As the economy continues to reemerge from the pandemic, many employers say they are having a hard time hiring enough workers for all their open positions. But one sector was already facing major staffing shortages prior to the coronavirus – providers for home and community-based services for people with disabilities.
The inability to hire and retain workers – in part driven by low wages due to low government reimbursement rates – was already a crisis, but now threatens to collapse the system, advocates say.
Direct support professionals, or DSPs, do everything from aiding people with medical appointments, helping with housework and cooking, assisting with complex medical care, and helping people with activities of daily life like brushing their teeth, bathing, and getting dressed.
“The inability of organizations to recruit and retain staff has been with us for quite a few years now. And then the pandemic hit. And we lost many DSPs, many DSPs found that they had to stay home with their family members. Others decided maybe it was time to find another profession. The work is hard. And for what we're able to pay DSPs, they could go to other employers in all different sectors in the economy and receive a higher wage,” said Nancy Murray, president of the Arc of Greater Pittsburgh and senior vice president at Achieva.
“Now that now that we're seeing a recovery, we don't we don't have the staff available to us any longer at the rate of the salaries that we're able to pay them with the rates that we receive to keep pace with, other sectors of the economy, whether it's Wal-Mart or Sheetz or, you know, some restaurants, we just can't, we just can't pay our staff what they can earn in in other places,” Murray said.
Much of the work DSPs do to care for people is reimbursed by Medicaid, a jointly-funded federal and state program that covers health costs for many low-income and disabled individuals. But low rates mean many staff earn low wages – leading to hardship for staff, and high turnover for provider agencies.
There’s more than 6,000 people with disabilities statewide who were receiving services prior to the pandemic, who now aren’t, Murray said. That’s because, in some cases, day programs never re-opened, or only re-opened partially due to staffing constraints.
“We know that some providers, for example, closed some of their community homes,” Murray said. “They didn't have the staff to keep them all open. So, many people with intellectual disabilities then were moved into another home, giving up a home that maybe they had lived in for quite a few years, but because the provider didn't have enough staff, they had to consolidate homes for people. So, when we're looking at things like that, we're beginning to see the collapse of the system because we're at a point where people with intellectual disabilities just aren't able to get the services that they're entitled to there and they're eligible for.”
Murray’s organization is one of a number of disability service providers that are asking the state to invest $541 million of American Rescue Plan funds into a rate increase, to increase DSP compensation. She and other providers argue DSPs should be paid comparable wages to workers in state centers for people with intellectual disabilities, who do similar work.
State human service officials have acknowledged the shortage of workers in the sector.
“To address the shortage of workers within the intellectual disability/autism service system, the Pennsylvania Department of Human Services has committed to both one-time funding to support provider recruitment and retention efforts and to proactively engage in the process of refreshing the data that informs the department’s reimbursement rates for providers serving individuals with intellectual disabilities/autism,” said Erin James, a spokesperson for the agency.
The state has asked federal regulators to let it collect new data it uses when calculating reimbursement rates one year in advance from when it normally would in 2022; it is awaiting federal approval.
