ANCOR Links: Season 1, Episode 12

Sean Luechtefeld

Hi everyone. I am really excited that today I am joined on the Anchor Links podcast by Erica Smith-Buchanan, who is the executive director of CADENCE of Acadiana in Lafayette, Louisiana. Erica, welcome to the show.

Erica Smith-Buchanan

Thank you so much for having me, Sean. I’m excited to converse with you this morning.

Sean Luechtefeld

Yeah, no, I’m excited for this conversation as well. And before we get into it, I just was hoping you could give a brief introduction to our listeners about who you are and really how you got started working in the field of intellectual and developmental disability services.

Erica Smith-Buchanan

Well, I, let’s see, I am the baby of a huge family. Native Texan. I actually came to Louisiana in 2008. It was a Black Friday, so I wanted to shop with my sisters, but my spouse at the time, we were moving to Louisiana, which was his native state. And I grew up with a wonderful sister named Michelle who had an intellectual disability. I didn’t, I don’t think I thought that was unusual at the time. However, when I came to Louisiana looking for a job, I could not find a job. And the only place that offered me a position was CADENCE of Acadiana as a supervisor. And they didn’t explain very well what CADENCE did because I’d lost Michelle in March of that same year. I would not have taken the job because I just wouldn’t have been prepared for it. So over the course of learning the job and going out and shadowing the case managers, support coordinators, is how I learned what the agency really did. And I just, I thought, I cannot do this. But as I was reading the plan of cares that were written for the individuals that were being served, I just wondered, who are they talking about? And I recognized that I really felt like I’d been sent to CADENCE to help humanize the people that were being served and then also to help me heal the grief that I was going through at the time. And from 2008 until now, I can’t imagine being anywhere else. And so that pain really became my purpose and it’s my why. And I think that’s why I love what I do so very much.

Sean Luechtefeld

I mean, that’s incredible. I mean, it really sounds like if you had known more about what you were getting yourself into, you might not have done it, right? But the reality was you needed to be where you were in that moment. And that happy accident has led to a 16-year career in counting. And now you have climbed to the ranks and are leading that agency, which is incredible. I was on the CADENCE of Acadia website. And I saw a quick snippet that I wanted to read, because I thought it was really powerful. It says, “our mission is to facilitate the attainment of your life goals by offering comprehensive guidance. We staunchly believe in the inherent right of every individual to participate fully in all facets of their community. And in line with this, we affirm that the opportunity is available to you should mirror those accessible to every other member of your community.” There’s two things I love about that. One is that you’re actually speaking to people with intellectual and developmental disabilities and not just talking about them, which is often the orientation of that kind of language. But also there are just so many promises wrapped up in that statement. And I’m curious, how does CADENCE of Acadiana go about fulfilling some of those promises?

Erica Smith-Buchanan

So some of what we really try to do is make sure that internally, when we are talking about the people who give us the privilege to serve them, that we talk about them as though they are in our family, that those people are people that matter personally to us. And so when we are discussing meetings or preparing to explain to them the services that are available to them or what their needs may be, we want to make sure that they recognize that they matter. And so we just, from the very beginning, set a tone of these are just, these individuals are just like anyone else. They could be literally related to someone in this room. And so always remember, is that how you would want your mother spoken to, or is that how you would want your child spoken to? And so have no tolerance for anything that doesn’t affirm, you know, a person. And that’s any person.

Sean Luechtefeld

Yeah, I mean, those of us with family members with disabilities, like it’s second nature to us, but it’s not so apparent to everybody else. And so I love that that’s the thing that you are encouraging all of your employees to keep front of mind. And it really just sort of reverberates out into the community then, right? People who watch the way that you are and the way that you operate as a business will also see the value in the people fortunate enough to be served by you. Yeah. Despite the fact that this work is so fulfilling in so many ways, I have to imagine that there are also ways in which it’s not a walk in the park every day. And I’m hoping you can tell me a little bit about what are the challenges that you’ve experienced over the years and what is the set of challenges that you’re grappling with today?

