NH’s eroding direct care workforce
A Medicaid rate increase is needed now to reverse growing crisis
As the CEO of a nonprofit charged with providing critical social services to some of our region’s most vulnerable citizens, I’m often asked what keeps me up at night. The complexity of providing community-based services 24/7 could make this a very long answer. However, the current workforce crisis and its implications for the future are by far the root of an ongoing nightmare.
Many direct support professionals, who provide safe, meaningful support to people with disabilities and brain injuries, work 60, 70, even 100 hours per week at a job with significant mental and physical demands. Turnover rates reach 30 percent some months. Hourly workers put thousands of miles each year on their personal vehicles with a mileage reimbursement rate far below the federal allowance. More and more local entry-level jobs in the hospitality, food service and retail sectors offer $15 per hour to start. Because of a budget cap, a career professional DSP can’t ever earn more than $15 per hour. The starting hourly wage is just over $12.
Why is the pay so low for people who do such difficult and important work in our community? Simply put, Lakes Region Community Services and the other area agencies in New Hampshire who support people with developmental disabilities have not seen a Medicaid reimbursement rate increase in 13 years.
A recent report showed that as of September 2018, there were 234 vacant positions for direct support staff statewide. Even those with a genuine calling for caregiving are opting out of the field in favor of positions that offer better pay, incentives and less stress.
And the truth is this is everyone’s nightmare because the impact of this shortage cuts across the entire healthcare system. Who will staff nursing homes? Who will work in healthcare and homecare as we age together in a state with a disappearing healthcare workforce?
LRCS also serves the elderly population through a program called “Home Assist,” which allows seniors to age at home longer with supports such as light housekeeping, meal preparation and some personal care. One might assume that our rapidly aging state would be a CEO’s dream — a growing market for our services. But we have had to turn clients away due to the lack of workforce. And the growing number of aging residents that cannot access this assistance will instead require nursing home care, placing a greater burden on the healthcare workforce.
This scenario, along with the critical staffing challenges we face in disability services, is repeated around the state in both for-profit and nonprofit sectors. The practice of desperately trying to fill schedules on the backs of overworked and underpaid direct care and healthcare workers is unsustainable and ultimately risks the viability of our communities.
Only swift, meaningful legislative action in Concord can awaken us from this nightmare. An immediate increase in reimbursement rates to Medicaid providers is needed now so that area agencies can begin to offer direct support professionals a living wage.
The state also needs to implement more incentives to attract new recruits such as scholarship programs, tuition reimbursement, student loan forgiveness, access to workforce housing and better public transportation. There has been plenty of talk in New Hampshire regarding our workforce crisis. This is the time for voters to insist that their representatives in Concord work together to end this nightmare and rebuild the state’s healthcare and direct support workforce.
Rebecca Bryant is president and CEO of Lakes Region Community Services.