A shortage of disability aids is forcing Texas providers to cut services

A shortage of personal aids to care for people with intellectual and developmental disabilities has caused providers across the state and nation to cut services.

An exodus of such helpers from organizations that provide Medicaid-funded services to people with mental and developmental disabilities has led providers to stop taking referrals, delay the implementation of new programs, and, in some cases, discontinue services altogether. services., according to a recent report by United Cerebral Palsy and the American Network of Community Options and Resources Foundation, which represents organizations serving people with intellectual and developmental disabilities.

In Texas, the turnover rate for personal aides, known as direct support professionals, was 46% in 2020, compared to 43.6 nationally. Vacancy rates for those positions jumped to 12% in the state in 2020, from 11% in 2019.

Lakendria Grice, Community Caregiver Facilitator, left, hugs Sherrie Porter, right, a person receiving care at Caregiver, which is a place that provides services to people with disabilities, Wednesday, March 16, 2022, in Sugar Land.

Marie D. De Jesus, Houston Chronicle / Photographer

Mark Lashley, CEO of Caregiver, Inc, a Fort Worth-based provider of services for adults with intellectual and developmental disabilities, said he was looking to fill more than 600 positions in Texas, or nearly a third of the jobs in the company in Texas. The company also has locations in Georgia, Tennessee, Indiana and Ohio.

The main reason he can’t find more workers: salary. The state, through its Medicaid program, provides enough for a base wage of about $8 an hour, and it pays employees about $10 an hour, depending on the market in which they work. He said he would like to pay more, but his company also faces rising costs for utilities, transportation fuels and materials for all maintenance projects.

“The state funds these programs and assumes we can find people willing to work for $8 an hour. It was always a challenge,” Lashley said. “It’s also high turnover because it can be hard work.”

Direct service professionals often work with people with very complex medical and behavioral issues, Lashley said. The work can be grueling. Attendants may need to bathe patients, move them from beds to chairs, or deal with behavioral outbursts.

The constant challenge of the job leads people to find less demanding jobs: In the summer, Lashley said he couldn’t compete with restaurants paying up to $15 an hour. Staffing shortages forced Caregiver to reduce its Texas caseload by 75 people.

12 hours a day, plus weekends

Graciela Flores, working as a personal assistant in El Paso, thought about finding another job that might pay more, but at 65, she figured no one would hire her at her age. But she understands why some of her colleagues left. His agency pays $10 an hour. With inflation and soaring gas prices, it’s hard to get by.

“It’s very little (money) for the responsibility I have,” Flores said in Spanish.

Those receiving care and support at Caregiver, participate together in a service of praise and worship, Wednesday, March 16, 2022, in Sugar Land.

Those receiving care and support at Caregiver, participate together in a service of praise and worship, Wednesday, March 16, 2022, in Sugar Land.

Marie D. De Jesus, Houston Chronicle / Photographer

Flores works with people of all ages, some with physical or intellectual disabilities. Sometimes they need help getting out of bed, bathing and dressing. It’s hard on his back and shoulders

She often ends up working 10-12 hour days, taking weekend shifts to keep up with her bills.

“I’ve worked all my life,” Flores said, “but I don’t have enough to retire to cover the expenses I have like my house or my car and other expenses.”

“Doesn’t solve the problem”

Texas Health and Human Services released a report in November 2020, acknowledging the high turnover rate in these positions and setting “long-term goals” such as increasing salaries and improving recruiting data collection. and workforce retention.

The Legislative Assembly has gradually increased the base salary for personal attendants over the years, from $7.50 in 2014 to $7.86 in 2015, and five years later to $8 in 2020. The year last, the wage was increased by 11 cents an hour.

Through the American Rescue Plan Act, a federal pandemic relief initiative, providers can provide one-time financial compensation to their direct care staff, including but not limited to lump sum bonuses, bonuses retention and paid leave for a COVID-19 vaccination. Health and Social Services said the amount of the premium or one-time payment depends on the provider.

Preston Williams sings with his heart during a service of praise and worship at Caregiver Inc., which provides long-term care services to people with disabilities, Wednesday, March 16, 2022, in Sugar Land.

