Imagine being told that you have to suddenly uproot and leave your home. It’s not clear how long you’ll have to live in your new place. It could be months — or longer.
Earlier this winter, residents in some of over 30 group homes run by Mount Olivet Rolling Acres (MORA) — a 50-year-old nonprofit dedicated to serving people with intellectual and developmental disabilities or behavioral health issues — were told that severe staff shortages meant that they’d have to move, either back home with their families, or into temporary accommodations in other group homes.
The move was necessitated out of concerns for the safety of residents and workers, explained Tracy Murphy, MORA president. Without enough staff to keep all of their homes running, the nonprofit’s leaders decided that they’d have to move residents to other locations until they were able to hire enough staff — or adjust the number of individuals they can accept into their programs.
“It breaks my heart that we have to make these decisions,” Murphy said. “But my top priority is to keep everyone safe.”
For residents, many of whom are nonverbal or lack the intellectual ability to understand why they have to leave their homes, the move has been especially hard to take. “We all thrive with a routine,” Murphy explained. “If these folks have to move from their home, their routine is extremely disrupted.”
The intricacies of staffing shortages and federal safety requirements can be difficult to explain to a person with an intellectual disability, she added: “They might not understand why their routine is being disrupted. For many residents, it might lead to increased behaviors, to stress and anxiety.”
The range of disabilities faced by MORA clients only adds to that stress: “Imagine you don’t have the autonomy to make your own decisions,” said Murphy. “How are you going to process that stress when you are told that we are changing your routine?”
Stephanie Kohl, MORA therapeutic services program director, said that the moves have been “life-shattering” for some people. “The way to put it in context for outsiders is like being displaced by a fire or a hurricane and you suddenly have to leave your house and you never know when you’ll be able to come back.”
‘This is an emergency now, no longer a crisis’
After years at a simmer, staffing shortages in Minnesota’s long-term care programs have reached a full boil, Murphy said. Even before COVID hit the state, group homes like those run by MORA had struggled to fill all available positions, but in March 2020, when the world was thrown upside-down, it became even harder than ever to retain and attract new workers.
“With the Great Resignation, the nonprofit sector has been particularly hard hit,” Murphy said. At MORA, it’s been especially difficult, because there is only so much that can be done: “So many employers are trying to put in new services to attract and retain people. But that is only like putting icing on a rotten cake. What needs to happen is to bake a new cake.”
The truth is, Murphy explained, that people in her industry had known that something like this was going to happen for years. Population models predicted a staffing crisis, with not enough workers to fill all open jobs. When the predictions proved true, employers began to realize that in order to serve their clients, real change needed to happen.
“This is an emergency now, no longer a crisis. We’ve been in crisis since 2010.”
The numbers are stark. At MORA, to be fully staffed would take around 500 full- and part-time employees. “Right now we have 360 people working for us, between part-time and full-time staff,” Murphy said. “We have 25 percent of our positions open.”
State and federal vaccine mandates have also put a strain on the caregiving sector, because some workers are reluctant to get a COVID vaccine. “The overarching response when we talk with them about vaccination mandates is, ‘I’ll just go work at Target,’” Murphy said.
Under new federal COVID vaccine requirements, MORA needs to have 100 percent of its employees fully vaccinated by the end of March. “We need to also prove that we are making good faith efforts to reach that goal along the way,” Murphy said. “Eighty percent of staff need to be fully vaccinated by January 26.”
As of January 5, she added, 79% percent of staff has been vaccinated.
While Murphy believes that vaccines are an important tool in controlling the pandemic and ensuring the health of residents, she has advocated for extending state mandate deadlines; not having enough staff to care for residents also puts their health at risk, she believes.
“If I lose another 25 percent of my employees … I’m going to be down to less than 300 employees when I should have 500.”
It’s the same situation at other care providers for people with intellectual and emotional disabilities, Murphy added. “Every other Wednesday we are on a call with DHS and MDH. Every single person on that call is making the same tough decisions that I am.”
