Randall Donner
Randall Donner, Communications Senior Professional

Disability Services Facing Staffing Crisis

Recently, United Cerebral Palsy in collaboration with ANCOR, the American Network of Community Options and Resources, released the annual publication Case for Inclusion for 2023. The document highlights the crisis affecting disability services in the United States today. To view The Case for Inclusion 2023, visit www.caseforinclusion.org. 

In 1999, the United States Supreme Court Olmstead decision determined that people with intellectual and developmental disabilities (IDD) must be allowed to live in the least restrictive setting possible. The decision contrasts institutional settings with home- and community-based services and declares that keeping people in institutions who instead could thrive in community settings is discrimination. 

Since that time, states have often limited funding for community-based settings or not provided enough community-based service waivers for all who would qualify. To understand the extent of the problem, there are 481,601 people with IDD on states’ waiting lists for these services. (Institutional care for people with IDD must be provided by law to all who qualify; no such requirement exists for home- and community-based services.) This number underrepresents the actual need, as there is no uniformity in reporting waiting list information.

Low funding is the core problem. 

The chronic underfunding of the services has long made it difficult to hire and retain the number of direct support professionals (DSP) needed. That challenge was worsened by the pandemic.

According to The Case for Inclusion 2023, “at alarming rates, providers are turning away new referrals and discontinuing existing services due to a lack of staffing. In turn, people are having to travel significant distances or forgo services altogether because even when their state approves them to pursue services, too few providers exist to offer them.”

“Medicaid-funded services are facing a crisis like none we’ve ever seen,” said Linda Timmons, Mosaic President and CEO. “Disability services, specifically, are at the breaking point we’ve been warning about for years.” 

Timmons served on the Case for Inclusion 2023 Steering Committee. 

More than a decade ago, anticipating direct support staffing shortages due to the rapidly aging U.S. population, Mosaic made the strategic move to less-staff-intensive models of service like Mosaic at Home where possible. While that lessened the impact of staffing shortages in many locations, the organization still faces challenges. Here’s some Mosaic data: 

  • The long-standing 45% turnover rate is now more than 70%, which impacts the quality of services. 
  • Through one-time pandemic relief funding, Mosaic increased DSP wages by nearly 25% but still faces a DSP vacancy rate averaging 20%-24%.
  • Many locations provide sign-on bonuses, additional pay for hard-to-fill shifts and enhanced scheduling options, yet hiring remains difficult in both rural and urban locations.  
  • Mosaic has made tough decisions like stopping day program services for people who do not receive residential services because there are not adequate staff.  

Here’s what is happening to other providers according to the Case for Inclusion

  • More than six in 10 community providers have discontinued programs or services in response to job turnover and vacancy rates.
  • More than half, 55%, are considering new or additional discontinuations of programs and service offerings due to high turnover and vacancy rates.
  • 92% of providers indicated they are struggling to achieve quality standards.
  • 83% of providers have turned away or stopped accepting new referrals due to insufficient staffing.

“Years of states and the federal government underfunding services makes it impossible for disability service provider organizations to offer competitive wages compared to other hourly wage employers such as fast food, retail and convenience stores,” Timmons said. Without significant funding increases for services, the challenge will only get worse. By 2030, “demand for workers to deliver home-and community-based services is projected to increase by 37% over 2020 levels, with an estimated 7.9 million new job openings in the direct care industry,” according to the Case for Inclusion

The report offers solutions that will help stabilize the direct support workforce, but those solutions require coordinated action by Congress, the Biden Administration and State legislatures and policy makers. 

Your help is needed! 

Continued advocacy that lifts up the needs of people with IDD is essential to keep the crisis from becoming so bad that the entire system of services collapses. Mosaic makes it easy to be an advocate for people through Mosaic Allied Voices (MAV). Here are the simple steps you can take to start making a difference for the future of services. 

  1. Visit www.mosaicalliedvoices.org.
  2. Sign up to receive email alerts regarding advocacy opportunities.
  3. Take action when you receive an alert. 

MAV volunteers often receive no more than two or three messages a year asking them to act. Each message is targeted to a specific issue, and it offers language you can use to email or call the appropriate state or federal representative. 

Community-based services for people with IDD have never faced a challenge like the current crisis. Solutions are possible, but only through coordinated federal and state efforts that ensure the promise the Olmstead decision made.

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