Human services sector struggling amid wage competition

For the first time in the 13 years that Chris White has served as the head of Road To Responsibility in Marshfield, the multi-service provider is putting people on waitlists to get into programs that serve people with intellectual and developmental disabilities.

The issue stems from what sector leaders from across New England describe as an industry in peril amid the COVID-19 pandemic. Challenges associated with paying competitive wages and retaining staff members have made it difficult to fill complex jobs.

For White, this means that their day programs that offer things like therapeutic services and housing opportunities are only open to approximately 55% of pre-COVID capacity.

"We're not accepting new referrals to our community-based day support services. And in our residential system, we have five vacancies that are getting filled really slowly, not because we don't have referrals but because it's really difficult to get staff freed up enough to go through the referral process for folks," he said during a virtual forum on Monday.

The industry provides care to one in 10 Massachusetts residents and supports over 180,000 jobs throughout the state, said Massachusetts Providers' Council CEO Michael Weekes, making the sector one of the largest employers in the state. But workers are being lost to other jobs in state government, the health and hospital industries, and even grocery and retail stores.

"While our chief competitor for talent was state government, and the health and hospital industries, we're now losing them to grocery and retail stores, both of which can offer higher rates of pay for all their employees," Weekes said.

Costco, he said, recently announced wages would start at $17 an hour while Amazon would pay entry-level workers $18 an hour.

"Unfortunately, with the state only benchmarking our direct service salaries to a median of $16.79 an hour, that's a position where we just cannot compete," Weekes said. "Additionally, our sector pays less than a living wage, as the well-respected MIT living wage calculator determines that the living wage for a single person in the Boston area is $17.74 an hour."

White says he knows the struggle Weekes is describing. The Marshfield-based service provider experienced a 52.9% turnover rate from March 1, 2020 through Nov. 30, 2021. The organization has 225 total vacancies made up of 179 full-time positions and 46 relief positions.

To put that into context, White said, the company's growth rate was plus 1.2% in February 2020 while the current rate is minus 13.7%.

"So just ugly numbers all around," White said. "At our current net recruiting rate, which is we have a net positive over the last three months of a whole three employees a month, it would take us 75 months to get fully staffed if this rate doesn't change. Obviously, that's unacceptable."

The situation at Advocates, a MetroWest-based human services agency, appears to be no better. President and CEO Diane Gould said in the organization's residential programs, five of eight directors have left in the last six months and the clinician vacancy rate is more than 50%.

"What that means is there are not supervisors to oversee the work that's being done by the direct service workers," she said. "Those we do have are doing shifts, and our direct care workers are routinely working 18 hours a day. They are serving people with complex medical needs, serious mental illnesses, and co-occurring disorders."

The clinicians and medical staff, Gould said, are leaving for private and group practice hospitals and health care systems where they can earn $20,000 to $30,000 more a year "with jobs that are less stressful." In the organization's day support programs, six staff members have left in the last three months and 18 positions are currently open.

"I think there's this terrible convergence of inadequate staffing with a dramatic increase in need," Gould said. "We have waitlists in our clinics. There are 245 people who are waiting for services including 200 children, 54 of them need language capacity in our region — that means clinicians who speak Spanish and Portuguese."

The Massachusetts Providers' Council, which represents community-based human service agencies, is urging the Legislature to pass a bill that they say can help alleviate the hiring shortage and allow for competitive wages.

The bill seeks to eliminate pay disparities between state workers and community-based nonprofit employees who are doing similar work by increasing the rate of reimbursement for human service providers over the course of five years. Lawmakers heard testimony on the legislation during a Children, Families, and Persons with Disabilities Committee hearing in mid-November.

Sen. Cindy Friedman, who filed the proposal alongside Rep. Kay Khan, said the proposal would be a "fair and effective step to recruit and retain our valuable human service workers."

"While we've made significant strides, our work to address the human service workforce crisis is far from over," the Arlington Democrat said. "I think the other piece that we need to be reminded of is that in Massachusetts, we believe we're going to have another bite at the ARPA money, because I think prudently, we didn't spend it all in one fell swoop. And so I know that we can, and I'm looking forward to, and I'm committed to going back to the pot to get more money for services to at least help us through the next four to five years."

Friedman also pointed to two earmarks in the Legislature's $4 billion American Rescue Plan Act spending package that are intended to help human service providers. The legislation allocated $30 million to human service workers, she said, of which $16.5 million is directed to a loan repayment program for human service, health, and home health workers.

Another $13.5 million is heading to a grant program for human service organizations and home-based health agencies to support retention and recruitment of workers.

"While this is welcome, and it's significant. I recognize that it's only temporary funding, and I appreciate the need to do more," Friedman said.

White understands both the blessing and curse temporary funding provides. Road To Responsibility increased entry level pay rates for their direct support professional workforce twice in the past eight months and handed out modest pay increases to all existing staff to "at least minimally address compression issues." White says awarding raises with one-time funds makes him nervous.

"I'm hoping if there are legislators from Massachusetts on this call, you're hearing that, because we're eating into our reserves," White said.



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