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1 | Question 1 - What challenges have you seen regarding the staffing shortage? For the people you support, personal outcomes and direct support professionals | Question 2 - What creative or surprising positive outcomes have you seen for people during the staffing shortage? | Question 3 - What creative strategies have you been trying to support people to have what is important to them present? | |||||||||||||||||||||||
2 | What I've seen is the need to cover the work load and how to cover the extra work load. | The increase in hybrid model working-if you are not a DSP. | My work role is not DSP, but one of my thoughts surrounds how to support DSP's with work culture. | |||||||||||||||||||||||
3 | Group homes so short staffed they are forced to close, a family is paying a former (let go) employee cash to care for their loved one because there is no one else to do it, lots and lots of waiting lists. | Family help | Family help | |||||||||||||||||||||||
4 | Balance: what did we learn from COVID and how we can implement for the current challenges: staffing/benefits, balance with work/self-care, attentiveness for staff growth, learning and dignity and compensation. | people that should have been working competitively but chose day programs now have jobs since the day programs are closed. more individualized training options now via zoom than was available before. more joy and appreciation when people do get out, get to see their families more, etc. Neighbors started bringing in treats, offering to volunteer, etc in neighborhoods with group homes since they know how difficult staffing is. activities being done in homes are way more outdoors based which is great for exercise and fresh air! (chalk on driveway, zoos, hiking, movies on driveway, backyard picnics). not a direct link to creative support for indivdiuals but this crisis has caused county commissioners to run a workgroup focused on legislative advocacy which is a first for our county board (reps include self advocates, service providers, schools, state agencies, families, etc) . | Using more technology to help people stay connected. Sometimes people are reluctant to try something in person, but may feel more comfortable trying something, sharing, or being involved virtually. Matching individuals who need support with providers who have similar things that are important to them (cultural, religious, etc). Keep asking DSPs what they are learning (like who are the person's friends?) | |||||||||||||||||||||||
5 | lack of staff for activities, fun things, creativeness; bathroom breaks have to be during shift changes (staff and people supported); lack of employment opportunities for people supported post covid; people who are willing to pick up the open shifts are burning out; no one available to do testing to start services, then when get on waiver there is no one available to do services; requests for assessments are higher with less funding; no PCA's for home care causing people to have to go into the nursing home prematurely; homes are being closed | Neighbors stepping up to help Families stepping up / utilizing CDCS more Genogram and echomapping to help identify and build up natural supports When paid staff leave, they still spend time with as an informal provider. Reaching out to agencies to see if there are any volunteers. Has had some success with the church. Assistive technology | This is what our group discussed: Ensure staff retention by showing you value them as a staff and offering flexibility, creating a culture of engagement and recognition, having employee appreciation parties, etc. On the other end: this is costly and may not be feasible forever but it has become the expectation of employees. Trying to be creative and encourage them to identify their passion for caring for others by doing things like team building | |||||||||||||||||||||||
6 | Long wait times for PCA assessments, little options to hire a PCA. Long wait lists for a DA or pscyh eval to get CMHCM or DD services needed. Frustrating for families to get services slowly. | People have tapped into technology more (video appointments, connecting with others, playing games, phones etc). Sometimes people engage more in virtual meetings or groups than in-person meetings. People not just learning new technology skills, but also teaching others (example: snapchat). Art program closed, so individual connected with others on TikTok and does videos with friends she met there. DHS is being more creative with ideas- LifeSharing, matching people, Integrated Community Support service. Notice that others in the community are supporting individuals; makes us wonder if it is happening more than we might think. | People are more cut to the chase about what is really important to the person; friend who needed a place to live is renting space in the house of two older adults and offers some support and engagement (intergenerational supports); Natural supports happen in a small community (neighbors who support each other); looking into free and new things for people to do and sends out a calendar of activities and offers transportation in a 6 person van; | |||||||||||||||||||||||
