New report shows Idaho’s shortage of direct care workers is worse than national average

A new report released to the Idaho Legislature on Thursday by the Office of Performance Evaluations found the state needs at least 3,000 more direct care workers to serve older and disabled Idahoans who rely on those professionals to remain in their homes.

The report found Idaho’s direct care workforce shortage is worse than the national average because pay is capped by Medicaid rates, which are set by the state. Evaluators from the Office of Performance Evaluations presented the report to the Joint Legislative Oversight Council during a public meeting at the Idaho State Capitol on Thursday.

According to the report, 76% of the more than 900 direct care workers surveyed by the Office of Performance Evaluations said that higher pay would keep them from leaving their jobs.

“The most direct and meaningful thing that the state can do to ensure that we have a sustainable direct care workforce is to make sure that our Medicaid rates support competitive wages,” Amanda Bartlett, principal evaluator from the Office of Performance Evaluations, told legislators Thursday.

Workforce

by the numbers

Idaho has a direct care workforce of about 23,000 people who help seniors and Idahoans who are disabled with daily tasks such as eating and getting dressed, as well as transportation, nursing and counseling.

The new report found Idaho would need 3,000 additional direct care workers to get up to national staffing levels – but that number is expected to triple by 2032, when the report estimates 9,500 additional workers would be needed.

Private insurance and Medicare often only pay for direct care over the short term, according to the Office of Performance Evaluations. That means seniors and Idahaons with disabilities are relying on Medicaid to pay for the service. The state sets Medicaid payment rates, which the Office of Performance Evaluations said caps pay and leads to low pay. For instance, the report found that Idaho’s Medicaid rate supported an actual wage of $13.93 per hour for attendants and personal care, versus a targeted wage of $16.55.

Due to low pay, the report found direct care workers who leave the industry have the ability to get raises of 36% to 39%.

Workforce shortage leads to lower quality of services, hiring people with fewer qualifications

The report found the workforce shortage led to several problems, including lower quality of services, direct care businesses hiring applicants with fewer qualifications or retaining poor-performing workers and workers leaving the direct care field for higher pay in other industries.

Christine Pisani, executive director of the Idaho Council on Developmental Disabilities, told legislators Thursday that shortage of workers means some people who depend on that care have, in some cases, been stranded overnight unable to get out of bed, get a drink of water or use the bathroom.

Overall, the workforce shortages could lead to declining health, unmet medical needs, strains on families and more Idahoans having to leave their homes and enter more expensive institutional care settings.

The report found a “vicious cycle of high turnover,” where remaining workers take on additional responsibilities as people leave the profession, Office of Performance Evaluations Director Rakesh Mohan wrote in a letter to legislators included in the report.

But, the report offered legislators state officials a handful of suggestions for confronting the problem, including:

Setting more competitive wage targets by using similar and competitive occupations. Adjusting Medicaid rates more frequently to stay closer to targets. By rule, Medicaid rates are set every five years, although there is a possibility to update them more frequently if state officials determine it is necessary. Considering Medicaid rates specific to the different regions of the state.

At the end of Thursday’s meeting at the Idaho State Capitol, Idaho Department of Health and Welfare Director Dave Jeppesen said he agreed with the report’s findings and believes the Office of Performance Evaluations will improve the department.

“We agree there is a clear shortage of available direct care staff in the state,” Jeppesen told legislators. “We agree that we need more management bandwidth at Medicaid to administer the program correctly.”

Jeppesen told legislators he had the opportunity to job shadow employees last year and met several of the Idahoans who depend on direct care services.

“It means that those individuals can live in the most independent way possible as productive members of our community,” Jeppesen said.

Disability community anticipated new report for weeks

Thursday marked the first meeting of the Joint Legislative Oversight Committee this legislative session. Earlier this year, the Idaho House voted to eliminate the Joint Legislative Oversight Committee, but the bill does not have the support to pass the Senate, Senate President Pro Tem Chuck Winder, R-Boise, told reporters earlier this month.

Meanwhile, members of the Consortium for Idahoans with Disabilities had been writing letters since February asking legislators to allow the Joint Legislative Oversight Committee to meet so that the Office of Performance Evaluations could release the report on the direct care workforce.

The Office of Performance Evaluation’s report has been completed for weeks and physical copies available at the Idaho State Capitol were dated “February 2023” but the report could not be released until the Joint Legislative Oversight Committee met and voted to accept the report.

On Tuesday, the Idaho Legislature’s Legislative Council appointed members to the Joint Legislative Oversight Council, which paved the way for Thursday’s meeting and the report’s release.

Read the report

The Office of Performance Evaluation’s report, “Sustainability of Idaho’s Direct Care Workforce” is available online, along with a shorter page of highlights from the report.