Direct Support
Workforce Initiative
2019-2025 Presented by: Leo Sarkissian
January 2019
arcmass.org
About The Arc of Massachusetts
The mission of The Arc of Massachusetts is to enhance the lives of people with intellectual and developmental disabilities, including autism, and their families. We fulfill this through advocacy for community supports and services that foster social inclusion, self-determination, and equity across all aspects of society.
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Crisis in the
Workforce
• 72 % of Mass. human
service providers report
that it has become
increasingly more
challenging to fill job
openings over the past
three years.
• Families rely on the
direct support
workforce for daily
routine, respite,
employment support
and avoid caregiver
fatigue.
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STATE OF AFFAIRS
Section 01
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Crisis for Families* & Agencies
• Individual w/disabilities & Family Caregivers face challenges in hiring staff for in-home services whether for care attendants, respite or nursing.
– 92% of Caregivers indicated difficulty with finding Direct Support Professionals (DSP) in recent FINDS Survey.
• The annual national turnover rate for the DSP workforce is an estimated 46% with a majority leaving within 1 year of employment.
• Massachusetts ranked 35th in the country on how well its Medicaid program serves people with I/DD.
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The Commonwealth of Massachusetts
The Massachusetts unemployment rate continues to remain low at 3.5 percent.
Unable to recruit college graduates burdened with high college loans.
Our state is the 3rd highest costly to live in & median price of home in Boston is 70% above national average.
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Job Market Values and Realities
Mean wages of DSPs are below those of janitors, clerks and others:
• Nannies $17.66 • Janitor $16.97 • File Clerk $17.53 We want to attract
committed, long-term DSPs who value their work with people with disabilities and families.
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How does a $8.85 - $14.08/hour DSP salary
compare to a local Domino’s Pizza Delivery
Driver?
• Cash Daily - Pizza
Delivery - SIGN ON
BONUS!!
• Domino's Pizza -
Boston, MA
• $15 an hour - Full-
time, Part-time
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MASSACHUSETTS WORKFORCE
AT A GLANCE
Section 02
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Workforce at a Glance Roles of DSP Staff…
• Teach instrumental activities of daily living -such as mobility, dressing, toileting, shopping or banking
• Provide employment assistance
• Build bridges to community activities, clubs and new relationships
• Ensure safety
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Addressing the Entire Workforce
The Workforce is hired by:
• Individuals with disabilities
• Caregiver families or neighbors
• Providers
• Public Sector authorities
DDS or MassHealth line items or programs affected include, e.g.:
• Family Support
• Employment/Day
• Residential
• DESE-DDS
• Autism Child Waiver and Autism Omnibus
• Day Habilitation
• Adult Family/Foster Care
• Continuous Nursing
• Personal Care
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Responding to Medical, Behavioral &
Other Conditions requiring
Specialists
•Consult to family and other caregivers,
agency services & generic practitioners
•Address complex medical or behavioral
conditions, communication needs
•Develop assistive technology strategies
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MA Clinical/Professional
Workforce Challenges
• In-home nursing rates have not kept
pace with medical settings and nurses
aren’t often prepared for community
care
• Lack of specialists, high use of
emergency rooms, lack of knowledge
• Inadequate regional capacity for
consultation and problem solving
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Individuals, Families and Providers
Need Staff Over 70% of caregivers are
family members – when
families don’t have support,
jobs suffer or are lost.
Staffed Homes w/vacancies
mean more safety risk and
disruption.
A nuanced response will result
in pay/benefits tracking with
health and education sectors
and access to clinical support
to decrease unnecessary use of
all types of hospitals & ER.
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MASSACHUSETTS WORKFORCE
PROPOSAL: FOUR STRATEGIES
Section 03
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4 Strategies The Executive Office of Health & Human Services adopt a planning process with Stakeholders to develop a specific
plan that reviews the following Recommendations & additional input while investing initial funding in FY’20.
WORKFORCE PROPOSAL
FOUR STRATEGIES
Workforce Investment
Innovation and System Design
Clinical Teams and Trained Staff
Building Human capital
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STRATEGY 1
Workforce Investment
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Significant investment is needed over the next few years to
achieve the entry & mean salary levels and improved
benefits to recruit and retain a stronger, more qualified
workforce and reduce high turnover costs.
