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Opinion | Direct care workers need better pay to help our most vulnerable

For years, those of us working in Michigan’s behavioral health sector have been warning of an imminent systemic collapse. Now, it’s reached our doorstep.

The cause? Our system only works when direct care workers are available to care for people in need of services. These individuals provide hands-on care and support for people with developmental disabilities and mental health challenges, helping with everything from training and counseling to daily bathing and food preparation.

todd culver and robert stein
Todd Culver is the President & CEO of Incompass Michigan. Robert Stein is general counsel for the Michigan Assisted Living Association.

Since Medicaid is the funding source for families and private providers, they can’t simply increase the pay of their DCWs. As a result, the pool of available DCWs is dwindling, due to poor compensation and benefits. This leaves many Michigan families in a state of crisis as they try to ensure their loved ones are safe and well cared for.

The hard truth is that inflation is pushing the cost of living higher than ever. And for the most part, salaries across Michigan have kept pace, with one notable exception: DCW pay remains low, with a starting wage of $15.20 per hour, according to recent survey findings. 

This level of compensation is just too low to keep DCWs on the job, leading to a 42-percent turnover rate in the field.  As you might imagine, turnover adds its own costs and risks to the care Michiganders need. These pressures are unsustainable and require urgent legislative action.

Long-term, statewide strategies to support DCWs who provide high-quality, person-centered support are long overdue. To best support this essential workforce and the individuals and families that rely on it, our organizations are backing a $4-an-hour wage increase for DCWs in the FY 2024 budget, with baked-in cost-of-living increases in the future.

And that’s not all. We need to ensure direct supervisors are included in these increases, so they can be adequately compensated for the work they do to support their care teams night and day.

We further recommend funding to support the inclusion of health care benefits and paid time off for DCWs and their supervisors, whose work is physically and emotionally arduous. Including these supports — as well as a supportive work environment on a regular basis — will help stave off burnout and keep effective people on the job for far longer.

With a $105.6-million increase in General Fund money, the cost of this change is not unreasonable. Michigan needs to support its most vulnerable residents. Over one-third of recent workforce survey respondents expressed concern for the health and safety of persons supported — this will only increase if the direct care workforce remains unstable and in crisis.

But that’s not all. Michigan still has massive amounts of unspent federal pandemic relief money available. We believe $188 million in one-time retention bonuses will help keep our state’s DCWs on the job for far longer and send an important message to these individuals about the value of the work they do. This request was made in the Governor’s supplemental budget request last year, but unfortunately was not adopted by the state Legislature.

Our organizations and many of our partners in the behavioral health sector strongly back these changes and look forward to supporting policy leaders as they work to adopt them early this spring. We also support funding increases for long-term care workers as we seek to reshape a system that can more effectively care for people in need of support.

So let us return to our main point: What will happen if these changes aren’t made?

If our state fails to respond to changing economic conditions and better support its DCWs, our system falters and crumbles. People in need of behavioral health care will be unable to find it. They will be forced to turn to high-cost emergency room services when needed, or — most troubling of all — they will choose to go without the support they need.

We already are seeing evidence of these trends. There are people who have been stuck in emergency rooms for months, simply because they can’t get a DCW to safely bring them home, not even for a shift. For Michigan’s already vulnerable residents, this is an extraordinarily upsetting and difficult situation that may set their health care journeys back by years.

Swift action is needed to resolve this challenge. We must fix our behavioral health system at its foundation. We must adequately support Michigan’s Direct Care Workers.

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