A Caring Crisis: Advocates argue proposed Pa. wage rate for direct support professionals is too low

Jan. 21—For years — and even decades for some advocates — those in the industry of caring for adults with intellectual disabilities have fought for better recognition and better pay to help them provide better services.

And though the Arc of Cumberland and Perry Counties stayed afloat during the pandemic with staff hunkering down to help their clients and hazard pay helping temporarily increase those wages, the age of the "great resignation" and burnout is affecting them just as badly as others in the health care industry.

"We have a 'caring crisis' in this country," said Anne Couldridge, executive director of CPARC. "There's not enough people to do the personal care work. I've had to make decisions I didn't think we'd ever have to make."

Those decisions have included paring down the day programs, which has mostly hurt those who need one-on-one attention, and consolidating residential housing. Couldridge said CPARC has 28 properties from apartments for those who are more independent to group homes for those who need 24/7 care and supervision. Three group homes — which housed three people each and employed nine to 12 workers — have been closed due to staffing shortages.

Couldridge said she had to uproot someone who has been a resident with their program for 28 years and move them to another home. It's a concern that's grown into a crisis, and one advocates hope to solve by simply paying their staff higher wages.

In Pennsylvania, the wages for direct support professionals in IDD care are reimbursed by billing the state through Medicaid. The state government sets those reimbursement rates, and Gov. Tom Wolf years ago set up a system where those rates would be reevaluated every three years — a change from flat funding for years with no recourse.

The Wolf administration at the end of December released the newly proposed rates, adding $400 million in funding. Advocates argue that increase isn't enough to prevent the care crisis from getting worse.

In the proposed increase in fee schedule rates, the wage reimbursement would be set at about $15 an hour for community direct service providers, up about a dollar from the previous wage rate.

"It is important to note that the Wolf administration does not dictate the wages providers pay, we establish rates," said Brandon Cwalina, press secretary for the state Department of Human Services. "The proposed fee schedule increases are projected to be an additional $400 million in funding, which provides us an unprecedented opportunity to support services for people with intellectual disabilities and autism and those who have been supporting individuals and families in our communities throughout the pandemic.

"We must consider rates in all human service areas (including home health care for long-term care and veterans care) and cannot provide rates outside of the market wages for just one program without considering the impact that would have on the entire system," he said.

Though Pennsylvania is not one of the states that has raised its minimum wage for all workers, some companies like Amazon, Target and CVS Health made the move on their own by offering wages as high as $15 an hour for starting employees. It's those companies to which advocates say they are losing their employees.

Couldridge also said community nonprofit organizations aren't likely to be able to find extra funding to raise those wages above the reimbursement rates given the nature of their work.

"We don't have the ability to increase the wages of our staff," she said, adding that she isn't able to cover shortages or increased costs by increasing prices for a product like companies do. But like those companies, she has to worry about costs of doing business, including wages, health insurance for staff, maintaining a fleet of vehicles, providing food for clients and paying for increasing gas prices. "I have one budget to absorb all this. I can't shift anything to increase the staff wage."

Other advocates argue that $15 an hour is far lower than what the state pays its own direct service providers. According to Patrick DeMico, executive director of the Provider Alliance, the state sets the reimbursement rate for staff at its state-owned centers at $18.66 an hour, and sets starting wages at $14.29, compared to $12.94 an hour for community workers.

He said that while Pennsylvania regularly raises the wages for its state workers, the wages for community direct service providers will remain fixed for another three years until they are reevaluated again — with no promise that the wage will be raised.

Advocates said the $15-an-hour wage isn't enough to retain workers, with their industry seeing 30% or higher turnover even before the pandemic. Couldridge said that in addition to staff burning out from 70-hour work weeks, she's seeing staff leave because they can get higher wages elsewhere.

And with fewer staff to help with residential housing or day programs, that pushes the duty back onto families.

"We can't fill 15,000 shifts on any given day," said Ruth Siegfried, president and CEO of InVision Human Services, which provides services in Pennsylvania. "That's incredibly dangerous if someone doesn't show up. Thousands of families can't leave home or go to work."

Wolf's proposed rates are public, and the state government is accepting comments on the fee schedule through Jan. 31. The governor will make a decision after that if the rates stay at that level, but advocates hope that he will instead use some of the state's "rainy day fund" or American Rescue Plan funds to help increase the investment by another $70 million to $136 million in order to reach the $19-an-hour mark.

With the surplus budget and the other funds currently available, advocates say this may be the best and only time to bridge the gap.

"If we lose this chance, it will never come back again," Siegfried said.

Email Naomi Creason at ncreason@cumberlink.com or follow her on Twitter @SentinelCreason

___

(c)2022 The Sentinel (Carlisle, Pa.)

Visit The Sentinel (Carlisle, Pa.) at www.cumberlink.com

Distributed by Tribune Content Agency, LLC.