May, Evans said, almost 40 individuals who had been referred to Arkansas Support Network for services were facing delays in receiving help due to the staffing shortage.<\/span><\/p>\n

Low wages, tough jobs<\/b><\/h2>\n

Before the pandemic, Evans said, Arkansas Support Network typically had between 85 and 100 job openings a month and about 120 applications. The numbers began to worsen in early 2021. By April of this year, the organization had 182 open positions and just 90 applications.<\/span><\/p>\n

When employers in other sectors struggle to find workers, they typically increase their starting pay. Providers of home and community-based services don\u2019t have that option.<\/span><\/p>\n

\u201cFast food can add 50 cents to every combo meal and generate additional revenue to raise their minimum wages to $15, $16, $17 an hour \u2014 we cannot. We're locked into state Medicaid reimbursements,\u201d Evans said. \u201cWe do not have the ability to adjust our pricing or what we're being paid or what we're able to bill.\u201d<\/span><\/p>\n

Starting pay for a direct care worker at Arkansas Support Network is $12 an hour but increases based on education and experience. On average, the direct care workers she hires make $14 an hour, Evans said.<\/span><\/p>\n

\"\"
Syard Evans, CEO of Arkansas Support Network (Credit: Mikayla Warford)<\/figcaption><\/figure>\n

The problem of recruitment predates the pandemic, she said.\u00a0<\/span><\/p>\n

\u201cIt is a field that has been underfunded and under-resourced from the beginning,\u201d Evans said. \u201cIn the mid-\u201990s, there were organizations that were putting out reports talking about the collapse of the industry if we cannot find a sufficient workforce.\u201d The labor shortage created by the pandemic \u201clooks like it potentially could be the straw that breaks the camel's back.\u201d<\/span><\/p>\n

Ekstrand said Easterseals participates in an employee retention credit program from the federal government that allows it to pay direct care workers $15 an hour and provide some paid time off and benefits. But the federal program is temporary, and it\u2019s not clear Easterseals can keep paying $15 an hour when it goes away.<\/span><\/p>\n

\u201cWe can\u2019t keep doing it if [Medicaid] reimbursement rates don\u2019t go up,\u201d Ekstrand said.<\/span><\/p>\n

Ekstrand said he believes many people would enjoy direct care work if they could make a decent living doing it.\u00a0<\/span><\/p>\n

\u201cThere are people who are wired in a way that they are caregivers by nature,\u201d he said. \u201cBut they look at that starting pay and the benefits, and they see these other competitive offers, and they're like, \u2018I\u2019ve got to put food on my table. I gotta pay my rent.\u2019 And so, we've got to become more competitive with what we're offering.\u201d<\/span><\/p>\n

Reade Roberts, a direct care worker who has been employed at Arkansas Support Network in Fayetteville since 2004, said many of his co-workers are leaving the field.<\/span><\/p>\n

\u201cWe've lost staff in my house in the last few months [because they took] a higher paying job,\u201d Roberts said. \u201cThey couldn\u2019t afford not to go make an extra $2 or $3 an hour. Even though they really love their work and like the people they support, and we all got along well, just pay-wise they couldn\u2019t continue to do it. And that\u2019s sad. And it\u2019s particularly sad for the people they support.\u201d<\/span><\/p>\n

Workers feel undervalued, Roberts said.\u00a0<\/span><\/p>\n

\u201cWhat I would want politicians and leaders to realize is that direct support professionals are not fast food workers. We have a lot more responsibility,\u201d he said. \u201cWe're the last line of defense for these people to [not] fall through the cracks. And if we don\u2019t step up and do our job \u2026 they're not getting taken care of the way they need to or deserve to be.\u201d<\/span><\/p>\n

Low pay, and the high turnover that comes with it, can also mean a lower quality of care for families.<\/span><\/p>\n

For the past four years, Teresa Dodson has been Nathan\u2019s only caregiver \u2014 a decision she made in an attempt to address behavioral problems her son had developed at school, Dodson said. Nathan\u2019s behavior has since improved, and Dodson recently started bringing a direct care worker into their home for a few hours each week. But she worries that the worker will leave just as Nathan grows to trust her.<\/span><\/p>\n

