The direct care workforce shortage has been an issue for years. The pandemic just elevated the crisis for all to see. According to a report done by the Wisconsin Health Care Association in 2020, 1 in 4 direct care worker positions in nursing homes and assisted living facilities are vacant.

The Wisconsin Survival Coalition did surveys and found that 95% of people with disabilities can’t find enough in home workers and 85% reported that they don’t have enough workers to fully cover open shifts. The report was published in May of 2021.

Wisconsin isn’t alone. By 2030, nationally, there is expected to be a 151,000 shortage of caregivers. By 2040, the number grows to 355,000 (source). As the baby boomers age, increase in need will increase and the number of working age people will decrease.

There are thousands of hours of needed care are going unmet. People are not receiving the care they need. Whether you work for an agency trying to find caregivers for clients or a person who is trying to hire workers yourself, finding caregivers is almost impossible.

Lots of advocacy groups are trying to come up with a solution to this. When you need to find direct care workers, individually or with an agency, what are some unique ways it can be done? Do you have an idea of how to help improve the current situation we are in? What are some ways we can start to mitigate this issue?

If you could ask for one thing right now to fix the problem, what would it be?

Let’s brainstorm ideas here!

I'm personally at a loss of ideas. I can't even find anyone to interview anymore. I'm curious to hear if others think  it's the wages/benefits alone? I definitely think think things would improve if the wages / benefits would improve, but I don't know if that's all of it. From what I'm hearing, people don't want to work, period. And, combine that with the fact that they can't get adequate pay as a caregiver, what do we expect? I just don't know. I wish I had the magic answer! Do others have some ideas? 

Hi, I'm a Support Broker and I help people who are self-directing their own workers and I have several things that I run into frequently that are roadblocks for finding workers.  Here are a few thoughts...

First, some kind of overarching umbrella through the state that allows for people to continue to self-direct their workers, but provides some benefits for the workers to make the positions more career oriented.  Such as:

1. Healthcare Benefits for individuals who work full time positions, even when working with numerous individuals (this would need to be worked out at a higher level, because each individual self-directing is a separate job, therefore the hours worked rarely are full time).

2. Time Off being available for those workers.  In order to make this possible, some type of float workers would need to be made available that can step in to cover for those individuals.  This is a challenge for each individual to do when hiring their own staff through self-direction.

3. CNA Oversignt so those who have a CNA can maintain what is required in order to keep updated to maintain their certification.

4. Scheduling Assistance- most of the individuals self-directing have very short shifts that make it challenging to attract the majority of workers.  Some kind of oversight that could group individuals and their needs to make a schedule that would be attractive to workers other than individuals who are solely looking for very part time work.

5. Mileage reimbursement for those who are willing to work for multiple people and work out a full schedule.  Currently, because working for each individual is a separate job the travel between individuals is all unpaid time, and the gas is not reimbursable.  Looking at some kind of solution for this would make it more appealing for those individuals to take on a position that includes working with multiple individuals.

Again, I do not want to lose the self-directed core of this, because I feel it is absolutely critical for these individuals to have that control over who they hire, and makes for better outcomes, but the state could look at something that would provide more incentives for individuals to look into this as an actual career it would make these positions more appealing to a much wider, and more qualified group of workers.

Thanks!

TOTALLY agree with everything you said, Lisa!!  Especially the scheduling issue! I used to have four short shifts every day. Scheduling was impossible, so about two years ago, we rearranged it so now there are two shifts. One short two hour shift in the morning and a seven hour shift at night. Scheduling had been a little easier this way for awhile, but now I can't find anyone to even interview. 

CNA oversight is another crucial one. Many of my workers are CNAs students pursuing nursing and they end up leaving me because they need to keep their credentials and working for me isn't considered certified. 

I wonder if we began forming a group around advocating for these issues? What do others think? 

Ditto Lisa's ideas.  Also a statewide database with available approved workers according to region.

As a Support Broker I do work with numerous individuals trying to help find workers, and can try to assist with setting up scheduling that will work for multiple people, that way the workers can do more than a short shift here and there, but these other issues often do create problems for keeping people.  It becomes easier for the workers to go work for a supportive home care agency where the travel between homes is covered and they have access to benefits.  May of those workers would prefer to work directly for the individuals, but those benefits can really impact them.  In terms of the CNA certifications, workers often end up retaining jobs within nursing homes and such in order to maintain certification on top of working for individuals, limiting their availability even further.  It hurts my heart trying to help people and not being able to find workers.  The system really needs some changes that go beyond wage increases (although that is always a concern, too).  I was a little disappointment in the governor's taskforce, because I didn't feel there was enough representation of individuals self-directing.  Having a choice in who works for you, deciding your own schedules, and being able to stay independent and comfortable in your own home for as long as you are able can be huge factors in maintaining health and happiness.  I also feel the Electronic Visit Verification roll out has neglected those individuals significantly.  Everything has been geared toward the agencies, and I fear that when the hard launch rolls out many people self-directing will lose workers who are already in short supply.  It isn't a solution by any means, but if you are self-directing and in need of some assistance, you might want to look into Support Brokers, obviously it takes another chunk out of your budget, and I'll be the first to tell you we struggle too in the current market, so there are no guarantees on finding workers, but having an ally can at least give you some extra support. It seems to be a newer service available for most areas of the state, but there are a few agencies out there offering the service.

Again, I totally agree with what you're saying! This is so much more than wages. The entire system needs to be revamped. I've tried a couple of agencies and have had horrible experiences.  Major safety concerns with the workers. And, if I would find a decent agency, the workers probably wouldn't be able to physically give me meds--we've run into that. So frustrating! Self-directing literally is my only option right now!

I'll be honest with you, I've been very hesitant about using a Support Broker because there are no guarantees. It's the same with paying for advertisements. Sites such as care.com have no guarantee either. Since there are no guarantees, it doesn't make sense to hire a Support Broker. I'd have to cut workers shc pay and my transportation miles. It just doesn't make sense in my situation. 

I completely understand that, too.  You have a budget to work within, and it makes it hard to go for a service that tends to be expensive.  Not all Support Brokers are created equally, too, so researching ahead of time to see who would actually be working with you is always a good idea.  I've explored some things like care.com but their ratings were not great, so I haven't used them.  We always try to mindful of the time spent and the hours that are authorized.  I don't know how other agencies handle that, but I would assume it is similar.  Sometimes it can be helpful for finding those workers who want to work for multiple people, since we often have a case load of individuals looking for assistance and can put together schedules.  I'm always honest with people though.  This has always been a difficult market, and since the pandemic it has only gotten worse.  It makes me feel bad enough when I am not able to help someone, so I'm not one to offer false promises.  I have also gotten creative with people who aren't able to find enough work through SDS workers or agencies and have decided to do a blended situation using both.  SHC agencies are all having the same difficulties as everyone else finding workers, so sometimes that can be a solution.  Maybe that could be something for you to explore, if you could hire SDS staff for medication management and an agency for some of your other shifts? Best of luck to you, in any case!