Erica Smith-Buchanan

Ironically they are the same set of challenges and they generally focus in three areas, one is staffing shortage. And so I’ll just start with that one. We have had trouble staffing the individuals that we serve the entire time I have been at this company. It has gotten worse over time because…The pay isn’t commiserate with the kind of work that they have to do. Relative to the staffing, not only do we not have enough people to coordinate the care, we also don’t have enough people that are in the provider agencies, the DSP roles, to serve them. So no matter how many people are sent our way by way of a linkage, a connection, we don’t have the people to work up the cases. And then even if we did, there are not enough people to provide the services that they desperately need. And that’s been the case the entire time I’ve been here. It’s just worse now. It’s worse now because fortunately more people are being offered these services, but there’s nobody to provide the care.

Sean Luechtefeld

So you have this shortage of people and then of course, underlying all of that I assume is the low wages, right? And a report that Anchor and United Cerebral Palsy just released, our annual case for inclusion report, finds that in Louisiana, the starting DSP wage is $8.53 an hour. The average direct support professional wage is 891 an hour. Louisiana is actually the only state in the country where those averages are below $10 an hour, and you’re more than a dollar below that. How does that impact your ability to not just recruit people to work in your organization, but also to keep them in those jobs once they’re there?

Erica Smith-Buchanan

Well, it’s very difficult to recruit. You’ve got to recruit, you have to train, you have to retain, and all of that is very expensive. Our agency hires support coordinators, case managers that will connect the individuals to those DSPs, a lot like the DSPs, our ability to pay our individuals is hampered by the rates that we are reimbursed. And fortunately, we did have some money that came through with ARPA and things like that. And we were able to increase salaries minimally. All of our staff are required to have a college degree. And so…you hamper that with such low wages, it’s impossible to get people to do this very hard job. It’s a very emotional job. It’s one, you know, when you’re dealing with coordinating and caring for people according to that mission, that’s very engaged. You’re not having superficial relationships with individuals. You’re having relationships that changes their lives and it changes your life. And it’s a lot to ask someone. It’s a lot of travel. It’s a lot of emotional and physical investment for such a very low return. We are a big group of working poor. And that’s the truth. We have a big group of educated working poor.

Sean Luechtefeld

Yeah, that’s exactly right. We expect you to be highly educated, we expect you to have certifications in a number of different areas, and yet we’re not gonna pay you enough. You mentioned that the ARPA funding, which for folks who aren’t aware, ARPA is the American Rescue Plan Act. So that provided additional federal funding for Medicaid-funded providers in response to the pandemic, and that money is available now, but will eventually expire in the first quarter of 2025. You mentioned though that you were using some of that money to be able to increase the wages of the people who work for you. Do you know about how much of a wage increase you were able to see with that?

Erica Smith-Buchanan

We directly spent over 80% of that money on wages and then their benefit. So for the most part, almost every bit of that money went to their increased wage. And to offset benefit increases, which every company had increased benefits. So we ate a lot of that cost with that money as well, because we didn’t want, especially because of the age of our employees, they’re very young and we really want them to set a tone for the rest of their life of being insured. We don’t want uninsured young people. We want them to…make sure they know their health matters. And so we want them to set those practices early and that they have health insurance. And then we gave the rest of them so that they could see that bottom line go up. But it still is a relatively low wage for a minimally bachelor level employee.

Sean Luechtefeld

Well, and the other thing that the case for inclusion finds about Louisiana is that folks in Louisiana are significantly less likely than their peers nationally to have the kind of benefits that we typically think of as making for a good job. So they’re less likely to have paid time off, they’re less likely to have health insurance benefits, they’re less likely to have support for continuing education, earning the credentials that are required to keep current and to be able to do that job effectively. So it sounds like at CADENCE, you all are paying better. You’re offering better benefits, and yet you’re still up against all these challenges. And then couple all of that with the fact that the money that you’re using to make all that possible is going to go away in 2025. So what happens then? Do you just lower wages and like expect that you can keep operating or what happens?

