The causes of the human services labor shortage

A tangle of issues affecting NH has exacerbated the need for direct support workers

Editor’s note: This is the second part of a roundtable discussion of the workforce shortage in the human services sector, hosted by One Sky Community Services in Portsmouth. At the table were Chris Muns, CEO of One Sky; Jay Couture, president and CEO of the Seacoast Mental Health Center; Peter Francese, advisor and principal of the New England Consulting Group; Kathleen Reardon, CEO of the NH Center for Nonprofits; and Le’Ann Millinder, state director of The Institute of Professional Practice Inc.

According to Peter Francese, the case is simply that human services organizations cannot compete on wages with large, private sector employers in the state. “They want to raise wages, they raise them,” he said of private sector firms. “End of story. Human services agencies can’t do that.”

Many human services organizations in New Hampshire don’t operate as for-profit entities; they rely largely on government reimbursements for the services they provide, through such vehicles as Medicaid and charitable, private donations to keep operating budgets operating.

Despite the latest state budget, which includes a 3.1% Medicaid rate increase, human services in New Hampshire are relying increasingly on donations to supplement the costs of services that are needed in the communities they serve.

It’s a point raised by Kathleen Reardon, who asked how these organizations are compensating for rates that are not keeping up with the cost of living. Jay Couture related that the Seacoast Mental Health Center is working with an outside consultant on fundraising for the first time in her 26 years at the center. Reardon asserted it is a similar financial picture for nonprofits across New Hampshire that are contracted to provide services for the state.

Range of issues

According to the Center for Nonprofits, New Hampshire nonprofits generate some $11 billion a year in revenue and employ 15% of the total workforce. And while 39% of the state’s nonprofits have missions in health and human services, perhaps the sector’s value to the community, and its effect on the lives of individuals through community work, is not fully understood or appreciated.

“I’m curious about how we have that conversation as a nonprofit community,” Reardon wondered. “It seems that there are a lot of forces in our society now that support the individual more than the collective. We’re very individually focused as a society as a whole. But what do we want for our communities?”

While wage rates are an important consideration in any set of workforce solutions, the discussion followed a thread that indicated just how deeply connected and interdependent are so many issues — a perfect storm of factors that would require as much in social engineering as simple policy pronouncements to reverse the labor shortage.

For Couture, Millinder and Muns, a wide range of issues are wrapped up within the workforce crisis their respective organizations face. Affordable housing, healthcare, transportation, education costs and student loan debt are among a host of factors exacerbating the shortage of direct support workers.

“We focus on the wage rates, and we should,” said Muns. “But I don’t think we talk enough about the other issues, and we really have to make that argument. The solution has to be holistic.”

There’s precedent for what Muns said. If New Hampshire is one of the fastest-aging states in the country, the reason may be as simple as a lack of affordable places to live for young families who would fill those direct support positions.

Workforce housing

In 2017, Stay Work Play, a nonprofit focused on recruiting and retaining a young workforce in the state, commissioned RKM Research to conduct a survey of 20-to-40-year-olds in New Hampshire. Lack of affordable housing was one of the top reasons cited for why they are leaving the state. And, if Francese is right, they’re being pushed out.

Francese’s current documentary project, “Communities and Consequences II,” with the tagline “Rebalancing NH’s Ecology,” lays out research that indicates age-restricted housing in the state has increased 42% this decade, while total dwelling units have increased only by 5% to 6% in the same period.

In pulling at the threads of a complex issue, the term “workforce housing” is frequently woven through the discussion, second only to wages as a recurring refrain.

Workforce housing actually has its own statute in New Hampshire — RSA 674:58 lays out the definition, including income and affordability ranges. Moreover, the law requires every community to provide “reasonable and realistic” opportunities for development of workforce housing, which can include affordable and subsidized housing, as well as market-rate and mixed-income housing. The statute explicitly excludes age-restricted housing from its definition.

But Francese asserted that many planning boards across the state discourage affordable housing and have plenty of community support in doing so. The common response he has heard from communities around the state falls in the “not in my backyard” category, because localities often view affordable housing as a burden on the town, raising costs through higher school enrollments and increased need for other services. He calls that view a “fiction.”

Indeed, even as overall school enrollment has been declining across the state, there are fixed costs to many services, from building maintenance to salaries, that must be paid out at consistent rates no matter how many students are in the district.

According to “A Decade of Dramatic Change,” a 2012 New Hampshire Housing Finance Authority report, “Enrollment declines do not necessarily mean lower costs, because many education costs are fixed. In some settings — Portland, Ore., for example — communities are considering policies to subsidize families in the face of high housing costs, so as to minimize enrollment declines. This is the opposite of the current thinking in many New Hampshire communities.”

That a conversation about the direct support workforce crisis wanders across seemingly far-reaching areas as school enrollment and affordable housing is indicative of how intertwined community services are and what a far-reaching impact these services have across the state on both the communities as a whole and the individuals who live there.

“I think the workforce challenge is one of the issues that, whether you’re for-profit or nonprofit, you see it,” said Reardon. “It’s a huge issue for all of us. And so it might be a good platform to start talking and ask ourselves, ‘What do we need in our communities?’”

Jeff Symes is a Participant Directed & Managed Services service coordinator at One Sky Community Services.