7 | People are not getting the training they need or require because the need to be working directly with the people we support. Provider cannot free people up for 2 full days because they need staff in the home There is a general sadness in the homes, people living there or people receiving services. So much turnover people never build relationships. Everything is a crisis People thrown in positions that they are not trained for are burning out and then leaving and then people left behind are picking up pieces and burning out. Low wages for such important to work but I can go work at a warehouse, make more and not have the same responsibilities and emotional attachment The need for bilingual staff, language barriers get in the way. Some of the training requirements get in the way. It takes twice the amount of time to get training complete because we need interpreters. Barriers to training people that need interpreters and the education or navigating the system if English is not your primary language. So much of language is lost in interpretation. There is no way to be sure that the language is understood. Young people that may to cook, much processed food because it is quick and easy. People cannot get out | There is a greater appreciation for staff support people; the relationships between roommates have become closer; people have learned to think outside the box and not do things the way they always have; families have become more involved; better connections due to virtual options (i.e. family that live out of state); a home closed down, and one of the staff opened his home to support a couple of the people that lived at the home that closed and this continued friendships etc; people have had opportunity to take more risks such as using public transit; We have had to combine outings so new interests have developed with individuals who previously would not have attended the outing; there is an interdependence between people and we support each other (natural support); collaboration with other providers, orgs and people to develop creative ideas to provide services; local day providers closed which encouraged people to find competitive employment...helped show people they were ready; we don't always need a middle person in supporting people; | People are more cut to the chase about what is really important to the person; friend who needed a place to live is renting space in the house of two older adults and offers some support and engagement (intergenerational supports); Natural supports happen in a small community (neighbors who support each other); looking into free and new things for people to do and sends out a calendar of activities and offers transportation in a 6 person van; | |||||||||||||||||||||||
8 | Quality of Care in long term care declines; the ability to form rapport due to constant turn over; people are having to be put in a facility rather than being able to stay home due to no staff; HR are also suffering from constant failure of being able to keep staff; people not being able to work; DSP's are overworked and underpaid leading to turnover; competitive nature of providers to keep staff; Providers do not want to complain or make waves in fear of staff leaving which allows bad behavior to happen sometimes or keeps employees longer than they should; other industries offering high wages and great benefits...hard for providers to compete; shifting from organization to organization; we will not solve problem by raising wages, or better recruitment...need to think outside the box; need to think about natural supports and friendship/relationship building to develop supports that we do not need to pay | Church connections teaching her skill and technology to help her to empower a person. Natural supports from friend & family. Self-directed services increase. Shifting for day services to do more in the community. Relationship building discussions - some repaired relationships. Finding other options for living arrangements. Working from home gives staff more autonomy. We talked about more people being able and willing to "pivot" and take on new roles/responsibilities. More family involvement and more compassion/empathy as some of the positive outcomes. technology allows more interactions with extended family that can help build relationships without the family feeling responsible for the whole person. | 1. Video calls and zoom meetings to be connected to other people important to them 2. Personally creating more opportunities to take a friend with disabilities out and spend time together to help him have a fuller life and not rely on paid staff or family 3. Take people to families for a drive by or short socially distance visit to help people who are missing their family. 4. Lots of drives to see sites, get treats or see different environments. 5. Technology to get paperwork signed in an efficient process 6.Being intentional to keep what is important to a person, so that those things still can happen. 7. Creative gatherings like movie nights in the community center so people can be with other people in a larger group despite the limited staffing. 8. Person who lost a primary PCA and could not replace her began attending a day program 2 days a week to be around other people and is loving it! | |||||||||||||||||||||||
