My Turn: Sustainable raises, training will help address direct-care provider shortage in NH

For the Monitor
Published: 7/31/2021 8:00:12 AM

If we’ve learned anything over the course of the pandemic, it’s the value of our essential workers, which includes Direct Support Professionals (DSPs). DSPs are paid caregivers who provide hands-on assistance with personal care services or activities of daily living for individuals with disabilities or seniors. Area Agency non-profits, contracted to provide services by New Hampshire, and other providers, are committed to providing essential services to thousands of individuals with developmental disabilities, acquired brain disorders, and autism, as well as seniors in need of care. We understand how critical it is to have a robust team of DSPs.

Despite the value of DSPs, these roles are lower-wage positions that do not require a college degree. Pay rates are based on Medicaid reimbursement rates and minimum wage laws, which in states like New Hampshire are historically low. Even with the 3.1% rate increase in the previous biennium state budget, wages are still low and direct-care providers are struggling to fill open positions to care for thousands of individuals.

Demand for workers at the lower end of the wage structure is high, locally and across the country. This creates more competition with other industries like fast-food franchises, retail giants and delivery services that can offer better pay and more perks. According to a recent Survey of Consumer Expectations Labor Market Survey, there has been a steady increase in job offer wage expectations, as well as the “reservation wage,” the lowest wage that workers will accept to take a job, and they are growing fastest for workers without a college degree. Further, we have an aging population decreasing the number of able-bodied workers and increasing demand for direct-care workers. Plus, more families are choosing alternatives to nursing homes after the havoc COVID-19 wreaked.

Without the ability to pay higher wages, area agencies and other providers struggle to find and keep workers. At Gateways Community Support, departments are juggling heavy caseloads and often scrambling to fill service needs. It seems individuals who may have otherwise served as DSPs are instead opting for better paying, less stressful jobs, such as at major grocery retailers.

Community Support Network Inc., (CSNI), the association of NH’s area agencies, calculates that the level of vacancies among area agencies is 33% and there is a similarly high statistic among private provider agencies. Without sufficient staff, existing staff and families are overburdened trying to meet the needs of the vulnerable populations we serve. The best solution is to increase wages through increased reimbursement rates. That could happen through the NH Department of Health and Human Services and state legislators supporting such an effort.

We have seen calls for reimbursement rate increases in every state, including Maine, Massachusetts and Vermont to help hire and retain workers and reduce waiting lists for services for thousands of adults and children with intellectual and developmental disabilities. There are also many workers, organizations, some federal legislators and state legislators elsewhere fighting for better salaries, advocating for a $15 minimum wage in their states, localities and federally.

The NH Department of Health and Human Services will be receiving American Recovery Act Funds and plans to support Medicaid home and community-based services, such as through Workforce Investment. We appreciate the goal to expand workforce capacity and hope this effort will create sustainable recruiting and retention support.

Sen. Hassan and some of her federal colleagues have introduced legislation to help. The Gateway to Careers Act addresses the workforce challenge by supporting career pathways strategies, which combine work, education and support services to help individuals earn recognized postsecondary credentials. Similarly, the Relaunching America’s Workforce Act allows employers to receive partial funding to keep workers on the payroll while employees improve their job skills through training. The bill also restarts a grant program supporting partnerships between community colleges and industry geared toward getting workers skills for in-demand jobs.

Of course, New Hampshire organizations are trying to address the problem too. In January, we joined The PLUS Company, a private provider, in partnership with the Wilbur H. Palmer Career-Technical Center at Alvirne High School to educate high school students about becoming DSPs. Funding came from a UNH Institute on Disability grant subcontracted through CSNI. A handful of students already started working for families. Similar DSP courses are expected to expand to other high schools and Adult Learning Centers over the coming year.

However, workforce shortage challenges will not be solved without sustainable raises. Just as direct-care agency leaders are calling for in neighboring states and beyond, we need our state policymakers to address this issue as a priority and help essential-service providers to compete on pay.

(Susan O’Callaghan is director of Public Policy/Legal Affairs & Chief of Staff for Gateways Community Services.)

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