Responses:
- Crystal (me) = 19 CAP employees over 10 years
- JC. = 2 CAP employees over 7 years
- PF. (child 1) = 6 CAP employees in less than 3 years
- PF. (child 2) = 6 CAP employees in less than 3 years
- CT. = 23 CAP employees over 8 years
- LB. = 3 CAP employees over 3 years
- BF. = an estimated 50 CAP employees over 7 years
- TH. = 5 CAP employees over 7 years
- SG. = 9 CAP employees over 5 years
- LW. = 6 or 7 CAP employees over 2 years
- AC. = approximately 15 CAP employees over 5 years
- RB. = 3 CAP employees in 3 years
- KF. (child 1) = 9 CAP employees in 7 years
- KF (child 2) = 12 CAP employees in 6 years
Can you guess the lucky exception?
Care to speculate the reasons behind such extreme turnover rates?
The implementation of the new 1915(b)(c) Medicaid / Innovations Waivers and
the service cuts it brings, will steepen and compound the
improbabilities of finding and retaining reliable, trustworthy and
professional direct-care staff to aid in the care, supports and
life-skill goals of our children.
While
for most families, the bulk of service hours allotted will remain in
the same ballpark, many others will have their hours cut due to a
maximum ceiling, irrespective of individual level of need. Of the total
service hours for an individual recipient, much of those hours will be
shifted from the higher paying Home and Community Supports (HCS) rate
to the much lower Personal Care Services (PCS) rate, essentially
resulting in a very substantial pay cut (in some cases, nearly half a
worker's salary) for direct-care staff who already make less than
peanuts for the important and vital work that they do - and with no
benefits.
In the last 10 years, I can recall no less than 19 CAP Workers / care providers to whom I have entrusted my helpless little girl; I cannot even remember all their names as the turn-over rates for these positions is quite high. (In special parent circles, a CAP Worker who sticks around past one year is Gold.) Consider the emotional and developmental damage that such constant inconsistency creates in the daily life of a child with special needs; learning a new person, loving a new person, and losing that person – over and over again (never mind what it does to the parent). And while there have been some wonderful trustworthy care providers in our life, I wish that were the only issue... During this parade of CAP Workers, practical strangers in my home and personal space, I have experienced: the physical abuse of my child when an employee pinched my 3 ½ year old numerous times leaving dark purple and green bruises on her tiny body, thousands of dollars worth of property stolen from my home, and a week’s worth of groceries devoured that I could not afford to replace; I had an employee who took my daughter on a date with her ex-husband she’d previously had a DVPO against who was unaware she was living with a new guy; I once had two employees who became friends and later found that they spend quite a bit of time hanging out together in bars smoking and drinking with my child in their care; one girl who was fired for drug abuse; and last but not least, yet another who filed a DSS complaint against me for “abuse and neglect” in retaliation for being terminated – an incident that wasted the time and resources of 5 separate agencies, including the Morrisville Police Department, Cedar Fork Elementary School, Wake County Human Services, and the Department of Social Services. And that’s just the stuff I know about; anything else that has happened throughout the years, my daughter is unable to tell me.
During the last Bush Administration, the federal Medicaid reimbursement rate was cut by eight dollars ($8.00) per hour, a significant amount when one considers the cost of overhead and employee salaries. Today, the average CAP Worker makes between nine to twelve dollars ($9.00-12.00) per hour when performing “Home and Community Supports” (HCS) services (this is the minimal time designated for working on pages and pages of specific life-skill goals and continuation of therapies, not unlike an IEP) and minimum wage to eight dollars ($7.15-8.00) per hour for “Personal Care Supports” (PCS) services (the bulk of allotted hours which includes bathing, grooming, toileting, etc.) and “Respite” (time built in for unscheduled relief). Comparatively, a Certified Nurse Aide 1 working in a long-term care environment in Wake County makes roughly $13.03 hourly, while a Wake County Teacher Assistant in Special Education averages $10.27 per hour and a Wake County Public Schools Custodian, $12.80 per hour, not including benefits or shift differential. For the record, the average Garbage Collector in the State of North Carolina is paid an average hourly rate of $11.75. A CAP Worker receives only their hourly wages with no benefits whatsoever when working consistently less than 30 hours weekly, not even mileage reimbursement to offset the cost of driving their clients around in their personal vehicles attending community activities as dictated by their care plan.
Suffice it to say that the vast majority of families not utilizing the maximum amount of service hours allotted are not choosing not to do so because the need is not present. Quite the contrary, there is a critical need that cannot be staffed with competent, quality, reliable, professional care providers dedicated to a profession that includes a daily routine of cleaning feces, urine, and vomit; preparing special foods and feeding; heavy lifting; changing G-tubes and catheters and diapers; administering medications; bathing and dressing; utilizing sign language and specialized communication devices; and completing endless amounts of paperwork tailored to a non-applicable medical model to justify their existence all while being subjected to nerve-racking and often abusive behaviors such as hitting and biting, because frankly, people can make a better salary emptying garbage cans than caring for an innocent human being unable to do for themselves.
* If you would care to share your stats regarding years your loved one has received CAP direct-care services and the number of CAP workers that have been employed in your home to care for your child, likewise any related stories regarding difficulties in direct-care coverage, experiences, etc. please feel free to respond to this blog post, post in our Facebook group or contact me privately via no2nchb916@gmail.com.