Erica Smith-Buchanan

You know, we’re all very concerned about what that’s going to look like. We have done a lot of advocacy around our local legislators to help them understand that that money will expire. We’re hopeful that that will be put into the recurring budget for our state. We had we got a lot of new legislators and so that’s been a big task for us at CADENCE but as well as our state association helping to educate all of these new incoming legislators about what’s happening, what that will mean and what that looks like. And so we are hopeful. We’re just very hopeful coupled with the work that Anchor does that people will understand. It is temporary. We, but we already see people because they know that money is temporary, starting to exit. We already see that.

Sean Luechtefeld

Right. Well, and that education piece of it is so important too, because I think whenever I talk to folks who are outside of our space, they say, well, why aren’t your members just paying their people more money? But the reality is that what you can pay your employees is dependent on what the state gives you in terms of reimbursement for delivering those services. And those services are not reimbursed at a rate that is rooted in any reality of the cost of service delivery, right?

Erica Smith-Buchanan

Correct.

Sean Luechtefeld

So you all are grappling with this, but you’re certainly not alone. I want to go back to something that you shared earlier, which was that you mentioned you deliver case management services as well. And so I think for folks who don’t necessarily know this space really well, I’m hoping you can explain how does case management work and like, what does a case manager do that’s distinct from, let’s say what a direct support professional might do

Erica Smith-Buchanan

Sure. That’s a great question. So when a person is offered a waiver, you know, a position in one of the programs, they get to select the person, the company, that they want to help coordinate those services, that they want to literally become almost like a member of their family. We’re their advocate. And we explain those services to them. We see what they already have in place. We don’t want to remove any of the services, natural supports that they have, but we want to ensure that those things that are needs that are unmet. And also those things that they desire to have in their life, be it community engagement, be it meaningful day activities, work, go to school. It could be anything that we help them get connected to that. And whatever it is that the waiver that they have does not provide, we will continue to look for. We try to ensure that they get their regular medical care, dental care, we help them look for whatever it is that they may need. Sometimes the families are able to do that. Sometimes they’re not, they may have no family. And so we help connect them to the company that will hire the DSP. And then we work alongside that company to ensure that that person’s life is, it looks like what they desire, what they choose, what they want. And it looks like a life that they’re happy with and satisfied with that they are safe. We also have to coordinate a lot with natural disasters. So when we have storms, and it doesn’t have to be a major storm in Louisiana, it can just be a day or two of rain, there can be terrible flooding. So if people are displaced, we’re responsible for ensuring they get somewhere safe and knowing where they are and making sure that they get back and that they’re made whole once they get back. It is constant, the points of touch for a case manager or support coordinator. It’s constant. So it sounds like you’re trying to connect a lot of dots and if there’s somebody who needs XYZ service over here, you try to connect them with that service over there.

Sean Luechtefeld

But I guess what stands out to me in hearing you describe that is like, there’s all these people who are in need, providers don’t have the staff to deliver those services, what happens? Like you mentioned somebody who might need services to help them have a meaningful day. If there’s not a day program provider that has enough staffing to take that referral on, what happens to them?

