SURVEYS: Low Wages and Part-Time Hours Identified as Michigan HCBS Employment Barriers

The first statewide surveys of Medicaid-funded home and community-based services (HCBS) providers to capture data and information on the direct-care workforce in Michigan have identified low wages, part-time hours, and the need for enhanced training as significant challenges to attracting and retaining direct-care staff to these programs.

Lack of affordable health care is also noted as a serious challenge.

PHI Michigan conducted the surveys of Medicaid MI Choice HCBS Waiver, Community Mental Health (CMH) Waiver and Home Help personal care program providers in 2012 to determine the size, stability, and compensation of the direct-care workforce. Information on health care coverage, core competencies, and training was also gathered.

Nearly 17,000 direct-care workers are employed by the 300 provider organizations that responded to the three surveys. Providers who participated in the survey reported:

• Low wages, part-time hours, and lack of mileage reimbursement are significant challenges to attracting and retaining direct-care staff.
• The starting hourly wage in the CMH program is $8.73, and $9.09 for the Home Help and MI Choice program.
• 60 percent of direct-care staff are employed part-time, at less than 36 hours per week.
• Only one third of HCBS providers reimburse their direct-care staff for mileage and/or gas for travel between participants.
• Retaining staff is a challenge for many HCBS organizations.
• The average annual turnover rate is 34 percent for direct-care workers.
• On average, each employer had four direct-care jobs open during the week of the survey.
• Providing affordable health care coverage is difficult for HCBS provider organizations, and paid sick leave is widely unavailable.
• 42 percent of responding organizations do not offer health insurance to their direct-care staff, and those that do have low participation rates as a result of the high cost for workers.
• Less than half of the employers offered paid sick time to their full-time employees.

Survey respondents were also asked about the training needs of their workers, and identified necessary core competencies beyond the current training standards in these programs. 

“This effort was critical to ensuring that Michigan can meet the increasing demand for long-term supports and services that older adults and people with disabilities depend on,” said Kari Sederburg, director of the Michigan Office of Services to the Aging (OSA), which supported the surveys with a grant from the Centers for Medicare and Medicaid Services.

“This survey has given us a better understanding of the needs of the state’s direct-care workforce and the challenges they face on a daily basis,” Sederburg said. “It also has presented us with a great opportunity to create new and innovative ways to grow this much-needed profession and we’re excited to get to work.”

“It is in the interest of every state to follow Michigan’s lead and conduct similar surveys so that they can also prepare to meet the increasing demand for the home and community-based services and supports that direct-care workers provide,” said PHI MI Senior Workforce Advocate Tameshia Bridges, who conducted the Michigan surveys.

Home health aides are projected to be the second fastest-growing occupation in Michigan, increasing by 53 percent over the 10-year period ending in 2020. Personal care workers are expected to grow by 42 percent in the same time frame. According to Michigan’s Labor Market Information service, about 25,000 new workers for home and community-based services are needed by 2020.

“Learning from employers about the direct-care workforce is a critical step toward ensuring that direct-care jobs are quality jobs that offer adequate wages, benefits, and training,” said PHI Midwest Director Hollis Turnham.

Results of the three provider surveys are reported in an executive summary, “Findings from Surveys from Medicaid Home and Community-Based Provider Organization Surveys: Understanding Michigan’s Long-Term Supports and Services Workforce.” All documents are available on the PHI Michigan website.

For more information on Michigan’s direct-care workforce, see PHI’s State Facts: Michigan’s Direct-Care Workforce and the PHI State Data Center.

— by Deane Beebe