Community-based IDD Care in Texas

Why community-based IDD direct care workers are important

What does a community- based IDD direct care worker (DCW) do?	Support people living in their own homes and in group homes, including assisting with daily, personal tasks (e.g., toileting, bathing), managing medications, cooking, and housekeeping. Due to resource constraints, there is often just one DCW on-site in a group home during a shift. Group homes serve 3-6 individuals.
Who do DCWs support?	DCWs provide services for individuals with intellectual and developmental disabilities (IDD). Many individuals have complex needs, including physical (e.g., paralysis, tube-fed, etc.), mental health, and behavior support needs.
Why is direct care work so important?	DCWs are not only entrusted with the lives and safety of the persons they serve, but they also support individuals with reaching goals. DCWs make it possible for persons with IDD to experience increased quality of life, opportunities to learn skills, and participate in their communities. Without enough DCWs, individuals with IDD and their families are struggling to find IDD providers with the capacity to serve additional residents.
How much money do DCWs make per hour?	The Texas Legislature set the base wage for DCWs at $10.60/hour. Community IDD providers are unable to retain and recruit workers, threatening the network capacity of IDD providers statewide to serve individuals with IDD and their families.

What happened in the 88th legislative session?

• Specific focus on community-based IDD services for people with intellectual disabilities was abandoned and an hourly wage adjustment for IDD direct care workers (DCWs) services was embedded in the larger appropriation for community attendants who support people with physical disabilities (Community Attendants). As a result, IDD direct care worker wages were adjusted to $10.60/hour, substantially short of the $15/hr. considered minimally necessary to recruit and retain DCWs in community IDD services.
• In comparison, significant and needed investments made in state employee workforce increased starting wages for DCWs working in State Supported Living Centers (SSLCs) from $17.71 to $24.75/hour.
  • The job duties of DCWs serving individuals with IDD in the community not only align with the duties of DCWs working in SSLCs, but include additional duties, such cooking, cleaning, and managing medications, that other state facility staff fulfill.
  • The large gap in starting hourly wages between state DCWs and community DCWs negatively impacts the ability of community IDD providers to recruit and retain qualified staff, further compounding the workforce crisis in community services.

What’s happening in community services right now?

• Quality of care is suffering, and providers are struggling to provide basic IDD services.
  • Residential settings are staffed at dangerously low levels, with staff vacancy rates remaining at unmanageable levels: 31% in ICF and 30% in HCS.
  • HCS and ICF DCW staff average 60 hours on-duty per week.
  • Impacts: Inexperienced, overtired staff are more likely to make mistakes and inadvertently fail to provide services according to the plans of care. Providers have been forced to temporarily close homes, sending individuals to other group homes or to stay with family members who are not equipped to provide this support.
• Shrinking capacity and access to services for individuals with IDD in their communities.
  • Providers across the state are closing group homes at an accelerating pace in 2023.
  • Providers that continue to operate are limiting the number of individuals with IDD they are serving and, in some cases, reducing services.
  • Historically, providers terminating IDD services could readily identify other providers willing to purchase their programs or step-in to operate and maintain services. This is no longer the case as the vast majority, if not all, providers are struggling to maintain current services. Very few, if any, providers are able to expand services and serve more people.
  • Impacts:
    • Individuals with IDD face traumatization and health and safety risks without a network of IDD services able to meet each individual’s unique needs.
    • The Texas Legislature allocated funding for approximately 1,400 individuals from the interest list to access HCS and TxHmL services. Without IDD services capacity in the community, these individuals who have waited more than 15 years for services will struggle to find a provider that can support their needs.
• Dwindling Safety Net providers
  • Community Centers providing community-based IDD services have historically served in a public safety net role.
    • Communities with no privately-owned IDD providers depend on Centers for IDD service.
    • Without the public safety net, individuals with IDD and their families will be forced to seek providers outside their community.
  • In the past several years, an accelerating number of Community Centers have terminated their IDD service contracts and more are considering contract terminations as of August 2023:
    • Of the seventeen (17) Centers currently providing ICF/IID services, seven (7) are considering contract termination.
    • Of the thirty (30) Centers currently providing HCS services, eleven (11) are considering contract termination.
    • Of the twenty-five (25) Centers currently providing Texas Home Living waiver services, nine (9) are considering contract termination.
• Flat Local IDD Authority funding also threatens IDD services
  • Rate issues also impact Local IDD Authorities, which provide Targeted Case Management (TCM) for individuals with IDD.
  • Cost reports show the cost of providing IDD TCM is almost twice the rate paid to conduct the service.
  • Local IDD Authorities conduct IDD TCM on behalf of the State of Texas.
• INSERT LOCAL IMPACT STATEMENTS
  • What is happening in your local service area?
    • Describe known closures, loss of service capacity in your service area
      • Residential services/group homes
      • Lack of ISS providers
    • Increased number of critical incidents
    • Increased interaction of group home residents with law enforcement ▪ Inability to find providers to serve new individuals
    • Impacts on individuals with IDD and their families
  • What is happening at your Center?
    • Describe the workforce challenges in the Local IDD Authority and/or IDD provider services
      • Turnover and vacancy rates
      • Overtime costs, reliance on administrative staff to complete duties
      • Paying higher wages than is reimbursed by the rate, inability to compete with other higher paying employers
    • Reducing IDD Services your Center is providing and/or number of individuals served
    • Ceasing IDD provider operations
    • Impacts on individuals with IDD and their families
• Actual capacity available in SSLCs
  • As of 6/30/23, the actual capacity available in SSLCs was 156 beds, short of the number of individuals with high medical and behavioral needs seeking access to IDD services.
  • From the time the application is accepted by HHSC, individuals and their families wait at least four (4) months to access the facility.
• Families are afraid because they cannot access the services needed for their loved ones in the community
  • SB 944 was intended to make it easier for families to get access to comprehensive services provided in SSLCs; however, capacity limitations in SSLCs may mean actual access to an SSLC will not be available and some individuals and/or their legal guardians prefer community services.

What are we asking state leaders to address?

• Emergency funding request to increase HCS and ICF/IID group home direct care worker average wages to $15/hour and retroactive to the start of the biennium (9/1/23) – $132.4M GR (Biennium total)
• Adding IDD DCW Wage to Special Session Call to address the IDD group home direct care worker wages
• Developing support for community DSWs in the 89th session (frame as, we’ve done it for state employees, the next legislature needs to invest in community services, too).