Michigan's Direct Care Worker Staffing Crisis

Michigan’s Community Mental Health system serves people with intellectual and developmental disabilities, mental illness and substance use disorders. Crain's Detroit Business featured an article on 10/21/18 on the "Staffing Crisis of direct care mental health workers faces clients, families" by Jay Greene. The article covers a Crain’s health summit panel that was chaired by Robert Stein, the general counsel for the Michigan Assisted Living Association (MALA). MALA represents providers of assisted living and similar services including mental health services to people with developmental and other disabilities. [note: direct care workers are also known as Direct Support Professional or DSPs.]

According to Stein, “We have a real crisis with support services to people with disabilities…Wage levels are not competitive with retail companies, fast food restaurants and others. The funding levels have been constrained for many years.”

A MALA survey found “the average turnover rate for agencies providing staff is 37 percent, the starting wage is $10.46 per hour and the average number of open positions for full-time staff is 12 percent, 20 percent for part-time staff.”

Although the legislature “approved $64 million in additional funding in the fiscal 2018 budget to increase the average hourly rate by 50 cents..”, the panel characterized this as a “drop in the bucket”.

The article quotes Robert White, a parent advocate who has two adult sons with autism, as commenting that "Paying [direct service professional] $2 above the minimum wage (of $10 per hour) prevents more people from leaving the system. …We also need a supplemental budget in the lame duck session and future budgets to come [that] must have non-negotiated budget items. We can't kick the can down the road. It is an infrastructure requirement, a civil and constitutional right to have these services like good roads, good education and clean water to drink." [emphasis added]

Here is a quote from State Rep. Christine Greig, D-Farmington Hills, the Michigan House Democratic Floor Leader:

"I get really frustrated by state government and how we fund things,…We talk about integration. We should be talking about great quality care, not about money. You start from an outcomes standpoint. What does the provider, patient need in services. The money flows from that."

[I agree, and I wish more legislators and advocates would support this approach to funding services, rather than promoting the idea that full inclusion in the “community” is the highest and only worthwhile goal of our our system of services.]

The panel also discussed the kinds of things that direct care givers do:

Robert White says in response: ”My older son has high medical needs, 24-7 supervision, in taking the meds he needs, bathing ... nutrition, safety, socialization in the community…The home he is in is currently understaffed. Managers are actively taking shifts. Many caregivers work many shifts. There is mental and physical fatigue, possible errors. It is not their fault. They are truly their lifeline."

John Williams, executive director of Progressive Lifestyles Inc., pointed out that "A lot of staff work two and three jobs. It is unattractive to get involved. …in many cases, it is a very physical job with wide spectrum of disabilities. One day you will lift somebody from a wheelchair to a bed. (The next day) help people move in, repair a stove, fix a washing machine. It's a very demanding job."

According to the article, Stein said MALA and others are “starting a grass roots effort to lobby state legislators to add a line item in the Medicaid supplemental budget that would amount to an increase of 75 cents per hour.”

Vote411: Voter information from the League of Women Voters

Here's how to get the information on candidates and ballot issues that you need before you vote on November 6, 2018.

Go to VOTE411 and enter your street address, city, state, and zip code. Up pops your personalized ballot. Click away to find out more about candidates and other issues on your ballot. For example, here is the page that popped up when I entered my address in Washtenaw County, MI. Further clicking revealed my personalized ballot information .

There’s a lot to read, so allow time to study your ballot. In addition, here are local Washtenaw County videos of Forums and presentations.  

Two of the statewide ballot proposals on voting and redistricting are especially important. Here is a video presentation about them. 

This is a recorded discussion on Proposal 2, the Redistricting ballot proposal (a.k.a. Voters Not Politicians) that would create an independent citizens commission to draw the lines for legislative districts in Michigan. 

Here is another recorded discussion on Proposal 3 that seeks to make voting in Michigan more convenient, accessible and secure with 8 common sense improvements that would be secured in the Michigan constitution.

