Direct care workers assist the elderly and those who have physical or mental disabilities — and qualify to reside in an institution or assisted living facility — but who are able to, and who choose to, live independently in their own homes. These individuals also qualify for Medicaid and Social Security.
Over the past year, there were 4,473 available job postings in Idaho for home health care and personal aides, and nursing assistants, according to most recently available data from Burning Glass — which put Idaho as the fourth highest state for such job postings.
“(Idaho was only) lower than Massachusetts, Minnesota and Arizona, which I think is pretty significant,” said Esther Eke, regional economist for Idaho Department of Labor. “When you look at the demand, (it is) significantly higher.”
In 2018, there were, on average, about 1,800, job postings for home health care and personal aides, Eke said; By 2020 that had increased to about 4,200, “which is a 135% jump.”
“It’s a growing industry,” Eke said.“Those occupations are in high demand, and will be going forward. We’ve had a jump, despite the pandemic, when general demand went down.”
Why is there a shortage?
These positions in Idaho also tend to be lower paying compared to other states, Eke added. Nursing assistants typically make $3 an hour less comparatively; personal care aides make closer to $6 an hour less.
Mark Leeper, executive director for Disability Action Center — Northwest, Inc., said while he has seen a shortage of direct care workers for years, the pandemic essentially grew the problem.
“It’s a crisis because it had been trending before that,” Leeper said. “People can’t go to work; they’re providing services, but they’re afraid they’re going to bring the virus into that home, or they’re afraid they’ll bring the virus into their families; we’ve seen all those scenarios. (And some) people are afraid to get those services.
Bill Benkula, founder of WDB Inc. in Twin Falls, said he recently had 133% in turnover, and 20.5% of direct care worker hours were overtime, partially because of that turnover.
Leeper added his organization, and other similar ones, have lost people to positions in neighboring Washington.
“It’s easy to cross the border and make more money,” Leeper said.
Providers of direct care workers are reimbursed an hourly rate from Medicaid that covers the hourly rate of the direct care worker, industry experts said, and the rest goes toward administrative costs, such as staff who do scheduling and billing.
Industry stakeholders are working to show the challenges to state leadership, ultimately requesting a higher Medicaid reimbursement rate as part of the state budget. That is put together by the Joint Finance Appropriations Committee, then approved by the Legislature and the governor. A percentage of that funding is matched federally.
“The trouble we’re running into is the (Medicaid reimbursement) rate supports approximately $10 an hour (for direct care worker wages), and that’s a wage difficult to be competitive with in the market,” said Lydia Dawson, executive director for the Idaho Association of Community Providers. “When the pandemic hit, other industries were able to increase wages and provide hazard pay, and we got left behind.”
Becky Baily, administrator at Center for Independent Living in Twin Falls, just posted a few available positions on Facebook ranging $10-$12 an hour, depending on the services that will be carried out by the worker. Today, Baily and other providers feel they can’t compete with entry level jobs in fast food, naming Chick-fil-A and McDonald’s specifically, and big companies, like the Treasure Valley’s recently opened Amazon fulfillment center, all of which offer early wages of close to $15 an hour.
‘Work is underway’
While local industry stakeholders are saying no changes in Medicaid’s reimbursement rate are planned to go before the Idaho Legislature this session, efforts are underway to create a proposal to go before it as soon as next fiscal year, and it will include more than a recommended wage increase.
Christine Pisani, executive director for Idaho Council on Developmental Disabilities, and Matthew Wimmer, administrator for the Medicaid division of Idaho Department of Health and Welfare, are working with various stakeholders to put together the proposal.
“We also really need training for direct care workers, and (employers) are in search of qualified staff,” Pisani said.
Pisani and , an organization of direct care workers and stakeholders and the individuals and families they serve, have been recently working on more recommendations to address “core competencies” — such as ethics training — and other requirements for the profession.
The hope is to tie tiered training and certifications to wage increases (like a career ladder) in the proposal ultimately going before the Legislature, Pisani said. This ideally will also help with direct care worker retention.
And, she and Wimmer hope for the “valuable work to be recognized.”
“That’s going to take some work,” Pisani said, “and we’re well underway to make that happen.”
Wimmer called a recent meeting with Pisani and other stakeholders a “culminating event.” “We had been hearing from a variety of providers with concerns. That’s a challenge when you’re in a state that’s seen as much growth as we have in recent years; it’s a very competitive job market.”
“I just have to applaud Idaho Department of Health and Welfare because they really worked for a solution,” Pisani added. “They were very responsive.”
Wimmer highlighted that, around the coronavirus pandemic, the Medicaid division managed to direct $38 million toward Medicaid providers, and as of last week, it has paid out almost $1.6 million in funding for PPE supplies and other appropriate COVID-19 related costs.
“We’re quite pleased with that,” Wimmer said. “We’ve been really fortunate in Idaho that we’ve had a really strong economy the last couple of years, and that’s carried us through the pandemic.”
“But what we really need is something more forward looking … to address the (direct care worker) shortage,” he added.
While Wimmer does not want to “sugar coat” the situation, and acknowledged there are current challenges — such as legal requirements around raising the wage rate — he praised current partnerships, like with Pisani and Community NOW!.
“I think the work you’ve done bringing Community NOW! together has been outstanding,” Wimmer said to Pisani. “There’s some good work going on … (and) I’m hopeful.”
For both Pisani and Wimmer, “we are all one step off the curb,” for a disability, as Pisani put it.
“This is about all of us and all our needs,” Wimmer said. “If we have a strong system of care, it’s not just a benefit to our friends, coworkers … it could potentially be something that helps you out along the way.”
“There’s a real role for (folks with developmental disabilities) in the community,” he added. “I think that gets lost.”
Idaho Department of Labor offers resources for direct care workers, other job seekers, employers
Idaho Department of Labor representatives added this demand for direct care workers is not unique, as many health care areas are experiencing a shortage of workers. Other industries are currently seeking employees as well.
To help address the issue, Idaho Department of Labor offers various resources to employers and job seekers, including:
- Assistance with job postings
- Resume help
- Apprenticeship programs (including in health care)
- VOC rehab
- Other additional training
“We do certainly partner with lots of businesses and agencies,” said Darlene Carnopis, spokeswoman for Idaho Department of Labor. “We try to understand what the employer’s needs are and try to match (employees) with those openings.”