\u201cThis [direct care worker] has been hired to come work with [Nathan for] $11 an hour. She can't survive on $11 an hour. So about the time that my son gets used to her \u2026 I have absolutely no doubt she's going to go find a better-paying job,\u201d Dodson said.<\/span><\/p>\n

\"\"
Teresa and Nathan at their home in Hot Springs (Credit: Brian Chilson)<\/figcaption><\/figure>\n

Dodson, who lives in Hot Springs, is a paid caregiver herself. Like many parents of adults with developmental disabilities, Dodson gave up guardianship of her son when Nathan turned 18 so that she could be compensated by Medicaid through a provider organization. (Her husband remains Nathan\u2019s legal guardian.) Although Nathan requires around-the-clock care, she said, the provider can only pay her for up to 60 hours per week.<\/span><\/p>\n

Dodson\u2019s new direct care worker is now in the home for about 8 hours weekly. \u201cI had to reduce the hours that I'm getting paid by the amount of hours that she is working. So if she works 10 hours a week, I'm only allowed to bill for 50 hours a week,\u201d she said. The worker\u2019s hours are also constrained, Dodson said, because she has three clients but is not allowed to work more than 40 hours total each week.<\/span><\/p>\n

Dodson said the situation was \u201cludicrous,\u201d considering Nathan requires 24\/7 care. \u201cIt's just very frustrating that, because of how little [the provider] is getting paid, they can't pay me for what my son actually needs,\u201d she said. Her emotional health has suffered under the stress, she said,\u00a0 but she can\u2019t find time for therapy because she has to stay home with Nathan.<\/span><\/p>\n

\"\"
Credit: Brian Chilson<\/figcaption><\/figure>\n

Tom Masseau, the director of Disability Rights Arkansas, a nonprofit that advocates for the legal rights of individuals with disabilities, said it\u2019s \u201cvery taxing\u201d for parents to provide care full-time. But, with a shortage of workers, it\u2019s common.<\/span><\/p>\n

\u201cA lot of times you see family members coming in and pitching in to help, or one of the parents will quit their job and stay home,\u201d he said. \u201cThe alternative is to go to a facility or an institution, and that goes against what we're trying to do with home and community-based services.<\/span><\/p>\n

A short-term boost<\/b><\/h2>\n

The $52 million in American Rescue Plan funds won\u2019t allow providers to increase wages long-term. DHS has told providers it can only be used for recruitment bonuses, retention bonuses and \u201ccomplex care retention bonuses.\u201d<\/span><\/p>\n

Providers will be able to spend up to $1,000 per new employee recruited. Each employee also may be paid up to $15,000 in retention bonuses for the period between October 2021 and March 2024. Providers can spend an additional $3,500 per employee to retain workers who provide care to individuals with complex needs, a category that includes people who are wheelchair-bound or who have a history of behavioral problems, among other issues.<\/span><\/p>\n

DHS has disbursed the money, but it has yet to reach providers. In Arkansas, Medicaid services for people with developmental disabilities or severe behavioral health needs are paid for through managed care organizations known as PASSEs, or Provider-led Arkansas Shared Savings Entities. DHS distributed the $52 million to the state\u2019s four PASSEs in late March, according to Gavin Lesnick, a DHS spokesman. The PASSEs will begin paying out the money to providers beginning July 1, Lesnick said.<\/span><\/p>\n

Evans and Ekstrand were part of a working group created to come up with a plan to use the federal funding \u2014 and, Evans said, to make sure the state applied for it at all.<\/span><\/p>\n

\u201cThe state was really hesitant about the logistics and the practicality of it all, because it\u2019s one-time money,\u201d Evans said. State officials are sometimes wary of one-off funding, she said, because \u201cpeople start to rely on it and expect it, and then when it goes away it actually is harmful.\u201d\u00a0<\/span><\/p>\n

Evans said providers were told the state would not use the American Rescue Plan money to boost reimbursement rates, since doing so could create an ongoing commitment after the federal relief funds run dry.<\/span><\/p>\n

