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Critically needed federal stimulus money still hasn’t come through for DDS residential providers facing staffing shortages

November 29, 2021 1 comment

Shannon Guenette still hasn’t seen any of the money even though Congress and the Biden administration released $8.7 billion in federal stimulus funds to Massachusetts last March.

“We’ve received some guidance (from the state regarding the funding), but we haven’t received any additional funds,” Guenette, executive director of Almadan, Inc., said five days prior to Thanksgiving. Almadan is a group home provider in the western part of the state to the Department of Developmental Services (DDS).

In August, Guenette told us her agency and other DDS providers throughout the state desperately needed the additional federal funding to retain workers in light of a worsening shortage of direct-care and clinical staff.

The Baker administration in Massachusetts has targeted hundreds of millions of dollars of the federal American Rescue Plan Act (ARPA) funding for human services workforce retention and recruitment.

But the state Legislature took months to come up with its own plans for distributing the funding after at least one legislative leader said they didn’t see a need for hurry.

Earlier this month, state legislators went home for their Thanksgiving recess without having reconciled Senate and House bills (S.2564 and H.4234) that specify differing distribution plans for the money.

Meanwhile, other than noting there will be three rounds of ARPA funding distribution, the administration itself has provided little clear information about the details of its distribution plan such as how many workers and which agencies would receive the money, and how much of that funding would go toward higher wages.

Under the administration’s plan, the first round of funding was supposed to augment provider rates by 10% from last July through December of this year. But, as noted, no money has reportedly been distributed for residential programs.

Repeated queries by COFAR to DDS Commissioner Jane Ryder and to Health and Human Services Secretary Marylou Sudders about the DDS staffing shortage and how to address it have gone unanswered.

Even when the ARPA money is finally distributed, we are concerned about a potentially low limit set on the amount of funding per worker under the Senate and House bills. Also of concern is a lack of clear oversight of the distribution of the funding.

And it appears at least some of the funding is intended to be used to move residents out of the state’s two remaining developmental centers and into the already overburdened privatized group home system.

A $2,000 limit per worker

Language in both the Senate and House bills would limit funding for higher wages to $2,000 per worker. It’s not clear how effective such a payment would be in recruiting and retaining workers, particularly if it is only a one-time payment.

The Senate bill would also establish an advisory panel to make recommendations to the administration regarding the “Essential Employee Premium Pay Program.” The panel’s report is due with its recommendations by March 31, 2022.

The advisory panel sounds like a potential recipe for further delay without necessarily providing a structure for ensuring that the funding goes to the workers.

The distribution of funding to workers may not have sufficient oversight

Information posted online by the administration requires DDS providers to attest or essentially promise that 90% of the additional ARPA funding they receive will be used for “compensation for their direct-care workforce.” That could include, “among other things,” hiring and retention bonuses.

While the providers will be required to submit spending reports, it isn’t clear that the administration has dedicated sufficient resources to auditing such reports and ensuring that the money is going in all cases to front-line staff.

State Auditor Suzanne Bump’s office reported in 2019 that increases in state funding to DDS and other providers resulted in surplus revenues for the providers, but that those additional revenues led to minimal increases in wages for direct-care workers.

According to Bump’s audit, while the increased state funding was at least partly intended to boost direct-care wages, it “likely did not have any material effect on improving the financial well-being of these direct-care workers.”

Some ARPA funding may be used to “divert” residents from developmental centers

According to the administration’s distribution plan, at least $44 million of the ARPA funding will be used starting in Round 2 to “divert” clients “towards community living … and away from facility-based settings.”

We are concerned that while at least some of this funding would reportedly be used to prevent the inappropriate placement of DDS clients in hospitals or nursing homes, a portion of the funding may be used to further reduce the population of facilities such as the Wrentham and Hogan developmental centers.  As such, this funding would only further reduce choices in residential care for DDS clients.

The residential population at both Wrentham and Hogan have been declining in recent years, and admissions to both facilities were zero in 2020.

Providers cite need for funding and higher pay for direct-care workers

In September, a provider-based “Collaborative” provided written testimony to the state Legislature’s Ways and Means Committee chairs seeking $174 million per year for five years in ARPA funding for human services organizations. The money was being sought “to provide recruitment and retention incentives to workers to help combat the workforce crisis in the sector.”

The Provider Collaborative testimony said the $174 million would affect about 34,800 staff earning less than $60,000, and nurses and clinicians earning less than $90,000.

The Collaborative noted that low wages paid to direct-care workers are a problem. “The low rates of pay for direct-care staff… coupled with complex, difficult jobs have led providers to struggle with recruiting and retaining workers even before the COVID-19 pandemic impacted programs,” the testimony stated.

The Collaborative blamed those low wages on the state’s “rate-setting process.” We think, however, that many providers, as the state auditor noted, could afford to pay more to their workers.

Shannon Guenette told us that Almadan is currently only able to pay its staff $15.25 an hour. The Collaborative stated that the median salary for direct-care workers is $16.79 an hour. According to the Collaborative, the MIT Living Wage calculator notes a living wage for a single person in the area is $17.74 an hour.

All of this points to the need for quick action to distribute the ARPA funding. It’s unfortunate that legislative leaders don’t appear to recognize that there is, and has been, a need for hurry. There is also a need for effective oversight of the funding to make sure it gets to those workers.