Preston Williams sings with his heart during a service of praise and worship at Caregiver Inc., which provides long-term care services to people with disabilities, Wednesday, March 16, 2022, in Sugar Land.


Marie D. De Jesus, Houston Chronicle / Photographer
Caregiver floor manager Rose Marie Patterson, right, shares a moment with Paul Pedro, a person receiving care at Caregiver, Inc., Wednesday, March 16, 2022, in Sugar Land.

Caregiver floor manager Rose Marie Patterson, right, shares a moment with Paul Pedro, a person receiving care at Caregiver, Inc., Wednesday, March 16, 2022, in Sugar Land.


Marie D. De Jesus, Houston Chronicle / Photographer

Marie D. De Jesus/Houston Chronicle

Bonuses may provide temporary relief, but don’t solve the long-term problem of low wages, said Dennis Borel, executive director of the Coalition of Texans with Disabilities, an Austin-based advocacy group.

Texas Health and Human Services said it could not use the funds to raise base pay because the American Rescue Plan Act funds were temporary.

“A condition of use of ARPA funds requires states to consider the sustainability of any project funded by the plan,” HHS officials wrote in a statement. “Increasing the base salary using time-limited funding is not sustainable and would not be permitted with this source of funding.”

stay independent

The labor shortage acutely affects people with intellectual disabilities who wish to live in the community and avoid being institutionalized. State-run institutions generally do not have waiting lists, but advocates have described them as more isolating and that individuals have a right to live within the community.

In a landmark decision for people with disabilities, the United States Supreme Court in Olmstead v. LC (1999) held that where community placement was appropriate, the undue institutionalization of persons with disabilities represents a form of discrimination.

James Meadours lives alone in an apartment in the San Antonio neighborhood and wishes to maintain this independence. He would need a personal attendant to come in 20 hours a week and help him cook, clean his fish tank and take him to his doctor’s appointments.

Meadours is also one of approximately 170,000 people in Texas on an interest list for home and community services through the Medicaid program. Meadours, who has an intellectual disability, has been on the list since 2008.

Brandon Vallentine, a care giver at Caregiver in Sugar Land, dances with a tambourine under his arm during a praise and worship service, Wednesday, March 16, 2022.

Brandon Vallentine, a care giver at Caregiver in Sugar Land, dances with a tambourine under his arm during a praise and worship service, Wednesday, March 16, 2022.


Marie D. De Jesus, Houston Chronicle / Photographer
Those receiving care and support at Caregiver, participate together in a service of praise and worship, Wednesday, March 16, 2022, in Sugar Land.

Those receiving care and support at Caregiver, participate together in a service of praise and worship, Wednesday, March 16, 2022, in Sugar Land.


Marie D. De Jesus, Houston Chronicle / Photographer
Those receiving care and support at Caregiver, participate together in a service of praise and worship, Wednesday, March 16, 2022, in Sugar Land.

Those receiving care and support at Caregiver, participate together in a service of praise and worship, Wednesday, March 16, 2022, in Sugar Land.


Marie D. De Jesus, Houston Chronicle / Photographer
Naomi Perimeter, left, and Rosetta Douglas, director of Caregiver Inc. day hab, smile at each other during a worship service, Wednesday, March 16, 2022, in Sugar Land.  The helper is a place that provides long-term care to people with disabilities.

Naomi Perimeter, left, and Rosetta Douglas, director of Caregiver Inc. day hab, smile at each other during a worship service, Wednesday, March 16, 2022, in Sugar Land. The helper is a place that provides long-term care to people with disabilities.


Marie D. De Jesus, Houston Chronicle / Photographer

Marie D. De Jesus, Houston Chronicle

In 2015, he was number 18,500 on the list. Four years later, it moved up to 13,000th place. As of last year, he is roughly the 7,000th person online.

“It’s frustrating. I’m 56,” Meadours said. “When my number is called, I might be 65 and my needs will be different.”

He hopes that by the time he is able to get services, he will be able to find a personal attendant among the declining ranks of the occupation. Otherwise, he fears, he could be institutionalized – where he would not be in control of his schedule or able to pursue activities he enjoys, such as slot car racing and visiting friends.

“With support, I can do it in the community,” Meadours said, “but not in a group home or an institution.”

becca.carballo@chron.com

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