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Care as Infrastructure

posted by Chris Sparks on Tuesday, August 17, 2021

My first foray into the field of community-based services was when my wife and I got a job in a group home for six people with intellectual disabilities. It was January of 1983, and it was also a crash course in the service system – as it was then – and really into a new and different culture. All those years ago workforce and staffing were among our most primary challenges. We often worked six days a week because we could not find the additional staff we needed. In the ensuing 38 years services have changed dramatically, but our workforce challenges have remained. 

Community services for people with disabilities are predominately Medicaid funded and a decades long cycle of inadequate rates then driving inadequate staff pay has prevailed. In part due to this, recruitment and retention problems for direct support staff are consistent challenges across the country, and high turnover threatens continuity and service quality. Probably to no one’s surprise, the impacts of the pandemic have served to worsen workforce problems, with even finding qualified applicants becoming a genuine struggle.
If you have gone to a restaurant lately you have likely seen the impacts of workforce problems. Many have reduced hours or are operating with skeleton crews. And, if you have a loved one in a nursing home or assisted living facility, you have almost certainly seen the direct impacts of high turnover and vacant positions. There are simply not enough caregiving staff available to meet the needs. 
As we grapple with workforce scarcity as a reality we are delighted that conversation among the Executive Branch and Congress includes our dilemma. On a federal level “The American Jobs Plan” contained a proposal to “solidify the infrastructure of our care economy by creating jobs and raising wages and benefits for essential home care workers.” One key provision was $400 billion of new monies for Home and Community Based Services (HCBS) - with the provision that workers have a “free and fair choice to join a union.” After bi-partisan discussion around the original legislation hit a dead end the “Better Care Better Jobs Act” was introduced. This currently includes $400 billion to expand care for people with disabilities and the elderly, improve compensation for critical direct care staff, and create mechanisms for rate growth for service providers. It is unprecedented and would make an enormous difference in our service system, and to our caregiving staff.  
As our friends at our national trade association, ANCOR, have written: “DSP’s are the backbone of disability support programs, meaning we can’t improve disability supports without strengthening this essential workforce. Responding to the unmet needs of hundreds of thousands of Americans with disabilities will require attracting and retaining more DSPs, particularly in light of a long-running recruitment and retention crisis that stems largely from shamefully low Medicaid wage reimbursement rates.”
Finally, whether you are a fan of the legislation in its current form, we ask you to consider the critical need for substantial investment in our caregiving workforce. People with disabilities and those who are elderly depend upon caring, compassionate, and reliable staff to live successfully. In turn, these essential staff should be able to earn a living wage that allows them to meet their expenses and care for their families.

About The Author

Chris Sparks served as EPI's third ever Executive Director from 1998 until 2022.