9 | Having limited services (not being able to provide all contracted services), providers that used to be really good are not anymore, people needing to go to nursing homes because there is not enough skilled nursing, good staff are stretched too thin, which impacts their quality of work. The staffing shortage can lead to neglect and maltreatment reports. Facilities closing and displacing people. Used to be idea of "take care of self" so you can take care of others, but that is gone because staff don't have time to take care of themselves. Staff can feel like a "zombie" or "numb" or "drained." Waitlists can be 3-4 years long. People also have the stress/balance of providing services in a career and also taking care of family members who need services, but there are not providers. Especially hard in rural areas. Guilt can become instilled in case managers because they can't find providers/staffing and feel like they are failing families. Families/providers may think that case managers are not doing their jobs. | Group 15: use of technology, pay changes/increases, hiring younger staff, variance for med passing for staff under 18, greater relationship between staff/employers/people supported, bonding as service community, gaps in schedules which in turn lead to individuals feeling more independent | We have a Thankful Wednesday where you can recognize a coworker for what they are doing and that information is shared throughout the agency with kudos. | |||||||||||||||||||||||
10 | Group 10-hard to hire our own staff and hard to find staff for people we support, counties seeing various agencies having staffing issues so hard to find services- which makes it hard to keep people in their homes and safe; impact at direct care so hard for people to get out and connect with their communities; lots of turnover so knowledge is lost; employers willing to give more people a chance to work because they need somebody; MNchoices complete and determine services but no staff to get the services; can get PCA if have family/friends but if need staff there is months waiting list- feels defeating; half number of MNchoices assessors- lack of our own staff; people feeling isolated and not asking for help; impacts of covid are extensive and things are much more delayed; need 1:1 supports to get a competitive integrated employment and leave enclave work; homes closing and people have to leave those homes- things they used to do are just not there anymore; staff in homes are working exceptionally long hours; | Staff stepping up to the challenge to support people and make sure they have social connections. Families supporting other people who maybe do not have family (nursing homes), Technology being used creatively to support people to have more independence when it is desired but have access to people if when needed, Changes in technology to support remote work (in the past was put off but the pandemic forced it forward), Being able to work remote helps staff as well, People support were able to connect more through technology due ability to purchase technology with covid checks - this has led to more connection with people in many ways, Robot pilot to help support staffing crisis, Creativity with things to do during the time the state was shut down, | Getting more family involvement for those who want more community access, churches stepping up to support people for basic needs - shopping etc., small local grocery stores offering new delivery services, Zoom being used as a way to connect people through activities - this has continued even now, branching out to use community resources like the fire dept in different ways (parades), Shift in family connections even when far away - watching shows together, or connecting more often - especially in rural MN, Pets more often - a shift in facilities allowing pets, Educational possibilities shifting online - increased educational opportunities, | |||||||||||||||||||||||
11 | People entering onto a waiver, but having no services to offer them because there is no staff available. | Our group talked about many of the same things that have been already been mentioned. One additional things we talked about is a program in Duluth is piloting a Robot program that can help relieve some of the staff stress | ||||||||||||||||||||||||
12 | No options for people for any waivered services, people stuck at home, DSP's being able to work only one job for one company due to higher wages and OT availability making that more possible. Paying stipends and overtime to salaried employees to incentivize them to stay when DSP's are often making more than management due to OT. | Children are transitioning sooner to academic from fulltime therapy or day treatment services Family members are becoming more involved Being okay with asking family members to be more involved. Parent/relatives and friends making time that they haven’t in the past Have started fully remote advocacy groups and connecting one another (virtual groups) We have a lot more people using technology have haven't in the past We have learned creative ways to work around challenges Staff members who are committed to helping have stepped up Staff picking up extra hours Home care providers have stepped up and developed new creative ways to change roles and responsibilities. If/when a house is short staffed, been able to cross train staff to be able to walk in to any house to work but has also brought everyone together– a lot more social activities are happening among houses which may allow for residents to form new connections and relationships. Family members recognize the importance of need during shortage and applied as temporary hires to help out at other homes | Ensure staff retention by showing you value them as a staff and offering flexibility, creating a culture of engagement and recognition, having employee appreciation parties, etc. On the other end: this is costly and may not be feasible forever but it has become the expectation of employers by employees. Trying to be creative and encourage them to identify their passion for caring for others by doing things like team building | |||||||||||||||||||||||
