by Amanda Pyle
Ours is a specialized behavioral day program that opened last May. In the first four months, we supported 5 participants requiring 7 staff and had several pending referrals. As a brand new company, this allowed us to grow while working out the typical kinks associated with being new. Slow but steady growth helped us provide extremely person centered services.
All of that changed in the fall. In October, another provider with services across the state succumbed to the inadequate reimbursement rates for programs supporting people with developmental disabilities. Regional Center case managers were scrambling to find a program for participants who were suddenly faced with no day program options in San Francisco.
From October through February, we have received 26 new program referrals due primarily to program closures. We have only been able to find staff for 6 of those referrals. From an outside perspective, having 20 pending referrals sounds like a great problem to have. In reality, it means that 18 of those 20 people are sitting at home with no program.
Increased time with no structured program is resulting in increased behaviors and greater difficulty transitioning to a new environment. It means that I am constantly in a state of trying to hire staff. It means that the program is in such as constant state of change that it increases the stress level for our existing participants which increases the behavior support our staff are called on to provide. It means that it becomes harder and harder to provide person-centered services designed around what is truly important to each participant because so many staff are new and are trying to get to know the participants. What do I need to get those 20 participants enrolled in the day program? I need 14 new direct care staff in order to provide proper staffing and to meet CA labor law requirements around breaks.
So let me ask you—How would you like to get paid to spend your day exploring your community, shopping, going to movies, going to the beach, helping people find jobs, doing arts and crafts, listening to music, and spending time on the computer all while helping others? Sounds great! And for $11/hour, I will pay you to do that. But, I will ask you to do much more. You will be a teacher. A friend. A listener. A personal care provider. A janitor.
You will be responsible for not only helping program participants stay healthy and safe, but also helping each person achieve what is important to to have a fulfilled life. If you take this job, you will do all of those roles and subsequently pay all of your bills on $1100 per month. If you cannot live on $1100 per month, you will look for 1 or 2 more jobs. You will spend so much time working that it may be difficult for you to work effectively with the people we support.
The people that are willing to do such an important and valued job such as this one become harder and harder to find every year. $11/hour does not attract experienced people to this position because they cannot survive on the pay.
I am forced to hire more and more people with little to no experience and hope that I can teach them the skills needed. When you have so many people waiting to get in to program and you receive countless calls from families and case managers all telling you why their referral has the biggest need, you have less and less time to dedicate to training. You hope that they can learn on the job. You hope that, even though staff are juggling 3 jobs, they are able to give everything they can to our program during their scheduled time.
You hope that you can offer the program that you originally designed, a person-centered program that allows participants to create their own program day based on what is important to each person as an individual.
Service provision and supporting participants should not be based on hope. You should not have to hope that staff can pay their bills, hope that quality staff will stay a long time, hope that you can find staff and even better, find staff with experience, and hope that you can run a good program that really supports participants to live an independent and fulfilled life in the community. Service providers should not have to hope that we can survive, tetering on the brink of financial collapse.
We should be on the brink of innovative programs and services that continue to implement the intentions of the lanterman act. Increasing provider rates by 10% with a subsequent annual 5% increase each year will not only help us meet changing federal and state mandates, but will help us attract and retain skilled staff while allowing them to live within the community they work.