Friday, April 19, 2024 Apr 19, 2024
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Battling Texas’ Community Care Crisis

Texans with disabilities are struggling to hire attendants to help them remain independent. The state set the minimum wage for these positions at $8.11.
Courtesy: iStock

Laurie Truesdell’s first community attendant quit after two days on the job, leaving her stranded at work without a ride. She had to call her parents to pick her up from work. Truesdell, who uses a wheelchair to get around, was fortunate that she wasn’t left at home alone or in a more precarious place. For decades she has struggled to find someone to provide the care she needs to be a productive citizen. “I can’t get my day started until someone helps me out of bed,” she says.

Truesdell isn’t alone. Lawyer Sean Pevsner says it has always been challenging to find an attendant and has had 80 different attendants in his life. Individuals with permanent disabilities and chronic conditions do not get reliable care in Texas, putting hundreds of thousands of Texans who need in-home attendants at risk.

There are around 300,000 Texans who are in the community care program through Medicaid. Most of these individuals are relatively functional and can live in a home in the community with some help. Because of physical or mental limitations, these individuals need help with medication administration, laundry, food preparation, getting into a wheelchair, and other personal tasks. Community attendants are a cost-effective way to care for these individuals and allow them to stay in their homes.

In Texas, the legislature set the minimum wage for these attendants at $8.11 with no benefits. While many of these caregivers work for organizations contracted by the state, the state’s minimum wage for community care attendants is the minimum they can be paid. Often, managed care organizations don’t pay much more than the minimum. In the last 13 years, the state has raised the minimum wage for community care attendants just 86 cents. “Many call Medicaid community attendants the worst-compensated workers in our state,” says Dennis Borel, executive director for the Coalition of Texans with Disabilities. “Compare that with alternative employment like fast food, retail, and light warehouse, which pays more than double, often with benefits, and compete for the same worker pool.”

D CEO Healthcare spoke with numerous Texans with disabilities and organizations that serve the community, and almost all spoke about the difficulty of attracting and retaining an attendant. Borel says that the annual turnover for these positions is about 150 percent. Each year, the state allocates funding for the number of hours that Medicaid estimates will be needed for the entire state. Borel says that while there are funds for additional hours, a large portion is never fulfilled or paid for because no one wants the job for those wages. We requested the data behind the number of hours allocated and filled by community attendants from the state via a Freedom of Information request but were told by the state that the data wouldn’t be available until June.

Frequently, Texans with disabilities are forced to take to social media or GoFundMe accounts to raise money to pay an attendant a wage reflective of the work, says Julie Espinoza, a skills coordinator at REACH, which helps individuals with disabilities live more independently. “They have programs out there that will pay for someone to come into the home, but they’re on a waiting list because there isn’t anyone available, which is shocking. It’s often a different attendant every time you open the door,” she says. “That’s uncomfortable for the person with the disability and the attendant because everybody wants something a little different.”

Raising the wage for the community attendants and making the position more attractive has obvious health and safety benefits for those with disabilities, but is also cost-effective. It is more expensive to institutionalize an individual with disabilities who live in a home in the community with an attendant. According to the National Council on Disability, a 2010 report found that the average cost of care in large state institutions ranged from a low of $104,025 per year in Arkansas to a high of $375,000 in Tennessee. Bumping up the hourly wage for attendants would be a fraction of those costs. A caregiver in the home also prevents accidents that result in expensive hospital visits, often paid for by Texas taxpayers.

“You can’t fill all of those hours,” says Truesdell, a social worker who advocates for those with disabilities. “It is so hard to find the right fit and find someone willing to do that many duties for so little pay.”

Many with disabilities cannot work or be productive members of society without community attendants. So instead of individuals making money and contributing to the state’s coffers, they are draining them with expensive healthcare that a community care attendant could have prevented. “I have civil rights to live in a home instead of an institution,” Pevsner says. “I have a right to work and be in the community.”

Oil and gas revenues have given the state a $27 billion windfall for Texas lawmakers to spend in the 2023 legislative session. Advocates for those with disabilities who wish to live in the community want some funds to be used to increase the minimum wage for attendants to improve the likelihood of finding a caregiver rather than flooding institutions with money.

“The indisputable truth in Texas is that the dignity and independence of a person with a disability are valued less than a cheeseburger—and it’s not even close,” Borel says. “The Legislature is convening now in Austin with unprecedented financial resources. 2023 is the year for legislators to step up to recover this critical workforce and plan for a future mechanism to guarantee that the worth of a human is more than a cheeseburger.”


Will Maddox

Will Maddox

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Will is the senior writer for D CEO magazine and the editor of D CEO Healthcare. He's written about healthcare…

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