13 | Question 1 - What challenges have you seen regarding the staffing shortage? For the people you support, personal outcomes and direct support professionals EIDBI can't support the kids they are trying to support. Families have had to move their kids back to school settings even though they meet criteria for 40 hours of service. Individuals who need personal assistance are finding it really hard to find anyone, the price is high and the "quality of the service provided" is low. Other families are saying the same. Even the folks who have in the past been able to find staff and create great supports are having a really hard time or staff want to work the 10pm to 6am shift. And very hard still for qualified individuals with disabilities to be seriously considered or selected for a position, even with the staffing shortage. Ombudsman office receiving phone calls from individuals who have been in dire situations such as in bed for many days when there is no staff or staff don't come. Heartbreaking. | 1. Technology can work for people that we maybe did not think could before, leveled the participation for those using assisted communication devices 2. Paid parent of minors and paid spouses during the pandemic 3. Upper management in agencies have been more flexible to do things differently and allowing more staff flexibility of where and when they work 4. Residential staff seeking to meet people's needs in new ways and doing more 1:1 with people in the community 5. Technology has allowed for more contact with family and extended family members, and sometimes that feels safer for family members to be involved 6. Families have taken on more responsibility for their loved one in residential facilities 7. People are liking shopping on line, and now they like shopping on line and are less willing to go out to shop. 8. People are leaning on technology to access a support person who is not able to be there in person and still feel safe and supported 9. Using artificial intelligence (ie. Alexa or Siri) gives more independence 10. Telehealth access and others don't have to be with the person. More access to providers not in the same geographic areas | ||||||||||||||||||||||||
14 | 1. Group homes inability to get out in the community as much as they want or have in the past. 2. MnCHOICES assessor - advocate for PCA Choice and people don't have staff. 3. MnCHOICES assessments take months to get after request because of lead agency staff shortages. People are frustrated because they need help and that brings staff morale down as well as there are no solutions. County boards are limiting new hires due to budgets. 4. Families are picking up the care and are tired 5. People are ready to move out to their own homes, but there is no PCA staff available to support them after the move, so they are stuck. 6. County's contracting with agencies to help with their capacity issues, but are also having staffing issues. So until we are a society that values these services and supports and the people who provide them, we won't be able creatively solve for these issues. 7. PCA provider shortages creates a bottleneck all the way through the system. Any adjustments we can make within the system just creates more bottlenecks elsewhere. So we need a much broader social and legislative shift to get to a real solution. | Neighbors stepping up to help Families stepping up / utilizing CDCS more Genogram and echomapping to help identify and build up natural supports When paid staff leave, they still spend time with as an informal provider. Reaching out to agencies to see if there are any volunteers. Has had some success with the church. Assistive technology | ||||||||||||||||||||||||
15 | -Significant changes with schedules (ABA)- putting people receiving support on rotations- can't provide full time resources-impacts progress and skills; Staff are working very hard- can't take PTO because may have to cancel a session, can't take care of self, guilt. -The work ethic- quality of support - impacted by the quality of staff. -Staff feel that they can "do what they want" because we need them. -Passionate staff working to the point of burnout -Limited time and resources for training -Impacts activities, skills, levels of independence -Ability to earn the same amount of money for a less stressful job/easier job -Having 2 or 3 jobs just to make it -Recruit able wage for higher quality applicants -Being rural is very difficult -How do we have positive support for staff who can't even cover their own health care | |||||||||||||||||||||||||
16 | Challenges – Going without choices of services and overall lack of supports. Not finding homemaking and PCA services willing to go into the home A lot of sitting idle so individuals are home sitting around more. Those still supporting individuals are exhausted and burnt out so they may not be as creative. Lack of transportation to appointments or shopping, etc. Seeing a more stressful homelife and causing mental health issues for individuals. Higher caseloads Breaking down trust because they are having negative experiences. Individuals may not have as much consistency when starting supports and this may take longer because they need to rebuild trust and rapport. People aren’t getting the training they need. It seems as though there is a general sadness. So much turnover that there aren’t relationships being built. Everything ends up being a crisis. Personal outcomes: Some individuals aren’t wanting to leave as often since COVID. Routines have changed. | |||||||||||||||||||||||||
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