Erica Smith-Buchanan

Well, they wind up not going to a day program, or they may wind up going to one that is very far away, so they’re spending a considerable amount of their time on a bus. Riding, you know, that’s if that… If there’s a bus available, right? If that bus, if that program has a bus willing to drive those extra miles. Otherwise, that person isn’t getting that service. And so they’re staying home. And that’s just not a very inclusive life or engaged life. So…It winds up then being the epitome of an access crisis, because you have individuals that are offered something that they can’t really get, you know? And so we have people that we’re trying to get connected to individuals. However, we don’t have the capacity to even work many of them up. Recently, there was another support coordination agency that just gave up a program because they didn’t have the staff. The linkages are coming in quicker than anyone can work them up. And they just said, we bow out of that. So we absorbed a lot of those individuals and we’re very grateful to be able to serve them. But the reality is we don’t have the staff to…to serve them, we don’t have the staff to work them up in the timeframes that are required. So then you run into licensing issues because in trying to do a good thing, which is help support them, you can’t meet these requirements. And then you wind up being penalized when, we could have told you it’s impossible to meet those deadlines. It’s impossible. That’s why that company gave it up. So it’s, and that’s very stressful. Again, when I say that many days or not, it’s not a good day, those are employees that just bow out under the pressure of it. Because despite the fact that you love what you’re doing, to be penalized…for something you have no control over and you’re doing the absolute best you can, that’s a tough job to have, and hence a lot of our turnover. A lot of the turnover is pay related, but it’s also, it’s an impossible job just based on the constructs of a system. The system is a very difficult space to operate in right now.

Sean Luechtefeld

So all of that was really helpful, but we did sort of transition into a new topic. So I’m gonna…I’m going to take a half a step back and just say, what you were describing a moment ago really speaks to a challenge related to access, that people don’t have the access to the services that they need, or they don’t have access to services when they need them, where they need them, etc. Then there’s this whole other challenge, which is that folks who do have access to services might be supported by an organization that doesn’t really have enough staff and you had shared recently in the case for inclusion, a story about how one of the local providers in your area had discontinued a program and you ended up supporting the folks who had previously been supported by that other program. So talk to me a little bit about what happened in that situation and how that’s put a strain on the folks at CADENCE of Acadiana.

Erica Smith-Buchanan

So due to the staffing shortages and the relentless number of linkages that they were getting just could not meet the time frame. The deadlines to get those cases processed and linked to care, to services, there was no support, you know, they felt so they chose to just bow out of the program. So we had the great fortune of, you know, being provided the opportunity to support them. However, we are very much like that same company, not able to keep up with that pace either. We also couldn’t attract any of their former employees because they just didn’t wanna do it anymore. And so it turns into people who have services, still not having enough people to provide the services on the direct support professional in, but then my staff having more cases than they can legitimately work because we are having difficulty hiring. And so it again turns into an access issue because we’re not getting those individuals the services that they need in the timeframe that we want and that we’re required to get them the services. So It’s just a no-win situation. Yeah, I mean, it really sounds like you’re in this impossible situation. It’s like, if you say, no, we can’t support you, you know that that means that those folks are just going without the support and the care that they need. If you say, we can support you, you’re ultimately saying we’re gonna take on the needs of more people without necessarily having more capacity to do so. Correct. And we have no way to attract people to this wonderful feel. We have no way to attract people. We can’t say, oh, let’s give you a $5,000 sign-on bonus, you know, like a nurse. You see something else where they offer huge sign-on bonuses and things like that. Well, where is that coming from? It’s very difficult to attract people.

Sean Luechtefeld

You’d probably give your left arm if you had $5,000 to it.

Erica Smith-Buchanan

I would love, I just would, I would love that. And so what we do is we try to create a culture within our organization that’s very supportive, team oriented, family oriented, so that we always tell people that our job is hard enough, this company won’t be able to. That’s part of the problem. We are going to have an environment that people feel supported, that they know they’re on a team, that if you go on vacation, we are going to keep things going somehow so that you don’t dread coming back. We do everything we can to be a really good group and support system for one another. And we always say teamwork is one of our superpowers. So, You know that’s those are things that we can try to control.

Sean Luechtefeld

And it sounds like as a result of that CADENCE is a great place to work but the reality is the strongest culture in the world is not going to overcome some of these other challenges. So I want to get a sense, you know, what are the things that need to happen whether it’s in your local community at the state level? At the federal level. What are the solutions that we need to be? Educating lawmakers about what are the solutions that we need to be investing in. So that way it can be your culture that keeps people there, but also, you know, a livable wage and strong benefits and long-term job sustainability, right? How do we get to those outcomes?

