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“Closed early due to staffing.”
Residents might have seen that message or a similar one posted on the door of a shop they frequent or their favorite restaurant sometime within the past few months.
The answers that most Bloomington businesses have found? Pay more and reduce hours of operation.
But that isn’t a one-size-fits-all solution. Some businesses can’t cut hours or increase wages. For many nonprofits, such as the Bloomington-based LIFEDesigns, the demand for services has completely eclipsed their limited funding and dwindling staff.
LIFEDesigns is a service and support provider for people living with disabilities. The nonprofit offers a variety of services such as job training, educational programming, permanent supportive housing and community engagement. LIFEDesigns currently serves about 200 clients in eight counties, including Monroe, across southern Indiana. This is a decrease from a non-pandemic year, but even with a smaller pool of clients, there’s still not enough staff to support them. The other counties are Bartholomew, Brown, Greene, Johnson, Lawrence, Morgan and Owen counties.
The clients of LIFEDesigns have a vast range of needs and degrees of independence. Many live on their own and have employment while others need 24/7 care. Each client has a direct support professional they can contact any time for support or services. A full-time, entry level DSP makes $13 to $14 an hour.
This staffing crisis affects both sides of the coin. Many clients have to adjust to a rotating cycle of staff members, most of whom are working an astronomical amount of hours with very few incentives and small compensation.
Pandemic spurs high turnover, long hours
Even before the pandemic, LIFEDesigns had trouble staying fully staffed, according to Chief Executive Officer Russell J. Bonanno. But that was changing for the better in mid-2019, when LIFEDesigns decided to deliver a 25% raise across the board in multiple departments, from entry level positions to supervising roles.
“Right before COVID, we were at our highest headcount that we had had in several years,” Bonanno said.
According to recruitment specialist Hailey Clark, the average headcount was 220 to 230 before COVID-19. Now, it’s between 160 to 180 staff members.
At the beginning of the pandemic, several staff members left due to personal concerns for their health. With a diminishing staff, LIFEDesigns had to be creative to adjust its operations in the face of the international health crisis.
COVID increased expenses — such as salaries and the cost of personal protection equipment — while decreasing others, chief financial officer Lori Schopmeyer said.
Many facility-based day programs were suspended in conjunction with businesses and restaurants around town shutting down. This meant LIFEDesigns needed to increase staff during the usual day program hours. But because staff were unable to take their clients out into the community to eat, watch a movie or play sports, clients had to mostly stay at home during the pandemic. To replace outside stimulus, LIFEDesigns invested more time in technology programming to entertain clients.
“So one of the things that has a number of people — it’s very common with autism but it’s common with a lot of disabilities — is they’re rule-bound or schedule-bound or routine-bound,” Bonanno said. “(Because of the pandemic), we totally destroyed their routine and had to try to create a new schedule. But with that new schedule, we had staff that kept changing.”
As the pandemic continued, leading to more staff resignations, LIFEDesigns started prioritizing client needs and assigning staff in that way, which meant that some clients — those who were more independent — didn’t receive attention that they should have.
Justin Brown is a client at LIFEDesigns. He lives in his own apartment and has been an employee of Best Buy for about 11 years.
He has a job training coach at LIFEDesigns, and he said he used to have a staff member named Timothy. Brown misses him a lot.
“When somebody moves on, it’s devastating,” Director of Community Relations Kristen King said. “You can imagine the staffing crisis and the retention problems that we have in the field, how devastating it is to our clients.”
As a more independent client, Brown hasn’t been able to receive as many services on-call as he would like or normally use. Though he is very independent, he still leans on LIFEDesigns services to support him at home, at his job and in the community.
“It’s very hard, very hard for me because it’s emotional. I get emotional very easily sometimes because it’s hard and I try like this high,” Brown said, raising his hand above his head. “As hard as I can, but it’s just very difficult.”
Unlike Brown, many clients require round-the-clock care. The idea of reducing service hours for them is unfathomable, according to King.
“Legally, this person cannot be out of eyesight for 24/7. What are you going to do when you don’t have staff? You still staff them,” King said. “So then you have people working amazing amounts of hours, making pretty good money, but at what cost?”
Many environments, such as LIFEDesigns’ group home setting, had to go to the minimum amount of staff required.
As staff numbers waned, working hours increased. Discretionary time off was canceled. Many LIFEDesigns employees are working between 80 and 100 hours per week. In a currently described “all hands on deck situation,” even LIFEDesigns office workers, unless they have a medical exemption, have been trained to be DSPs to work directly with clients.
“Pretty much everybody in the office has pulled some (DSP) shifts.” Bonanno said.
The long hours are compounded by the nature of the work. Many clients have had a difficult time adjusting to the massive change that COVID-19 caused.