2018 Together for Choice Conference, 10/17 - 10/19

Together For Choice is a national non-profit organization formed "to protect and advance the right of individuals with intellectual and developmental disabilities (I/DD) to live, work, and thrive in communities and settings of their choice." TGF is sponsoring a conference in Chicago, October 17 to 19, 2018. I regret that I will not be there, but I hope that others will attend and that there will be plenty to share with people who could not be there in person.

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Please join us October 17-19, 2018 on Misericordia's beautiful campus in Chicago.

Together for Choice is a national grassroots advocacy organization formally incorporated in 2017 with over 800 members in 47 states. Our mission is to protect and advance the right of individuals with intellectual and developmental disabilities (I/DD) to live, work, and thrive in communities and settings of their choice. We work with national networks, self-advocates, families, and service providers to advance choice, quality, and increased resources for the I/DD population. Since our incorporation, we have been educating the public and governmental officials on the need for Medicaid funding of choice-based housing and employment/developmental training models, as well as increased resources at the federal and state levels to ensure quality services. Our continued focus is to develop policy reform initiatives addressing the myriad of I/DD community needs.

Agenda and Conference Schedule

The conference includes an impressive array of speakers:

David Axelrod, Keynote Address

Rodney Biggert, "The Trials and Unanswered Questions of the 14(c) Certificate"

Taylor Brose, "The DSP Workforce Crisis: Finding Solutions"

William Choslovsky, "Protecting the ICF Entitlement: the Real Meaning of Olmstead"

Sr. Rosemary Connelly, RSM, Conference Opening Statements

Michael Diaz, "Creating Sustainable Community Partners to Enhance Service Options"

Jill Escher, "The National Council on Severe Autism: What is an Essential Care Non-Profit?"

Melissa Harris, "HCBS Regulation and Implementation"

Rob Johnson, Keynote Address

Jim Kokoris, Keynote Address: "A Special Life"

Paul C. Landers, "The DSP Workforce Crisis: Finding Solutions"

Christopher B. Lowther, "CMS's Medicaid Home- and Community-Based Settings Regulations: How We Got Here and Where We're Headed"

Crystal Makowski, Ed.D., "Where Do We Go From Here? Best Practices!"

Patrick Mannix, "America’s Workforce: Empowering All – Updates from the Office of Disability Employment Policy"

Molly Nocon, Housing Model Discussion

Philip J. Peisch, "CMS's Medicaid Home- and Community-Based Settings Regulations: How We Got Here and Where We're Headed"

Meet VOR: A Voice of Reason

This description of VOR, an organization that I have belonged to for over 15 years, was part of the packet of materials passed along to every member of the US House of Representatives and the US Senate in June 2018. Regretfully, I missed this year's VOR conference, but VOR's message is clear: even though we represent a small minority (about 5% of the I/DD population), we support a full range of services and residential options to meet the needs of all people with I/DD. 

"The goals of one group should never be placed at odds with the needs of the other. "

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Meet VOR:  A Voice of Reason, speaking out for people with Intellectual and Developmental Disabilities

For 35 years, VOR has advocated for high quality care and human rights for all people with intellectual and developmental disabilities (I/DD). Our membership is mostly comprised of families of individuals with severe or profound intellectual disabilities, often complicated by significant medical, psychological, or behavioral conditions. Many of our loved ones are non-verbal or non-ambulatory. Many engage in self-injuring behaviors. They often require 24/7 care, provided by well-trained and caring direct support professionals. Our family members constitute a minority within a minority. They represent about 5% of the entire population of individuals with I/DD. The home and community-based settings that work for many people with I/DD often fail to meet the needs of these severely disabled, vulnerable individuals.

To acknowledge the extensive range of needs and aspirations of all members of this diverse population, VOR supports Individual and Family Choice, and a Full Continuum of Care. In order to have choice, there must be a full range of quality options available, tailored to meet the intellectual, psychological, behavioral, and physical needs of this diverse population. One size never fits all. 

