The State of America’s Direct Support Workforce Crisis 2022

The longstanding direct support workforce crisis, exacerbated by the COVID-19 pandemic, has led to closures of critically needed services and a denial of access to community-based supports.
Access the Report
Connections - 10.28.21

CEO Perspective: On Hope, Dahlias, and Pixie Dust

Share this page

by Barbara Merrill, CEO, ANCOR

“Every morning I get up, I scrape five inches of mud off my crystal ball…any effort to predict a future course beyond 30 days relies on pixie dust for its basis.”
—Michael Osterholm, Director, Center for Infectious Disease Research and Policy at the University of Minnesota

 Barbara Merrill, CEO, ANCORAs this issue of Connections is published, it appears Democrats are on the verge of an agreement that will infuse more new money into the Medicaid system at once since the inception of the program. With the Delta variant subsiding, and the workforce crisis finally a congressional and Administration priority, I’m feeling cautiously and tremendously hopeful. Seeing those two adjectives side by side seems a bit absurd, but it’s consistent with the roller coaster of emotions wrought by this pandemic and the actions it has forced us to take!

Remember the predictions made by epidemiologist Michael Osterholm at ANCOR’s 2020 Policy Summit? His crystal ball wasn’t muddy then—he pretty much nailed it. He told us the virus would be with us for a long time, pointing out that children hadn’t been included in the original clinical trials, and how long it will take for the rest of the world to be vaccinated. As a long-time political junkie, there was a time when I would often confidently quoted Nate Silver and his election predicting team at FiveThirtyEight. But these days, I look for what Osterholm has to say—recognizing that, like Silver’s (and everybody else’s) failure to predict President Trump’s defeat of Hillary Clinton, the business of predicting the future is, well, murky. And yet, it’s business we nonetheless must try to attend to.

What does an unpredictable pandemic mean for how ANCOR supports its members? We put that question to the ANCOR Board of Directors last month, teeing the challenge up for an extended conversation at their February meeting. None of us has any interest in cancelling another in-person event–or of assuming unacceptable risk. Hybrid meetings are likely the way of the future—our 2022 Annual Conference (April 11-13 in Miami) and the 2022 Policy Summit (October 11-12 in Washington, DC) will likely be both in-person and virtual. But are smaller, regional meetings a longer-term prospect? How do we support critical member networking opportunities? How is the pandemic shaping the support expectations of individuals, family members and policymakers, and how does that impact our advocacy agenda?

I read every article I come across on the national workforce shortage. The Big Quit. The Great Resignation. How employers in almost every sector are now experiencing the type of shortages that has been our field’s reality for years—except now their squeeze has greatly exacerbated ours.

We were just given a chance to tell the top Medicaid official in the country about our top priorities. With this opportunity, would we roll out the laundry list of issues, or focus on the most important issue? We spent all of three minutes debating that question before it opting for the latter. At the listening session with CMS Administrator Chiquita Brooks-LaSure, other national associations spoke of many of the same concerns we share (clarification for who gets boosters, remaining telehealth barriers, the housing shortage, quality measurements, etc.) before we shared the results of our latest DSP workforce crisis survey. (If you contributed to the survey, thank you!) That report paints a grim picture, but one that the ANCOR Board of Directors and the Government Relations Advisory Committee felt was essential to tell.

Our message to the CMS leadership team was that it is urgent for them to recognize the workforce crisis as a direct threat to everything else: access to services, compliance with the HCBS Settings Rule compliance, quality of care—all of it. We urged them to use all the tools at their disposal to ensure adequacy of provider rates and extend regulatory flexibilities to enable providers to remain viable and nimble enough to keep people safe and well supported in the community.

After the lightning storms of the 2017 debates over block grants and per-capita caps, 2018 and 2019 seemed like a dream. We pivoted from the dire predictions of the impact of slashing Medicaid to the ANCOR Foundation’s Included. Supported. Empowered. campaign. We were telling positive stories about the everyday successes experienced by people supported by provider agencies! Now, we are not only painting dire predictions, but we are providing evidence that they are coming to pass. That’s the roller coaster we’re on. And, it’s why this pandemic and its jarring side effects have me simultaneously cautiously and tremendously hopeful and constantly seeking deeper inspiration to stay strong.

I’m personally coming out of a tough summer. While many people became accomplished bakers during the pandemic, I planted dahlias. Lots of them. An unintended consequence was that I got bit by a Lyme disease-bearing tick. My recovery was lengthy—almost as long as it took for my dahlias to bloom this year. But they’re blooming like crazy right now, and I’m starting to feel like myself again. As such, I’ll close with this from author Maria Popova: “Critical thinking without hope is cynicism, hope without critical thinking is naïveté.” My favorite app these days is Wisdom, which features On Being’s Krista Tibbet. I’m listening to a course on hope, in which it’s referred to as a muscle that needs to be stretched in order to remain limber. I recommend it. Along with following Michael Osterholm. Oh, and Hollyhill Six in One.

Got a recommendation for who else we should be following? Thoughts about how ANCOR should respond to an unpredictable pandemic? Drop me a line—I’d love to hear from you!