More than $4,200 per person. That’s how much the Legislature has cut from DHS services to 1,300 of the state’s most vulnerable adults since 2010.
That’s the number on the spreadsheet. But ask JoAnn Holton and other AFSCME members what the number really means when you work in a group home, caring for adults with developmental disabilities who cannot live on their own.
It means there might be only one worker taking care of four to six disabled adults – even in an emergency. It means workers and residents are more at risk for injury or worse, partly because of reduced staffing, partly because mentally ill individuals with violent histories are being mixed into the group home population.
It means less time and money for training, even though workers need to deal with an increasing variety of diagnoses and behaviors among their residents. It means jumbled schedules and a chaotic personal life for workers and their families. It means fewer opportunities for these vulnerable adults to be part of their communities.
Trying to make a great idea work
The group homes are run by Minnesota State Operated Community Services. MSOCS is part of State Operated Services, which is part of the Department of Human Services. MSOCS runs 109 small group homes and 19 daytime vocational centers. The group homes care for 440 residents; the vocational centers provide job opportunities or other skill-building for an additional 860 people.
Traditionally, “it’s a career caring for these guys,” says Local 701’s Sheila Blokzyl, who works in an MSOCS home west of Willmar. “You don’t have the turnover you have in the private sector, where there’s less long-term commitment.”
The MSOCS homes are part of the statewide trend to “deinstitutionalize” care for people with developmental disabilities and mental illness.
“That was the goal, that people who can live in the community should live in the community,” says Anne Barry, deputy commissioner of DHS.
“Putting them in smaller homes, taking them out of bigger regional treatment centers, for most of them, it was a good move,” says Laura Hagen, of Local 607. In fact, she calls her home in Austin a “success story.” It is an example of how, “with well-trained and consistent staffing levels, MSOCS is able to give these individuals hope and a quality of life they never would have had. These individuals are much better off than they were.”
The smaller homes succeed when staff can provide firm, fair and consistent treatment, Hagen says, treatment that helps residents feel safe, teaches them control, and gives them guidance.
“But this is hard to do when we have no backup,” she says. And having only one worker on duty is increasingly common, AFSCME members say. They scoff at suggestions by Rep. Steve Drazkowski and others that homes can use electronic monitors to supplement staffing.
“Honestly, baby monitors?” says Cindy Yund, a member of Local 390 who works at a home in North Branch. “That is not the answer. I don’t think anybody who has never done this job can truly comprehend this job.”
Legislature forces homes to ‘break even’
Beyond caring for residents, staff are responsible for grocery shopping, cooking, cleaning, laundry, yard work, snow shoveling, painting, paperwork, medical appointments, and other tasks. If one worker is taking care of errands or taking care of home maintenance, it means a co-worker may be caring for residents alone.
The tighter staffing is the result of a legislative mandate requiring group homes and other DHS facilities to work on an “enterprise” model, Barry says. “The philosophy is, you live on the revenue you produce for your program.”Despite the “safety net” role that DHS plays, there is no supplemental funding from the state budget, Barry says.
A drowning death last year in one MSOCS home points out the ultimate risk of low staffing. The resident was a 56-year-old man, paralyzed from the neck down, who had severe brain damage and could not speak. Three other disabled residents also were in the home, under the care of only one staff person.
“The perfect doesn’t happen with human beings,” says Holton, a member of Local 607, who is president of Council 5’s DHS policy committee. “If you’re doing something else, something’s going to happen. It’s an accident waiting to happen.”
Different clientele bring different risks
Single staffing means workers have no backup if one resident acts up, attacks the worker, or attacks another resident. That’s an increasing risk as the state moves more patients with disabilities and mental illness out of secure settings into the group homes.
“It used to be all mental retardation, developmental disabilities,” says Holton, who works at a home in Brooklyn Park. “Now we get more dual diagnoses, criminal behavior. We’re getting them from St. Peter, the old METO, Anoka. Behaviors are getting worse all the time. It’s a lot more of a challenge.”
“There are homes in some areas that have individuals with violent histories or current violent behaviors that in no way one person can handle,” Hagen says. These residents, she says, “are smart enough to know when staff are most vulnerable.”
One member in Hagen’s local was working alone in a home with “a very high-functioning, but very difficult, individual,” Hagen says. “He beat her up. Beat the crap out of her.” With these kinds of residents, she says, “there should never be only one staff. Ever.”
Opportunities for a normal life decline
Low staffing affects residents’ lives in other ways, too.
Vulnerable residents typically do better when homes have predictable staffing and routines, members say. When that doesn’t happen, “behaviors increase,” says Sebrina Hegg, a Council 5 board member from Local 761, who works in a group home in Akeley. “They don’t like change,” she says. “Some of them, it can affect quite a bit. It can be a real problem.”
Lower staffing also reduces opportunities to take residents into the community, which is one of the main reasons for moving them out of institutions to begin with. In many cases, a resident’s care plan requires community outings.
“We become their family, whether MSOCS admits it,” Holton says. “They expect us to take them places. When it doesn’t happen, they get frustrated and their behaviors increase.”
But low staffing levels often make it impossible to hold the required outings, AFSCME members say.
“Outings help them feel part of their community, and make the community part of their lives,” says Local 701’s Blokzyl. One of her residents, she says, has a favorite place in town to eat.
“He uses sign language, and the people behind the counter know him, talk with him. It gives him personal contact beyond paid staff. It makes him part of the community. But we need staff being there to get them out into the community.”
DHS’ Barry says she understands. “The question really would be, what opportunities for community outings are we missing? Are they in early evening, are they on the weekends – and what might we do to supplement staff, even for short periods of time, to create that greater community integration?”
“If one of my guys wants to have a burger at a local bar during a Vikings game, he should be able to do that,” Yund says. “It’s good for the individuals. It’s good for the community, too.”