By Mona Dougani
In 2004, two weeks after her high school graduation, Brittany Stone was driving to pick up her younger sister from vacation Bible school during a storm. She hit a pothole and lost control of her vehicle. In the accident, she suffered a traumatic brain injury.
Seventeen years later, Stone has landed a place at Whittecar Group Home in Raleigh, where she and five other residents get the help they need to live their lives. For the most part residents at the group home can take care of their basic needs, but Stone, for example, has trouble washing her back and hair because of tremors. She uses a walker to get around, but she does chores around the house. She can’t drive or run to the store independently.
The people who help the six residents live their lives start at a salary of $11.50 an hour. For Lutheran Services Carolina, the agency that runs Whittecar, it has been challenging to hire employees to help those with conditions similar to Stone’s. This year, with the pandemic, has been a particular challenge, especially since there needs to be a staff member at the house 24 hours a day.
Rholanda Artis, the program director for Whittecar, said the low wages turned away some potential employees.
“We had a job fair back in March,” Artis said. She said they had six job candidates. “It went okay, but the pay– they just didn’t want the pay.”
“When we said $11.50, and that was because of their experience, some had no experience, some had experience, and when I went up to $13.00, they said, ‘I just can’t make a living off that,’” Artis said.
Starbucks pays better
Across North Carolina, the average hourly pay of direct care workers is roughly $5 an hour lower than retail jobs at corporations such as Target, Walmart, Starbucks and Costco, according to Karen McLeod, head of Benchmarks, an umbrella advocacy group for organizations that provide care for children and families. With an average pay rate of $10.31/hour for direct care workers, it is challenging to hire and retain staff.
House Bill 665 addresses the staffing crisis impacting care for individuals with disabilities, and House Bill 914 focuses on increasing the pay for long-term care workers. Both bills passed through the House Health committee Tuesday with overwhelming support, which bodes well for facilities like Whittecar.
Rep. Tim Moffitt (R-Hendersonville), the primary sponsor for HB 914, has a personal connection to that bill. Moffitt’s younger brother has severe autism, he told the committee, and Moffitt is the direct caregiver for his brother during homestays for about 60 days each year.
“It’s an important role. It’s a role that I treasure. It’s an appropriate role for an older brother, and we wouldn’t have it any other way,” Moffitt said.
For a long time, Moffitt said he didn’t know how much his brother’s care providers received.
“When I found out what the wages were, candidly, I was embarrassed,” Moffitt said. “These direct care workers are so valued in our lives. We haven’t really appropriately valued them from a compensation standpoint.
“So I’m on a mission. I’m on a mission to make sure that we have enough resources to appropriate to that group of direct care providers to where they can take care of those that are most vulnerable in our society. That’s their role. It’s our role as policymakers to make it happen.”
The Support Our Direct Care Workforce bill, would provide a Medicaid rate increase for the agencies that employ these direct care workers in a variety of settings:
- Workers who support people with disabilities on the Community Alternatives Programs for Children and for Adults;
- Workers supporting Medicaid recipients on the state’s Innovations Waiver program;
- Workers providing care for traumatic brain injury survivors;
- Personal care services providers;
- Workers at intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), including ICF/IID-level group homes;
- Home health providers;
- Nursing home employees;
- Workers at a variety of residential behavioral health facilities.
The lowest payer
Adam Sholar from the North Carolina Health Care Facilities Association said that about two-thirds of all nursing home residents in the state receive Medicaid reimbursement. He also explained that Medicaid reimburses for care at the lowest rate of any other payer. He argued it’s the main factor contributing to nursing shortages in the state and he said he’d like to see more funding from Medicaid.
Medicaid’s low rate, “really constrains what we’re able to pay in wages,” Sholar said. He said that in the cost report data submitted to federal agencies, he can see that many facilities operated at a net loss in recent years.
Medicaid reimbursement is set by the state, and state dollars pay for a third of costs, with federal matching dollars making up the difference.
“We’re doing as much as we can to increase wages to try to attract more caregivers into the profession,” he said. “It’s the Medicaid piece of that we need to see meaningful movement from. We need increased funding from the Medicaid program.”
McLeod said about 92 organizations have banded together to push for passage of HB 914, ranging from providers of direct care to people with disabilities to mental health agencies to advocacy groups.
“We brought all the industries together,” McLeod said. “What’s been happening prior to this, is each of our industries would go after money specifically for our independent agency. We reached out to all the different industries and said, we’re just robbing Peter to pay Paul, we all share the same workers and will have a much greater voice, and people will understand how important this need is in the crisis we’re in if we do a collective bill.”
With support from the 92 agencies and the movement of the bill to the Senate, some challenges that Artis and others at other residential facilities face will be mitigated.
“Here, it’s home”
Reps. Gale Adcock (D-Cary) and Hugh Blackwell (R-Valdese) both expressed concern about how the money in the bill would be appropriated. One mechanism is through putting the measure in its entirety into the state budget, which has yet to be written. Another way to push for the pay increases would be to pass HB 914 and HB 665 as standalone bills.
“I don’t like being even remotely a harbinger of doom, but we lost this last time,” he said, referring to the state budget in 2019 that contained increases for direct care workers. That budget was vetoed by Gov. Roy Cooper in a disagreement with the legislature over Medicaid expansion. “We need to be sure we don’t lose it again, if there’s consensus on this, and we’re going to do it, seems to me the sooner we do it the better.”
“If we tie something that’s critical like this to that budget, we could be tying it to an anchor and dropping it off the boat,” Adcock said after the meeting. “That’s not what we want to do.”
That’s not what they want either.
For Artis and other employees at Whittecar, increasing wages could mean less overtime and more staff and could alleviate stress for their workers who sometimes need to work multiple jobs to make ends meet.
Despite the challenges of the work, Artis said the residents are like family. Her co-worker Shari Webb sat on a couch next to Stone, the two of them giggling as Webb elbowed Stone in the ribs.
“I’ve lived in Greensboro,” Stone said, referring to one of her previous homes. “It’s a lot nicer [here.]”
“We’re here because we love what we do,” Artis said. “That’s what we want to promote here, and that’s what we want to bring in is someone that’s going to treat them the same way that we treat them.”
Though both HB 914 and HB 665 had an easy path through the House committee Tuesday, the future of long-term care facility worker pay and retention remains to be determined by the full House of Representatives and the Senate in the coming weeks.
NC Health News editor Rose Hoban contributed to this story.
Correction: This story originally stated that the Whittecar Group Home was run by Easter Seals UCP of North Carolina and Virginia.