\u201cArkansas was very, very clear from the beginning \u2026 they would not take one dollar if it was going to mean that they would have to invest a dollar after the fact and try to figure out how to fund it from someplace else,\u201d she said.<\/span><\/p>\n

Asked why DHS did not use the money to jump-start an increase in direct care worker wages, Lesnick noted that the one-time federal funds were \u201caimed at stabilizing programs as they weather the negative effects of the pandemic.\u201d\u00a0<\/span><\/p>\n

The agency is making other changes to help providers recruit and retain staff, he said. \u201cThis includes eliminating experience requirements for direct support professionals and replacing them with training requirements that mirror what we have allowed during the pandemic,\u201d Lesnick said.<\/span><\/p>\n

Home and community-based services are already costly. According to a legislative report published in January, annual spending on Arkansas\u2019s developmental disability waiver program reached $307.3 million by 2021, most of which was paid by the federal government. With a total of about 5,000 individuals on the waiver program, the average cost per client was $61,804.<\/span><\/p>\n

But institutional care is even more expensive. In 2020, <\/span>Medicaid spent almost $118 million<\/span><\/a> on the 885 developmentally disabled clients housed in the state-managed residential facilities called human development centers \u2014 over twice the per-person cost of home and community-based services. (H<\/span>uman development center spending includes the cost of room and board and some other services paid for by Medicaid, however.)<\/span><\/p>\n

Ultimately, providers say, they need a long-term increase in rates if they\u2019re to pay better wages. Rates are negotiated between providers and the PASSEs, which receive a lump sum from the state for each individual they serve and are tasked with controlling spending.<\/span><\/p>\n

Ekstrand said the PASSEs must get enough money from the state if they are to reimburse providers adequately. But he also said the PASSEs could be devoting more existing money to developmental disability services.\u00a0\u00a0<\/span><\/p>\n

\u201cIt seems like the resources are there,\u201d he said. \u201cWe just need to allocate them the right way.\u201d<\/span><\/p>\n

(Ekstrand noted that Easterseals is an investor in one of the PASSEs, Summit Community Care, though he said Easterseals is not involved in Summit\u2019s decision-making and does not have a seat on its board. Such a relationship is not unusual in Arkansas: Under state law, PASSEs must be majority-owned by providers.)<\/span><\/p>\n

Ekstrand sits on the board of the <\/span>Developmental Disability Provider Association<\/span><\/a>, a trade association that is commissioning a study to determine what would constitute a competitive wage for direct care workers. He hopes the study, expected to be published in September, could start discussions about a rate increase.<\/span><\/p>\n

\u201cWe have to make sure that the PASSEs are paying us enough that we can pay our staff, so we can provide our services,\u201d he said.<\/span><\/p>\n

This story is courtesy of<\/span><\/i> the Arkansas Nonprofit News Network<\/i><\/b><\/a>, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

In December, Governor Asa Hutchinson announced a plan to bring relief to thousands of families stuck on a waiting list for Medicaid-funded services for people with intellectual and developmental disabilities. Under the governor\u2019s plan, Arkansas will spend an additional $37.6 million each year to expand a program that pays for direct care workers and other […]<\/p>\n","protected":false},"author":43,"featured_media":23071,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[111],"tags":[479,473,470,130,474,472,471,115,431,475,476,477,478],"class_list":["post-23059","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","tag-american-rescue-plan","tag-arkansas-support-network","tag-developmental-disabilities","tag-disability-rights-arkansas","tag-easterseals-arkansas","tag-hcbs","tag-home-and-community-based-services","tag-medicaid","tag-passe","tag-ron-ekstrand","tag-syard-evans","tag-teresa-dodson","tag-waiver"],"yoast_head":"\nHome aide shortage threatens care for developmentally disabled Arkansans - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2022\/05\/20\/home-aide-shortage-threatens-care-for-developmentally-disabled-arkansans\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Home aide shortage threatens care for developmentally disabled Arkansans - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"In December, Governor Asa Hutchinson announced a plan to bring relief to thousands of families stuck on a waiting list for Medicaid-funded services for people with intellectual and developmental disabilities. 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