Strategy 1:
Workforce Investment
Strategy 1: Workforce Investment
$17/hour entry
salary
FY’20 –
Jump start
competitiveness
in the market for
employees
Fund increases
for staff above
entry who earn
less than
$75G/year to
address
compression
Employee and Contract Staff Salaries
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Strategy 1: Workforce Investment
Example Wage
Targets by 2025
• Three target examples
of workforce positions
to increase wages are
Direct Support
Professional, Frontline
Manager and Nurse RN
tied to health care and
education sectors.
Role Entry Mean
Direct
Support
Professional $24 $32
Front Line
Manager $36 $40
Registered
Nurse – Day
or Block $36 $42
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Strategy 1: Workforce Investments
Employee Benefits
– Tuition or loan forgiveness.
– Initiatives to fund tuition credits at public colleges, universities, and technical schools to recruit younger workers.
– Room and board, child care, discounts at local retailers, and transportation benefits.
– Tax credits to allow retirees to receive an increased benefit from employment in the human services industry.
– Address legal immigration barriers (H1B) on a national level.
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STRATEGY 2
Innovation and System Design Improvements
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Strategy 2: Innovation and System Design
Improvements
1. Individuals and Families First: Offer packages to maintain family life while addressing adult needs (incl. guardians).
2. Provide care management.
3. Enhance resources for supported and/or shared-living; job & life coaching.
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Strategy 2: Innovation and
System Design Improvements.
4. Transition those in institutions to home
and community.
5. Implement technology for individuals’ advancement and service system improvements.
6. Review regulations.
7. Task Force to address DESE/LEAs preparation of students with I/DD for adult life.
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STRATEGY 3
Address Lack of Clinical & Specialists Teams
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Strategy 3:
Address Lack of Clinical & Specialists
Teams
Assist Families &
Service Providers
Expand to five regional
consultant teams.
Collaborate with
practitioners to support
families and agencies to
manage complicated
situations or urgent need
cases.
Assist Practitioners
Provide communication to
& consultation for
medical, behavioral,
dental or other issues.
Possible model: The Arc’s
Operation House Call.
Short-Term Utilization
Specialists “live” or by
telehealth (short-term basis)
to address specific conditions
or prevent unnecessary
emergency room visits.
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STRATEGY 4
Human Capital Development
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Strategy 4: Human Capital Development
Increase rates for recruitment, onboarding,
retention, and training
1. Review existing allocations for onboarding and staff
training.
2. Pilot a regional or other employment collaborative for
workforce recruitment for individuals, families &
providers.
4. State to facilitate high school and college preparation
for our field.
5. Ensure accountability for staff training.
6. Develop career paths and consider alterative
certification.
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In Conclusion…
The Commonwealth of Massachusetts has long been the leader of the nation when it comes to supporting people with I/DD in public education and community integration. Once again the Commonwealth can be a trailblazer for the nation, this time as it resolves the workforce crisis.
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“The link between interest group activity and spending can be powerful…” Your commitment to the Workforce campaign and advocacy is essential! Visit our webpage: https://thearcofmass.org/workforce/
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Bibliography United Cerebral Palsy and ANCOR, January 2019. The Case for Inclusion. The Providers Council. February 2017. Who Will Care? The Workforce Crisis in Human Services. 2018 Disability Data Digest (Rep.). (2018). Rochester, NY: MediSked. Workforce turnover cited https://cl.ici.umn.edu/node/6 (ICI at the Univ. of Minnesota, Workforce report in partnership with ANCOR) Dept. of Labor and Workforce Development (DLWD). Scott Cohn, CNBC, July 10, 2018. The most expensive places to live in America. From Life in the Community Summary Statement. Obtained from Bureau of Labor Statistics, https://www.bls.gov/oes/current/oes_ma.htm#21-0000 A. E. Hewitt et al., Minnesota: Research and Training Center on Community Living, Institute on Community Integration, University of Minnesota, FINDS Community Report 2017, Minnesota, https://www.thearc.org/FINDS. State of the States in Intellectual and Developmental Disabilities; Data Brief 2018; A. Lulinski et al; Coleman Institute for Cognitive Disabilities, University of Colorado and The Arc; http://www.stateofthestates.org/images/documents/SOS-Brief-2018_2_Rebalancing.pdf (IBID, 2005 Issue on Civil Rights and Advocacy) Google Images
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Contact Information
• Leo Sarkissian, The Arc of Massachusetts
Executive Director
• Phone: 781-891-6270, ext. 106
• Email: [email protected]
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