Rule changes to serve “the unserved”

rule making

 

Washington State Department of Social and Health Services and the Developmental Disabilities Administration (DDA) has posted immediate rule changes to increase the capacity of families enrolled in the Individual Family Support Program (IFS).  The reason behind this change is to “enable families to continue caring for their family members in their own homes and help stabilize families and individuals who are experiencing increased caregiving stress and crisis by providing respite from their caregiving duties.” I wholeheartedly support the idea behind this rule  change but also understand that this is an attempt of too little, too late and does not even address the real issue.

DDA states that the families receiving funds at this time are not utilizing their full “awards”.  DDA reports that only 55% of the IFS funds were used for respite and that  only 8% of the total number of families have used 81-100% of their awards.  (see attached for full explanation and percentage of funds utilized) WSR 13-17-062 Rule Change for IFS

It is extremely unfortunate for our families in need that the right question is not being asked and therefore, the solution DDA proposes will not address the problem.

The right question is – When you have families in need and they are awarded funds for services which would help relieve some of their crisis, why are they not using the funds provided?

Asking this question might give some answers to the problem.   DDA skipped this important question in determining a solution. DDA has concluded that since these families are not using the funds, they don’t need them and so DDA has decided to reduce the award and give the unused portion to other families in need.  On the surface, this is a logical solution, but again, it is not the answer to the question that needed to be asked.

The real problem is that our state has put a limit on the number of caregiving agencies families are allowed to use with these funds. These contracts are only opened up every 3 years so no matter how much money is awarded,  we do not have caregivers who the state will allow these families to use these funds for.  We do have caregivers available, but since the state has closed their contracts, these families in crisis can not access the use of these qualified caregivers.

I know this for several reasons – as a family who had been awarded funds for respite and not being able to hire a contracted caregiver I was well aware of the situation in the family.   The funds were useless without a caregiver to use them for.  In no way did this mean that we did not need a caregiver  – it meant that there were no qualified, contracted caregivers available.  This not only drove us into deeper crisis.

Now I work for a Home Health Care Agency.  We are licensed, bonded, run extensive background checks on our employees and all caregivers are certified nursing assistants who are supervised by a registered nurse.  I was excited to work for this locally owned and operated agency for several reasons  – one of which was that I could be part of the solution (or so I thought) to the caregiving crisis experienced by our families.

What I found out was that DDA contracts  (although supposedly the waivers are participant driven with respect to choice of providers) were not available.  We were informed that Roads to Community Living, COPES and the New Freedom waiver had sufficient caregivers to serve their clients.  We were denied a contract with the Health Care Authority based on a WAC which pertained to agencies which had their contracts terminated ( given this was our first application this WAC did not even pertain to our agency).  We still have not had an answer to our inquiries and are bounced between various people – no one being able to give accurate information.

 

No wonder our families are in crisis – the Department which is there to help them and navigate them through crisis does does not know their own rules, policies and how to connect a quality care agency to those in need.

So, DDA has a long way to go in trying to solve this problem.  Given that they do not even know the questions to ask to investigate what the problem is and make up solutions to non-existent problems, there is little hope for improvement.

How can we have stability and sustainability with up to 45% staffing turnover?

Stability and sustainability are critical to adequate care for everyone and most important for our most vulnerable.  With staffing turnover rates of up to 45% where is the stability for those who most require it?

This is the graph from the Division of Developmental Disabilities survey.  King  County has higher wages than the surrounding area – maybe this explains the lower turnover rate?  SOLA’s are state employees and this setting does provide more stability in staffing when compared to non-profit and private supported living homes.

The graph below is taken  from the same survey which indicates the high rate of staff leaving within the first 6 months of employment.  What does this rapid cycling of new staff not only do to the clients but how does it affect the training and staffing costs to the agencies?  Why are these people leaving so quickly?  Is it lack of training, lack of support, inadequate orientation, poor fit to the job, poor wages?

I’ve looked at the IRS 990 Tas Returns for at least 65 non-profit agencies which work with people with developmental/intellectual disabilities in our state.  You can view this excel workbook here:

non profits and financial statements

It is interesting to see the profits of some of these agencies – I can only wonder what the above graphs could look like if some of these agencies with large profit margins could increase the wages of the caregivers just a tad – would that help reduce this rapid cycling of staffing turnover?  Maybe just by slowing the turnover rate a bit the training and education costs would also decrease so the profits may not actually decrease – wouldn’t that be a win-win situation for all?

This is just wishful thinking in my part, I’m sure but I still can not help but think that it could be a possibility?  What do you think?