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Staff turnover hurts providers for people with disabilities
Sep 12

The Bismarck Tribune

BISMARCK, N.D. (AP) _ Tim Lamont is a stickler for proper use of the English language.

While watching the daytime television talk show ``The Talk'' one afternoon last month in his Bismarck living room, Lamont caught one of the hosts using a common slang word.

``They said `ain't,''' Lamont told Jennifer Preabt, his direct support caregiver. ``They better say `isn't.'''

``Should we put her on a treadmill and crank it up and then make her do some tuffies (pushups)?'' Preabt joked back to Lamont.

``Because if they don't they're going to get zonked,'' Lamont joked back.

Preabt has worked 20 years as a direct support caregiver for Pride Inc., a nonprofit organization providing community-based services, employment and advocacy for adults and children with disabilities. She has been a caregiver for Lamont for 10 years and for his roommate, Marlene Simon, for 20. Both Lamont and Simon have intellectual disabilities and have been sharing the two-bedroom home for the last decade.

If Lamont gets a catchphrase stuck in his mind and constantly repeats it, Preabt _ patient, willing to adapt and good-natured _ happily repeats the phrase back to him in song.

``I turn it into a game,'' she said. ``It makes him smile. Nothing gives you the same satisfaction as this job does.''      

The married mother of one is part of a 7,000-person workforce in North Dakota clocking long hours and working inconvenient shifts, overnights, weekends and holidays, often in high-stress situations, and doing everything from documentation to cooking and cleaning _ all for what is considered inadequately low pay. For the past three years, Preabt has been working six days a week, two of which are split-shifts. She still maintains a positive attitude.

``The more humor you can bring (to the job) the better,'' she said.

Pride Inc. CEO Tony Baker said, ``Not everybody has lasted as long as Jennifer has. She knows things about the (clients) that she can't probably even tell people _ she just recognizes them naturally. Just little cues here and there.''

Baker looks on his computer screen inside his office and sees more than 1,400 uncovered hours of needed care his 480 clients with disabilities need each month. The direct supervisors at Pride Inc. are tasked with figuring out which of the 318 direct support care professionals must add additional time to their already tight work schedules.

Baker loses as many as 15 direct support care workers each month due to job stress, long hours, irregular schedules or low pay.

``That's where the problem is. We are constantly training, constantly hiring,'' he said.

Businesses and nonprofits caring for people with disabilities in communities across North Dakota see an average of nearly 50% staff turnover annually.

``The turnover rates and length of stay are typical across North Dakota for many service providers,'' said Bruce Murry, executive director of the North Dakota Association of Community Providers. ``But it's the length of the time needed to replace them that has doubled and tripled for some service providers.''

``The direct support professionals are helping to serve more and more needs on the behavioral and medical front,'' Murry said. ``The folks we used to serve in group homes are living independently now, and so all across the board the people we are serving have higher needs than they did years ago.''

The Legislature this year approved a 2% wage increase for workers this year and another 2% increase for 2020 _ the first wage increase since 2013, The Bismarck Tribune reported. Murry, who lobbied for a much higher increase, sees 2% as a break-even number to help stall staff turnover _ but not reverse it. He'll be asking the 2021 Legislature for a wage hike up to 10% to help keep the turnover rate below 40%.

Starting pay for a direct support care worker at Pride Inc. is $14 an hour. There also are benefits such as a health savings account with an employer contribution match.

``We try to communicate the benefits we have,'' Baker said. ``We don't have a product where we can increase the price of like a burger by 50 cents and then pay staff more.''

The applicant pool for support care workers has changed, with fewer people applying and more people not able to pass drug screening or background checks, Murry said.

He also sees a change in the legislative outlook.

``Legislators are starting to understand how expensive turnover is, because each new employee costs about $6,000 to train. We have about 7,000 employees in the industry in North Dakota, and we are retraining 45% of them at $6,000 a pop. That gets into the tens of millions of dollars pretty quickly,'' Murry said.

The Association of Community Providers received a $400,000 grant over four years through the state Department of Human Services to promote workforce development. Officials have found from staff that pay is important, but a positive environment with co-workers and how well the supervisors are trained in leadership are equally significant.

``We are trying to do our due-diligence, to do as much as we can to not just make it about money,'' Murry said. ``It's certainly a calling. They are doing it because it's meaningful work, not for the money. You need to give them the tools to succeed.''

Many of Pride Inc.'s clients require 24-hour supervision and care, which can include a daily checklist of tracking behavior, dispensing medications, transporting to medical visits, shopping, and handling various household chores.

The goal is to provide each person with the best care possible in their home community and not in a more-restrictive institutional setting.

``This is not a job for everyone'', Preabt said. ``You are hoping they (staff) have the good traits. It just comes naturally to me. There are natural caregivers of the world, and there are natural office workers of the world. You have to find your niche.''

Staff turnover is an issue for organizations across North Dakota providing care for people with a host of complex disability issues. A person on staff who stays for a year or two is considered a long tenure. Many are high school or college students working their way through school who will soon leave to pursue a career.

Preabt said the consistent turnover of direct-care staff can have negative effects on clients.

``It makes them feel like they are not worth much when the staff keeps flowing in and out,'' she said.

Baker agreed.

``I mean it's hard enough for us to get used to new people, but they have people coming in and out of their home and helping them and getting to know them,'' he said.

Longtime staff members help keep continuity when changes in personal moods or a dramatic shift in a group home dynamic could mean the opposite result.

Preabt feels her years of experience are valuable, and she likes to pass along her knowledge to newcomers working at Pride Inc. when they are job-shadowing. She talks to them about watching, listening and getting to know each client in order to know and understand their idiosyncrasies.

``You can't find a more worthwhile, heartwarming job, I feel,'' Preabt said.

Each Monday morning, Preabt takes Kelly Arthawd, a 57-year-old male client with an intellectual disability, grocery shopping for a week's worth of meals.

Preabt said Arthawd likes home cooking, he's just not comfortable cooking other than reheating in a microwave. So meal plans are designed without complicated steps. Each yogurt, banana and frozen meal, sometimes prepared by staff, is labeled with a date to eat and to help Arthawd with appropriate portion control.

``He's really independent,'' Preabt said. ``We just have to make it simple for him.''

Preabt has worked with Arthawd for two decades.

``I treat him more like family,'' she said. ``I observe and listen to him more. When people treat them like they are disabled, they kind of get put off.''

Even as easygoing as Preabt is, the stress of the job builds from the long days and nights. On her nights off, she will receive phone calls or text messages asking for her help in solving a problem or behavior issue with a client. She knows it's part of the job and that she is on a team dedicated to what is best for the client.

``It stressful at some points,'' Preabt said. ``Because you feel like you are just going, going, going and your only life is here. They encompass your life sometimes.''

``But then they are so appreciative, and you take them out for an ice cream cone and it's the best thing in the world. Or you get to go for a drive down by the river, and just that made them so happy and giddy that your problems and your stress kind of melt away because that made him so happy. How can you beat something simple like that? It helps you re-examine what really matters in the world.''


Information from: Bismarck Tribune, http://www.bismarcktribune.com

By The Associated Press, Copyright 2019