Letter from Theresa: Residential and/or Waiver Supports
June 15, 2021
Dear Individuals, Parents, and Guardians Receiving Waiver or Supported Living Services,
I hope this letter finds you well and enjoying the summer. As I was preparing to write this letter on a critically important topic, I spent some time reflecting on my 31 years in the field of developmental disabilities. In 1990, as I began my career, waivers and funding to replace an outdated residential system were on the horizon. I remember the first Individual Options (IO) waivers. Then came the Level One waiver, SELF and the idea of refinancing the Adult Services system with waiver dollars for day support and voc hab. In many ways it seems like years ago, but then again it seems as fresh as last week. As many of you know, the DD system has undergone tremendous change in the last 30 years. We have built a very nice service system, where individuals have the right to choose where they live, who they live with (in many circumstances), where they work and who will provide their services. As with all choices, there are limitations and nothing is perfect. We have continued to work toward the concepts of person-centered services – where all people make decisions about how they will live and spend the funds allotted to them for services. It is a system I truly love and believe in, but it is very vulnerable at this time.
You are receiving this letter because you or your loved one is actively receiving residential and/or waiver supports and could possibly be contacted to consider alternative options in the upcoming days or weeks. However, just because you receive this letter does NOT mean you will be impacted. This letter is to make everyone aware of what has been developing, and to prepare you in case you are contacted.
Since taking on the role of Superintendent for an organization with a topnotch workforce and true dedication to the field of developmental disabilities, there have been many tough moments. At the top of the list is the transition out of Adult Services in 2016, when we had to help Marimor Industries privatize so they could operate within the rules of the Medicaid waiver system. Then in 2020 came COVID. I have been so incredibly proud of how well our agency and provider agencies have pulled together to support each other the past 18 months. There has been truly exceptional work done by the providers serving in Lima/Allen County to keep people healthy, safe and engaged during months of shut down, and as the service system continued to have many restrictions placed upon it. As we started June 2021, we all felt as if this was the beginning of getting our life back – back to community jobs and helping those we serve do all they want in their communities. However, we have a new threat that might be more serious then all those mentioned so far: the shortage of workers in Ohio.
In recent years, our county, state, and nation have experienced a growing level of concern and need for workers at all levels. In the past three years, finding employees to work 5-10 hours per week has become exceedingly challenging, and we know many homes are not operating with all the staff we have authorized in ISPs. We have paid for commercials to recruit Direct Support Professionals (DSPs), and financially committed to help recruit and retain the staff needed to work in our Medicaid waiver environments. I am sure you have seen the news that Cedar Point is paying a starting wage of $20.00 per hour. Where do you think those workers come from? Nursing homes, group homes, fast food and any other service industry paying less than $20.00 per hour. It seems easy to say “We need to pay these people more.” While I agree, Medicaid rates are set and have to be statewide. Provider agencies have little flexibility, when so many aspects of their business come out of that Medicaid rate. The rate is only one problem though. There is a shortage of people entering the workforce.
The overall shortage of workers in our field – in the homes and, workshops, driving the vans – is being called a DSP crisis.
As mentioned earlier, we have been working through staff shortages for 3 years now; however, in Allen County, we have a new level of concern. We have recently had some very difficult and heartfelt conversations with one of our largest residential providers about their staffing crisis. The shortages they have are very, very serious. No agency wants to give up and say they are finished or “serve notice” that they cannot provide services any longer, but some residential services are at a point where ensuring staff is available – even for the most essential and minimum health and safety services – has become impossible.
Providers are reporting that some employees are ranging in overtime from 80 to 120 hours per week. Managers and DSPs from other homes are filling gaps, day program staff are filling residential shifts and office staff are performing their duties, then covering home shifts to ensure needs are met. This has been going on for months, and while we commend our providers and staff for stepping up and doing this, it is not realistic to think this can safely continue much longer. We also know that even this is not sufficient, and some people are having to go to other “homes” for the weekend to have adequate care.
We continue to work toward solutions to these issues. We are forming an internal Workforce Crisis Task Force and staying closely connected to ideas from our peers in other counties. We meet with the providers regularly and will continue this practice. I want to inform you that in coming days, you and your team may be approached with some information to consider. Some of these choices may not be easy. Some may be long-term ideas, others simply a short-term stop gap until more staff can be hired and trained.
Please know that regardless of how challenging or undesirable these conversations may be, we have to keep the health and safety of all a priority. None of these discussions, or lack of choices, are in line with our mission or the concepts of person-centered services. Providers will be asking families to consider moves. If collapsing some homes cannot be accomplished, they may have to give notice that they cannot serve you or your family member any longer. That sentence was painful to type. The reality is that we may not have any choices, if no other providers in our pool can pick up more work. We already see more on the waiting list due to providers not taking on new people. We will need to be creative and problem-solve in ways we have not had to do. We must look at each situation in a unique way, as the availability of in-home supports becomes harder to access. Technology and the sharing of services may be the best options, should the lack of in-home support continue. There is no easy answer, but we must work together until we have a stable and sustainable workforce.
Your SSA and team will work through these situations, if your residential provider(s) believe your services may be impacted or need to be changed due to crisis staffing levels. If you have any questions on potential impact to your services, please contact your SSA rather than your residential provider. Provider staff are actively working to ensure shifts and services are met, and they may not be able to quickly answer your calls or emails. Our SSAs and providers are working hard to meet needs and problem solve as each day develops. In some cases, you may see SSAs or other Board staff helping with waiver services that are typically handled by home staff.
We are all very much committed to supporting each other through yet another challenging time. We have been successful before, and I am confident we can overcome this challenge. If I can be of any assistance at all, please do not hesitate to reach out to me or Jana McVetta, Director of Community Support Services, at firstname.lastname@example.org. If you want more information on remote supports, please contact Melissa Ricker, SSA Manager, at email@example.com .
Theresa M. Schnipke
419-221-385 ext. 1321