Recruitment and Retention
We cannot recruit and retain staff as service providers, which means that families have even more challenges recruiting. For unionized agencies in B.C., generally the highest paying; 1/3 of community living agencies had turnover rates greater than 20% and just under 10% had turnover rates over 30%. Younger people are particularly difficult to recruit.
Recruitment and retention of the community support labour force will not be improving in the future:
The American Network of Community Options and Resources (ANCOR) recently reported on U.S. Direct Support Worker Tenure – 35% last less than 6 months; 22% last less than 6-12 months; 35% last over 12 months and 56% leave within the first year. Federal policy changes similar to those in Canada and Australia increased demand without increasing funding (state budgets are shrinking, Medicaid is threatened by the repeal of the Affordable Care Act).
Population trends tell us that the potential workforce will get smaller as the need for services increases. Wages are not commensurate with the responsibility involved:
- 45% average DSP (direct support professional) turnover rate
- Wage compression
- Turnover impacts quality of care and service – staff leave before developing a relationship with the person
- DSP occupation is one of the most in demand in the future
- Low wages de-value the work of DSPs
Women aged 25-64 are the main demographic of DSP workers. In the next decade, demand for DSPs will increase by 48% but only 2 million addition women 25-64 will enter the entire US labour force, down from 6.3 million in the early 2000’s. This shortfall of potential workers will be a persistent challenge. Increases in diagnoses (e.g. autism) and community-based services creates an escalating demand but there is a decreasing number of people to do the job and cuts in government funding will create further decreases in wage rates, although many are already at minimum wage (and qualify for programs like food stamps that are also under threat of being cut). There will be an increase in private (family) –pay but there won’t be anyone to hire unless these pay rates are much higher than at present. Services provided by DSPs are labour intensive, with regulatory requirements mandating certain staffing levels. Current job market entrants are not interested in high levels of responsibility, low-paying caregiving jobs or careers with no opportunities for future advancement. These jobs:
- Pay low wages
- Offer insufficient professional supports
- Lack public recognition
- Lack options for a career
- Require a workforce that is not growing while demand is escalating
- Are increasing due to increased autism and other diagnoses
- Will need a new influx of employees to replace retiring Baby Boomers and aging care-givers
- Need to respond to a growing number of dually diagnosed adults and those with complex and multi-sensory disorders – need competent staff
- Are lodged in agencies that have turnover costs averaging $4,200 to $5,200 ($US) in recruitment, orientation, etc. expenses. Existing staff must often do extra work to compensate for unfilled staff vacancies but this negatively impacts morale and quality of care.
The community living sector must also compete for employees with the following sectors (that all generally pay more):
- Home health care
- Personal Care
- Physical/Recreation therapy
- Social and Human Services organizations
- Mental Health
- Education – special needs
- Child and Youth Services
- Aboriginal Services
Managed Care at Home
Forbes magazine recently noted that Long Term care is increasingly becoming managed care at home. In 1965, Medicaid delivered long term care in nursing homes. During the last ten years this has shifted to Home with community assistance. A Kaiser Foundation study in 2013 noted that States now spent more long term care dollars in the community rather than in nursing homes. Nursing homes are also shifting from long term care to post-acute care in convalescent homes. Long term care rates have been kept so low for so long, though, that service providers can no longer stay in business. Again, this leads to more home care.
A Conference Board of Canada report (2016) recently noted that by 2026, more than 2.4 million Canadians aged 65+ will require paid and unpaid continuing care supports. This is a 71% increase over 2011. By 2046, 3.3 million will need continuing care supports. Spending growth will exceed the pace of revenue growth – from $28.3 billion in 2011 to $177.3 billion in 2046. Two-thirds of this funding will come from the government (unless there are further funding cuts).
Labour demand to deal with this major increase in care needs will increase at a rate of 3.1% per year until 2026, then demand will increase to 3.7% annually from 2026 to 2036. Afterwards, there will be a 1% per year annual growth rate in demand for caregivers. The major jobs will be Home Health Care Aides and Personal Support Workers. Issues for employers will be education, training, compensation, work environment, retention, recruitment and relationships with clients.
The report continues: “Providing sustainable continuing care supports for older Canadians will require changes and new solutions”.