Beyond vaccination reluctance, another reality that makes it hard to attract and retain employees is pay. Such facilities are financed primarily through public dollars — often from Medicaid or via state money for low- income individuals — which mean that average hourly pay for these challenging jobs remains low.
“Jobs at Mt. Olivet Rolling Acres are all national minimum wage,” Kohl explained. “We’ve been able to improve it a little to make it more competitive, to like $14 an hour, but Amazon, McDonald’s still beats us.”
Consequences for residents
For MORA group home residents, a visit to the Pearson Center in Victoria is often the highlight of their week. A year-’round recreation and community hub where people of all abilities can make connections and find healthy activities, the center has, “a gym, a computer lab, activity space with a big-screen TV, video games, a reading nook, a sensory room and a mini kitchen,” explained Nate McKenzie, MORA recreation and therapeutic services supervisor.
At the beginning of the pandemic, the number of clients who could go to Pearson Center was severely limited, and many programs shifted online. But this summer, when lower case rates meant that some social distancing restrictions were eased, clients were allowed to return to participate in some popular activities. Then the staffing crisis hit, which meant there often weren’t enough people working in homes to allow for residents to be transported to the center.
This setback hit some people particularly hard. “We know somebody who has been coming to our dance program every Monday for five years,” McKenzie said. “All of the sudden they aren’t coming here anymore. … For reasons outside of their control, they can’t do something that they love. That would have a negative impact on anybody’s quality of life.”
While McKenzie and other recreation and therapeutic services staff were able to shift some activities to Zoom, the number of participants in those programs has dropped. Virtual programming doesn’t build relationships in the same way that in-person experiences do, he said, and many people with intellectual disabilities have a hard time making connections in a remote environment.
Murphy agreed. “We’ve been doing yoga over Zoom,” she said. “We did our Halloween dance over Zoom. We can offer virtual activities, but many of the people we support have a physical disability and an intellectual disability that makes their ability to use technology and to connect in that way really hard. The people we support do much better in person with touch and looking people in the eye.”
McKenzie said that he and his colleagues are working on addressing staffing shortages by picking up residents at their group homes and driving them back to the Pearson Center for activities. This provides group home staff with some respite hours — and residents with an activity that gets them out into the world.
“It’s good when people can do things they enjoy,” McKenzie said. “Given the current situation, I think it is important that this opportunity is there for people to, at the bare minimum, just get out of the house.”
An honorable wage for an ‘honorable’ job
What will it take to attract more workers to Minnesota’s long-term care programs? Murphy thinks that long-term improvement requires, “dramatic and immediate,” change. “The systems we created are not sustainable now. We know the right thing to do but we have to rebuild it to get there.”
Such change requires a major adjustment in how society values the work of caregiving, said Sarah Smith, MORA’s residential department quality enhancement lead. “If there is one thing that we can do for those who work as caregivers in disability services, it’s compensating them fairly and providing a living wage.” \
Smith said she has worked in the field for a decade, and has known many support staff who, because of the low pay rate, need to work, “around-the-clock hours at numerous jobs,” just to make ends meet.
“We should treasure those who are willing to sacrifice so much to care for those who cannot care for themselves, and show that work is treasured through fair compensation given our current economy. Caregiving is an honorable job and should be seen as such across society.”
If government and lawmakers made this issue a priority, she added, “they would know we have to find the means to increase these hourly wages.”
Natasha Merz, Minnesota Department of Human Services director of disability services, said that her department believes that, “Ensuring skilled, compassionate care for people with disabilities is extremely important.”
Because of this, she added, “The Minnesota Department of Human Services worked with the legislature in 2021 to approve rate increases for critical services that support people with disabilities. We have implemented cost reporting to monitor provider costs compared to Medicaid rates, and have used enhanced federal funding to support the critical direct support professional workforce.”
But she admits there is more to be done: “We recognize that much more work lies ahead for DHS and others to further address these critical needs.”
Murphy said she believes that it may be too late, that it may actually require a complete rethinking of the way her nonprofit and others like it do their work in order for them to keep providing care for their client base into the future.
“This is not just a disruption but a very needed dismantling,” she said. “We’re taking the system apart and hopefully putting it back together in a different way.”