I have spent my lifetime around people with intellectual disabilities.
My uncle was born in 1917 in Arkansas. At 9 months of age, he developed a fever, the cause of which was never diagnosed. The fever left him with a significant intellectual disability. There were no services for people with intellectual disabilities in 1917. So, my grandmother became his direct support provider. They were together every day of their lives for 62 years. If my grandmother was sick and in the hospital, my uncle was in the bed next to her. If my uncle was sick and in the hospital, my grandmother was in the bed next to him. My grandmother passed away in 1979. My uncle passed away three months later because the only caregiver he had ever known was no longer in his life. This is the dramatic impact these dedicated caregivers have on the lives of the people they care for.
The Association of Developmental Disabilities Community Providers (ADDCP) is a statewide membership organization. ADDCP supports members from Carlsbad to Farmington and Las Cruces to Taos. All of these agencies provide some form of services and supports to citizens of New Mexico with intellectual and developmental disabilities. Our mission statement is “To promote and advocate for quality, community-based services for children and adults with intellectual and developmental disabilities in New Mexico.” The central component of that statement is the direct support workforce that provides those services.
In her “The Executive’s Desk” commentary Nov. 1 in the Business Outlook of the Albuquerque Journal, Adrienne Smith, president and CEO of the New Mexico Caregivers Coalition, correctly outlines the current plight of the direct caregiver workforce. ADDCP member agencies report not being able to fill vacant direct support positions in their agencies. The COVID pandemic exacerbated the situation. But, nonetheless, we have a crisis in finding capable, competent workers.
The job of a direct support professional in today’s market is quite sophisticated. The training requirements are well-defined and rigorous. Regardless of the innumerable reasons for not choosing this field of employment, there is also a need to understand the intricacies of funding these extremely important services.
Developmental disability services are reimbursed on a fee-for-service basis. The reimbursement rate for services is based on cost studies typically contracted by the New Mexico Department of Health. The latest cost study was conducted in fiscal 2018 and finalized in fiscal 2019. It was partially based on fiscal 2017 cost reports provided by ADDCP member agencies and other providers. This cost study only fully funded 19 of the 34 individual service rates. The remaining 15 rates will hopefully be funded beginning July 1, 2022. The funding for those rate reimbursements is included in the Department of Health budget request for fiscal 2023.
ADDCP supports raising the wages of direct support professionals, as well as all other people working in this field. Providers cannot increase wages when the reimbursement rate for services being provided is three to four years behind the cost of providing those services. There is a projected allocation of 4,100 people into services in the next two years. This will potentially eliminate the waiting list for services (Albuquerque Journal editorial Nov. 2).
Without significant funding appropriations to the Department of Health, there will not be service providers to serve these new allocations or continue to serve the current service recipients. Sixteen service providers have stopped providing various services since fiscal 2021. A solution to this crisis will not be easy. It will be costly. With the projection New Mexico will need to fill 75,000 new positions in home health and direct care by 2026, the question to answer in relation to this crisis is, “If not now, when” do we begin to care about our direct support caregivers?
Jim Copeland has spent his lifetime in professional, personal and family services to people with intellectual disabilities. His brother-in-law passed away in 2008 in the care of the Developmental Disabilities Waiver in New Mexico.