An estimated 5.3 million Canadians provided some level of unpaid continuing care to seniors in 2015. By the year 2046, this number will increase to 11.6 million. These ‘friends and family’ provided an average of 21.9 hours of help per week from an average of 5 different individuals. This totals 1.2 billion hours of unpaid continuing care provided to seniors annually. In addition to this, 62.5% of caregivers also pay privately for care for seniors while 100% of the public continuing care budget is spent annually, creating a huge demand for caregivers. This creates major concerns about the potential labour pool available for such work.
Social Services Budget Cuts
After noting that the number of adults with developmental disabilities is increasing at the rate of about 6% per year, governments in Canada, the U.S.A., Australia and the U.K have been reducing and/or capping the amount of money available for support services. The dramatic increase in the numbers of people with autism has contributed to this increase, which shows no sign of slowing down anytime soon.
In addition to the 6% increase in youth with developmental disabilities becoming adults, another area of growth is aging seniors. For decades, parents of Baby Boomer children with developmental disabilities kept them at home, usually accessing day program or respite services, but otherwise providing 24/7 care at home. Now these Baby Boomer children are becoming seniors themselves, many living with very elderly parents who will soon be unable to continue to provide support.
Because budget cuts and demand are outweighing supply, many adults currently sit on wait lists for service or may never be eligible for supports, which are not an entitlement but ‘voluntarily’ offered by the provincial government in B.C. The situation in the U.S. is far worse – states like Ohio already have waitlists in excess of 40,000 per year and all funding comes through Medicaid, which is currently under threat from lawmakers who promised to repeal the Affordable Care Act.
This lack of government funding throughout Canada, the U.S., U.K., and Australia/New Zealand (and the much greater lack of services in Europe, China and the developing world) means that families of children with special needs are increasingly on their own. This means that they must bear the extraordinary costs of raising children (often with severe health/physical needs as well as intellectual disabilities) far into adulthood, with no additional supports. This is an expensive and exhausting proposition and often stunts the young adult’s opportunities to gain employment, develop their own social circle, learn how to use public transit, develop the skills necessary to live on one’s own and so on because they remain dependent on their parents.
A personal-service robot could help these families. From waking a person up in the morning to managing their schedule and connecting them to the world, a personal service robot can become the repository of all information related to the individual, an organizer, a monitor, a teaching assistant at school or college, a teacher at home, an assistant at a job and problem solver/communicator everywhere. If families are able to recruit a personal support worker for an individual, the cost would be about $50,000 to $60,000 per year for one staff to work 8 hours per day. Some individuals have needs that require two or even three staff – making the annual cost in excess of $150,000 per year. This is an extraordinary expense for all but the most affluent parents and prohibitive for most people. With a personal service robot, the same outcome could be achieved with a capital investment that we hope would cost about $10,000, with upgrades perhaps every five years.
By implementing these robots in staffed programs for people with developmental disabilities, government could also save considerably while delivering potentially better outcomes, increasing both efficiency and effectiveness.
“Person-Centeredness” is a hallmark of social service delivery today, but home support and other workers often have little time to get to knowt he individual’s background, personal details, goals, interests, medications, communication styles or about their relationships with others. Our robot is totally customized, loaded with each individual’s complete information, and can act as an assistant to any person – paid or unpaid, who is helping to support someone with vulnerabilities. People would not receive “one-size-fits-all” services but unique, person-focussed attention that is driven by the individual’s needs, strengths and goals. Areas where our robot could assist individuals are:
- Security/Safety (during the day and overnight)
- Grocery lists and Menus
- Cooking instructions
- Personal Hygiene and Dressing
- Laundry/Folding Instructions
- Transit- Bus schedules and advice re: routes
- Community Events recommendations
- Recreation and Leisure – game playing, concierge, scheduler
- Problem solver
- Emergency detector – call for help
Technology can also:
- Streamline administrative tasks
- Reduce worker strain and time allocation
- Expand opportunities for clients (iPads, assistive devices)
- Assist DSPs with their workload- robots can run programs (learning trials), sense danger, watch that people are safe, play games, keep clients on schedule, provide reminders – e.g. medications, maintain an database of all the client’s preferences, etc., for continuity of care
Entertainment and Learning
Although our robot will be more of a concierge than a companion, people who are shut-in or alone can use internet connections, uploads and downloads to play games, take courses, ask for information, learn by trial-and-error, watch movies, listen to music or read a book with their robot assistant.