DDS provider head trying to raise the alarm about direct-care staffing shortage

August 30, 2021 5 comments

Shannon Guenette, who heads a corporate agency that runs group homes funded by the Department of Developmental Services (DDS), is trying to get state lawmakers and policy makers to understand the impact the COVID crisis has had on direct care staffing in her agency’s residences.

She is facing a staffing shortage that appears to be afflicting the entire DDS system, yet legislative leaders don’t appear to be aware of it. And DDS Commissioner Jane Ryder confirmed in an email to two COFAR members only late last week that the staffing shortage is a “severe” problem affecting “all of our agencies.”

Guenette,  who is the executive director of Almadan, Inc., which operates three DDS-funded and two Department of Mental Health-funded group homes in western Massachusetts, maintained that, “This isn’t a situation where we can turn grills off at night. My fear is we’re going to hit a breaking point if something doesn’t change soon.

“It’s a heavy weight on our team,” she added. “We have concerns for staff burnout, and worry what will happen if the staff shortage continues.”

The irony is that the state received $5.3 billion earlier this year under the federal American Rescue Plan Act (ARPA). Of that amount, some $500 million can be spent on DDS and other Home and Community Based Services (HCBS). The ARPA is one of the federal stimulus bills passed last spring.

The ARPA funding is earmarked, among other things, for higher pay to at least temporarily recruit new direct care workers.

Yet, Guenette said, even though she understands the federal Centers for Medicare and Medicaid Services has approved the state’s plan for spending the ARPA funding, the money still hasn’t been distributed to DDS group home providers. She said she was told at one point that the ARPA funds might be distributed by late fall. The delay won’t help the current critical need, she said.

In addition to the ARPA funds, the state began the current fiscal year in July with a projected $4.2 billion budget surplus. Yet the money is not reaching direct-care workers.

Guenette said Almadan’s total staff, which is normally around 100 full-time and part-time workers, is now down to 65 employees. Almadan provides residential, shared living, and individual support services, and some of its programs are more than 40 percent vacant in terms of staff.

Low wages have forced many direct care staff to work for multiple providers to earn a living, Guenette said. She said raising wages could help in hiring staff with more experience or passion in the field. Some staff have in fact left to accept higher paying positions in other fields.

DDS commissioner only now commenting on staffing problem

Ed and Gail Orzechowski, who are COFAR members, wrote last week to DDS Commissioner Ryder about the Almadan staffing problem. Gail’s sister, Carol, is a longtime resident of one of Almadan’s group homes in Pelham.

In an emailed response to the Orzechowskis on Friday, Ryder she she is “well aware of the severe staffing shortage all of our agencies are experiencing. It is a great concern to all of us. “

Ryder added that the administration is “in the process of getting the ARPA funds out to our agencies, but unfortunately it will take some time.”  She said the funds  will be retroactive to July 1.

Guenette noted that even though the funds will be retroactive, they are intended to be provided only through December of this year, and thus will only be “a temporary fix for a much larger problem.”

Ryder’s email is the first acknowledement she has made, that we are aware of, of the staffing shortage. Neither Ryder nor state Health and Human Services Secretary Marylou Sudders ever responded to our request in mid-July for comment when we first heard reports of a DDS staffing shortage.

In response to a follow-up email on Wednesday of this week from the Orzechowskis, state Senator Joanne Comerford said she planned  to contact Ryder about the staffing and ARPA funding situations. “ARPA funding is moving through MA — albeit more slowly than I’d like,” Comerford stated.

Legislative leaders don’t see a need for hurry

Despite the concerns about the staffing shortage from Ryder, Guenette, and from parents and guardians of DDS clients, legislative leaders don’t appear to perceive a need for hurry in distributing the federal funding.

According to CommonWealth magazine, Senate President Karen Spilka said in early August she believes there is “wisdom in waiting” to spend federal ARPA recovery money. “We are no longer in the state of emergency, the major state of emergency at the height of COVID,” Spilka said, according to the magazine.

Spilka added that, “We are no longer in the rescue situation where money is needed to be spent urgently and quickly. We are now in recovery mode and back to the more normal budget type of appropriation process.”

But without the additional federal funding, Guenette said, Almadan can’t afford to pay its direct care staff enough to recruit new workers and compete with jobs that pay a living wage as little as $18 an hour.  Almadan is currently able to pay its staff $15.25 an hour. She said she sees the low pay, in part, as a social justice issue because much of the staff of DDS-funded facilities are from marginalized, minority populations.

Guenette said Almadan has been fortunate in that there are currently no COVID positive residents or staff in its group homes. Almadan has a 90% vaccination rate among staff, and 100% among residents. DDS is requiring that staff be tested every week.

She said that when the crisis began, Almadan was proactive in their measures to keep everyone safe “with a dearth of (DDS) guidance.” The agency immediately began purchasing PPE and cleaning supplies, she said, and found food delivery sources that didn’t require any contact with the community.

Many DDS providers, however, are not in Almadan’s advantageous situation with regard to staff vaccinations. The Baker administration last publicly reported in April that less than 50% of DDS provider staff had been vaccinated.

We urge people to call or email their legislators, and call the Children and Families Committee at (617) 722-1660 to ask them to push for quick distribution of the ARPA funding in order to boost direct-care wages in the DDS system.

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