Erica Smith-Buchanan

Well, I really feel like we get to those outcomes by ensuring that our rates are supporting the kind of system that everyone wants to see. And we have to stop treating the services that are being provided as though they are, you know, that they’re things people do out of the goodness of their heart. These are careers. And so we have to monetize providing these services. So we have to fully fund and support every aspect of it from the direct support professional, also to the support coordinators, and everybody who has to support them needs to see value in it. We also need to take a look at the systems itself. Some of them are very antiquated. There is not a lot of thought as to what truly is necessary to support individuals. I think…We operate on lots of theory and we want to put in place lots of theoretical ideas, but once they get down to the individual, it doesn’t really translate into a better life for that individual. It just sounded good. And so I think that we need to really focus on what people truly want, what matters to them. And I think that we would have better outcomes. We would have healthier people that we’re serving. I think we would have staff that is healthier and that’s in it for the long haul. And so I think we need to continue to educate advocates, legislators. And I think that by way of advocates, we all need to recognize we truly want the same thing. And we need to partner as allies to push this forward. And I think that we can do that.

Sean Luechtefeld

I think you’re right and it’s not lost on me that we’re smack in the middle of developmental disabilities awareness month right now. And oftentimes we think about raising awareness about developmental disabilities. The reality is we also need to be raising awareness about the services that enable people with developmental disabilities to do what you describe in that mission statement, right? To pursue all facets of their community. To have opportunities that mirror those that are available to everybody else in your community, right? And so there’s a role for all of us to be playing in making sure that lawmakers at all levels of government are educated about what problems we’re facing and what the effects of decades of underinvestment have been in our services. But also, what are some of the positive things that we can do? It’s not just raising reimbursement rates and increasing funding, but there’s ways that we can simplify the system and make sure that the regulations actually translate into a better life for the people that we support. And you just really sort of summarized all of that so beautifully because it’s not just one silver bullet, right? There’s not one answer that’s going to solve it all. Yes, the funding piece is crucially important, but there are a whole lot of things that go into a better job than just the pay, right? And similarly for the people that we support the quality of their service is going to depend on the longevity of the people who are supporting them and how well supported they feel when they go to work each day.

Erica Smith-Buchanan

Absolutely. I think that we will know our effectiveness by the life that we see people living. Lives where they are stuck in a home where they don’t have to be and that they are, you know, individuals or watching the same television program and that’s not what they want to do. I think we will see our effectiveness and I think we will be held accountable and not just us in this field, but us in this world. I think we will be accountable for getting this right. And I know that we can get it right. We can.

Sean Luechtefeld

I think that’s a perfect place to wrap things up today. Erica, is there anything else that you were hoping to share that we didn’t get to touch on?

Erica Smith-Buchanan

You know, I love the conversation. I really just, my overarching thing is that we have to, when we think of supporting these beautiful people, we have to not pick apart these service delivery components. We have to keep the DSP connected to the support coordinator because you don’t get to a DSP without a support coordinator. And without a support coordinator, you know, we’re not going to everybody’s just on a list, you know, so a support coordinator has to take that person has to get in there and engage in that person’s life and then help make that life the reality that they want it to be. And so I think that as we as we move and march forward, we must keep those pieces connected and not let them be pulled apart because it’s in that we see some drift, that we can only do this, not this. And the system itself has to be made whole.

Sean Luechtefeld

Well, I think that is as good a place as any to wrap things up. So I will just say, Erica Smith Buchanan, thank you so much for joining us. Thank you so much for the amazing work that you are doing at CADENCE of Acadiana. If folks listening are interested in learning more about CADENCE of Acadiana, they can do that at https://www.CADENCEofacadiana.org/. And of course, we’ll put that link in our show notes wherever you listen to the ANCOR Links podcast. Have a great rest of your day and we’ll talk to you soon.

Erica Smith-Buchanan

Thank you so much. Thank you.