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.
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Connections - 11.30.21

Why the American Rescue Plan Matters to You Now

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By Dr. Maulik Trivedi, StationMD

 Headshot image of Dr. Malik Trivedi, StationMDOver the past several months, there has been a lot of discussion about a provision of the American Rescue Plan signed into law in March 2021 that increased funding for home- and community-based services (HCBS) for people with disabilities. But exactly what does this additional funding entail?

The American Rescue Plan authorized significant additional funding for states to tailor HCBS enhancements based on the needs and priorities of the individuals receiving services. While disability advocates and the broader community of providers do not need to be part of the “sausage making” behind state and federal policymaking, we do know what the everyday problems and challenges are, and we have perspective on what solutions should be implemented. It is important that those on the frontlines take initiative to make our voices heard now about how and where to spend that funding, to ensure the maximum benefit for the people we support, as well as DSPs, families and provider agencies.

Then & Now

For years, the infrastructure behind HCBS was not getting the support it deserved, and people with disabilities were inconsistently having their needs met through HCBS. Over the past year and a half, it has become evident that people with disabilities are among those disproportionately impacted by COVID-19. To prevent crises like vulnerable individuals becoming ill, support staff from leaving the profession, and health care settings from being completely overwhelmed, federal, state and local governments have been looking for guidance on what is most effective at keeping people safe in their homes and in the community.

They are doing this through improving, strengthening and expanding HCBS, which ensures more and better care and support services are delivered directly to the individual. This helps keep individuals with disabilities out of hospitals, allows them to stay in the community and maintain their independence, and protects the support staff and agency providers from work interruptions due to illness, quarantine, pay gaps and general lack of resources.

The Path Forward

Many states now have spending plans in place for exactly how to use the additional funds offered through the American Rescue Plan, and often the plans are flexible enough to meet many needs. However, it is up to us to ensure continued feedback reflects what’s working and what’s not, so that we can collectively improve the system today and for future generations.

When we look at the expansion plans of places like Indiana, South Carolina or Washington, DC, we find that these jurisdictions are using funds to supplement services like:

  • Expanded telemedicine so people can get medical treatment in their home, and can avoid expensive and often traumatic hospital visits.
  • Improved access to transportation, food and affordable housing so social needs are less of a barrier for people with disabilities to live independently.
  • Bonuses and other pay enhancements, such as child care bonuses, paid family care, and training and career ladders to recruit and retain direct support professionals in the community.

Getting the Services You Need

While those system upgrades sound great, how can you make sure the funding meets your needs and improves your personal situation?

  • If you’re a person with a disability, or if you’re caring for someone with a disability, talk to your care coordinator about your needs and see if there’s a service that will help you.
  • If you’re a DSP, talk to your provider agency administrators about resources that would help you better serve individuals in your care and make your job easier. If you need training, be explicit about what kind of training you need and ask for support in securing it. If you need more on-the-job tools to support your caregiving, explore what tools would make your job easier and make a case for your request so they can make a case for government funding.
  • If you are a community provider of services to individuals with disabilities, and your staff needs resources like more pay, updated technology or medical support, spell out for your state disability services director how funding for those resources will safeguard the health and well-being of the people you support.

The key takeaway is that you don’t have to solve all your problems on your own. Right now, the government is saying, “tell us how to meet your needs.” Providers who have gone to their respective agencies and have said, “we need telemedicine in the spending plan” are now delivering specialized medical services to thousands of people with disabilities, and it’s eliminating thousands of unnecessary hospital visits and millions in costs.

As Delta and other COVID-19 variants continue to circulate throughout the country, it’s critical that the disability community relay personal experiences to illustrate how to optimize and supplement existing HCBS. When you have more choice and control over services that help you have a better quality of life, everyone wins, and in the end, it is your success stories that will provide reason for continued investment to serve our community best.

Dr. Maulik M. Trivedi is a board-certified Emergency Medicine physician and a founding partner of StationMD, a physician practice that delivers medical care specifically to people with disabilities using telemedicine. He continues to practice as an ER doctor in the New York City area and currently lives in midtown Manhattan with his family.