We support the goals of those who aspire to integrate into the society around them in their choices of residence, education, and employment. We also support the needs of those who would be endangered in an under-protected environment, who can never integrate fully because they cannot even perform the simplest of daily skills, like brushing their teeth, washing, toileting, or verbalizing their needs, their desires, their agitation, or their anger. The goals of one group should never be placed at odds with the needs of the other. We support all residential options, including the individual’s own home, family home, group homes, intentional communities, and larger congregate settings, such as public and private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF’s/IID, or ICF’s).

By the same principle, we support a full range of employment opportunities for people with I/DD. We support the drive for integrated, competitive employment and laud the proliferation of programs aimed at helping people with intellectual disabilities achieve their full potential. But we oppose the movement to eliminate center-based employment, sheltered workshops, and the movement to eliminate compensatory wages by eliminating Section 14(c) of the Fair Labor Standards Act. People who cannot compete in the open job market need this opportunity. They enjoy this level of work, the peer environment, and the opportunity to be productive. The movement toward competitive employment for some should not mandate the elimination of programs that work for others. 

There is no singular solution that is appropriate to all individuals with I/DD. Yet, this is the underlying premise of policies promoted by many powerful advocacy groups. This is a dangerous assumption, especially for the most vulnerable... 

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For more information on VOR, read more of the 2018 conference materials

Michigan: The Burden of Funding Crises should not be borne by People with Disabilities

Some Michigan Community Mental Health Agencies and administrative regional entities called PIHPs (Prepaid Inpatient Health Plans) are facing diminishing revenues in combination with demands for more services that they are required to provide. Washtenaw County appears to be having difficulties similar to those in Western Michigan, though not as extreme (yet). 

When the response to these fiscal crises is to reduce services to people the agencies are obligated to serve, families and their disabled family members need a refresher course on their rights while demanding that local and state agencies sort out how these shortfalls in funding will be resolved. 

This is a note from DD Advocates of Western Michigan with some good advice on what to do when service reductions are contemplated:

“Note that a Medicaid recipient is entitled to services ‘appropriate to their needs’, not subject to available (or reduced) budgeting. It is the CMH's responsibility to provide all of those appropriate services. It is the state's responsibility to provide adequate funding. The Regional Entity [the PIHP] is the intermediary in this process, possessing the contract for providing eligible Medicaid services through it's provider network and CMH agencies. If the Region does not have adequate funding, then it must press the state to allocate more funds for these needed (required) services. Oversight of individual CMH agency funding and the region's budget is a critical component of its mandate. … Encourage the prohibition of ‘rationing’ in any shape or form. ‘Utilization management’ can just be a buzzword for rationing, and is what the medical insurance business uses to limit their financial exposure. The more they restrict or make difficult to access, the better their bottom line. If a service is appropriate and needed, is Medicaid allowable and requested via the PCP [Person Centered Plan], then insist on its delivery, or challenge any such failure to provide it via the Medicaid Fair Hearing process. Demand what is your entitlement. It's their job to figure out how the provide it.” [emphasis added]

Washtenaw County Community Mental Health Board

Having been to many Community Mental Health meetings over the years, I can say that some are more entertaining than others depending on the range and relevance of topics covered. Anyone wanting to understand how this part of local government works can find out more by attending the CMH Board meetings and following their activities.

Your local Community Mental Health Agency funds programs and services for people with developmental and other disabilities. Administrative decisions are ultimately the responsibility of the CMH Board of Directors.  The Washtenaw County Community Mental Health (WCCMH) Board meets on the 3rd Friday of every month. Board materials are available before each meeting and minutes are posted after they have been approved: 

WCCMH Board meetings 

9:30 a.m. on the 3rd Friday of every month 

Washtenaw County LRC 

4135 Washtenaw Avenue

Ann Arbor, MI 48108 

Materials for Board meetings, past and present, are available at the Agenda Center on  the Washtenaw County Website. 

When you download the agenda, it has all the items for that meeting included in one packet of materials.

Here is the Calendar of Washtenaw County Boards and Committee Meetings.

WCCMH Board members

The Disastrous Privatization of Medicaid in Iowa

See more on Iowa's managed care disaster here.