“Even a different staff person is a disruption and nobody responds well to change but a lot of our clients respond poorly to change, so that’s created more issues, more behavioral issues,” Bonanno said. “We went an entire year with virtually no workers comp cases until COVID. And now because we have more behavioral issues, we have more comp issues with staff getting injured in the process of doing their work.”
Burnout has become commonplace. Turnover at LIFEDesigns is around 73%.
Limited state funding for clients
For revenue, LIFEDesigns relies on funding through the reimbursement rate from the state in Medicaid and the Family and Social Services Administration, which can fluctuate depending on the state’s biennial budget.
Because the reimbursement rate from the state is not enough to meet the needs of clients or compensate staff, LIFEDesigns also hosts fundraisers and accepts donations.
“We have no control over our revenue. We make what the state allows us to make. The state decides what we get paid. They set the reimbursement rate they are going to pay. For group homes, they decide way after the fact,” Bonanno said. “You will hear from group homes the reimbursement rate is based on what it actually costs to provide the service. However, you get that (money) two to three years after you’ve spent it. So we’re spending more money now than the state is reimbursing us for. In two years, they’ll increase that rate based on what we spent. Now, we’ve got to make it through those two years.”
Many grant opportunities for those with disabilities are directed toward children. That puts LIFEDesigns, which primarily cares for older adults, at a disadvantage.
“If you look at developmental disabilities at all, you’ll hear people talk about ‘the cliff.’ Children fall off this cliff, depending on what state, the day they turn 21 or 22 or graduate from school. They’re no longer children. They lose access to lots of supports,” Bonanno said. “We’re dealing with all those people who fell off the cliff.”
Many clients also deal with invisibility in their own community.
“The issue is people will pay attention to visible disabilities. Look at all the sidewalks that have been redone, to make them wider and get the right curb cuts, sensory curb strips because those are all visible disabilities,” Bonanno said. “If you have an invisible disability, it is just that — invisible.”
Without grant support and due to this reimbursement model, LIFEDesigns is not able to increase wages right now. To supplement, LIFEDesigns has added as many incentives as it can, such as multiple bonuses for birthdays or anniversaries and employee recognition for longevity.
But other local businesses are also hiring during this labor shortage — many with better pay and shorter hours.
“You look at what we pay — in spite of the fact that until the latest increase from the state, we were one of the highest paid agencies in the state — you can make as much money going to McDonald’s and flip burgers,” Bonanno said. “So why not flip burgers for eight hours as opposed to possibly get COVID, have to help people shower, clean up, maybe be scratched or hit? It’s very hard to get people to do that for that money.”
Hiring obstacles persist
From September 2018 to March 2020, LIFEDesigns hired an average of 13 employees per month. From March 2020 to October 2021, an average of seven employees were hired per month. That’s nearly a 50% decrease.
Even one of the first steps of the hiring process has worsened, as many of those who do apply for a job don’t show up for an interview.
“Before COVID, we were seeing roughly four to five no call, no shows to interviews in a month-long period. Now, within the last month, we have had 21 no call, no shows to interviews scheduled,” Clark said.
The people who do go through with an interview are not guaranteed a position. Each candidate is heavily screened by LIFEDesigns.
“It’s definitely a challenge because we’re not in the agency to just fill spots. We don’t want just warm bodies. We want someone that actually cares for our clients,” said Eduardo Barrueta, recruitment intern and direct service staff member.
Hiring is a challenge, but it is not impossible. LIFEDesigns’ presence on social media has attracted many millennials and members of Gen Z.
“I noticed that in the recruiting process, some people don’t realize what good we do, and if you just push those factors like ‘Oh, you could be making a difference'” it makes the job more attractive, Barrueta said.
In addition to working in recruitment, Barrueta is also a DSP to three clients.
“They’re all my best friends. Like, I don’t consider it working. I’m hanging out with some really, really cool individuals. It’s just like trying to get people to feel how you are feeling,” Barrueta said. “We’re in a time where people want to change their career choice and they want to be doing something that means something rather than working for a paycheck. Yes, a paycheck is very important. But if you can do both at the same time, that’s how you make a fulfilling life.”
Community support needed
King said she wanted to bring more awareness to how the staffing crisis affects nonprofits and service providers that rely on support from the government and the local community.
“We can’t just pay more. We can’t just shut down. We can’t do all these things. So what is the community willing to do to help support us? That’s all I’m asking,” King said.
That help can look different for different people, according to King.
“What I’m not accepting is people not willing to try to learn to understand what we do and why it’s important,” King said.
Amidst a high turnover rate and long hours, The Herald-Times asked King, Barrueta and Bonanno why they have stayed.
The overwhelming answer? They see the big difference that they make in their clients’ lives.
“It’s a journey, an uphill battle, but we’re working through it,” Barrueta said.
Contact Rachel Smith at [email protected] or @RachelSmithNews on Twitter.