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Michigan Employers Report Compensation, Lack of Full-Time Hours, and Training as Barriers to Recruiting and Retaining Direct-Care Workers in Home and Community-Based Programs, New Surveys Find

May 6, 2013

– Surveys to Inform Planning and Shape Policies to Strengthen Direct-Care Workforce in Michigan's Home and Community-Based Long-Term Care Programs -

The first statewide surveys of Medicaid-funded home and community-based services (HCBS) providers designed to capture data and information on the direct-care workforce have identified low wages, part-time hours, and the need for enhanced training as significant challenges to attracting and retaining direct-care staff to these programs.

Through a grant from the Centers for Medicare and Medicaid Services (CMS) to the Michigan Office of Services to the Aging, PHI Michigan conducted surveys of providers in the Medicaid MI Choice HCBS Waiver, Community Mental Health (CMH) Waiver and Home Help programs in 2012 to determine the size, stability, and compensation of the direct-care workforce. Information on health care coverage, core competencies, and training was also gathered through the surveys.  Surveys were also completed by direct-care workers supporting participants in MI Choice and CMH self-determination waiver programs, and allowed for analysis of these workers based on their relationship to the participant.

"This effort was critical to ensuring that Michigan can meet the increasing demand for long-term supports and services that older adults and people with disabilities depend on," said Kari Sederburg, director of the Michigan Office of Services to the Aging. "This survey has given us a better understanding of the needs of the state's direct-care workforce and the challenges they face on a daily basis. It also has presented us with a great opportunity to create new and innovative ways to grow this much-needed profession and we're excited to get to work."

Home health aides are projected to be the second fastest-growing occupation in the state, increasing by 53 percent over the 10-year period ending in 2020. Personal care workers are expected to grow by 42 percent in the same time frame. According to the state's Labor Market Information service, about 25,000 new workers for home and community-based services are needed by 2020.

Provider Organization Surveys

Nearly 17,000 direct-care workers are employed by the 300-plus provider organizations that responded to the three surveys.   

Provider organizations from the state's Medicaid home and community-based long-term services and supports programs reported:

  • Low wages, part-time hours, and lack of mileage reimbursement are significant challenges to attracting direct-care staff.
      • The starting hourly wage in the CMH program is $8.73, and $9.09 for the Home Help and MI Choice program;
      • 60 percent of direct-care staff are employed part-time, at less than 36 hours per week;
      • Only one third of HCBS providers reimburse their direct-care staff for mileage and/or gas for travel between participants.
  • Retaining staff is a challenge for many HCBS organizations.
      • The average annual turnover rate is 34 percent for direct-care workers
  • Providing affordable health care coverage is difficult for HCBS provider organizations.
      • 42 percent of responding organizations do not offer health insurance to their direct-care staff, and those that do have low participation rates as a result of the high cost for workers
  • Core competencies and training for the home and community-based direct-care workforce must be expanded.

"Learning from employers about the direct-care workforce is a critical step toward ensuring that direct-care jobs are quality jobs that offer adequate wages, benefits, and training," said PHI Midwest Director Hollis Turnham. "Quality jobs for direct-care workers lead to quality supports and services for elders and people with disabilities."

Workers Serving Self-Directing Participants

PHI Michigan also conducted companion surveys to learn more about the workers hired and supervised directly by participants in the MI Choice and CMH self-determination programs. Among the findings:

  • Workers supporting self-directing participants are, overall, satisfied with their jobs.
  • The majority of CMH workers supporting self-directing participants believe that training in certain core competencies should be mandatory.
  • In MI Choice, 49 percent of workers are family members, compared to only 27 percent in the CMH-waiver programs.
  • Most family members (65 percent) do not live with the program participant for whom they care.
  • Family members who are paid caregivers tend to earn less than workers with no prior relationship to the participant.

"By quantifying information on the direct-care workforce and identifying workforce issues faced by organizations and individual direct-care workers, these surveys provide much-needed data to better plan for the delivery of, and develop policies for, long-term services and supports in home and community-based settings," said PHI MI Senior Workforce Advocate Tameshia Bridges, who conducted the surveys.

Results of the three provider surveys are reported in an executive summary, "Findings from Surveys from Medicaid Home and Community-Based Provider Organization Surveys: Understanding Michigan's Long-Term Supports and Services Workforce." More on the survey findings on self-directed workers is reported in "Findings from Surveys of MI Choice and CMH Self-Directed Workers Executive Summary." All documents are available on the PHI Michigan website.

Michigan is one of seven states to receive federal funding through a State Profile Tool to collect basic information on the direct-care workforce in HCBS programs.

For more information on Michigan's direct-care workforce, see PHI's State Facts: Michigan's Direct-Care Workforce and the PHI State Data Center.

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PHI Michigan is a program of PHI (Paraprofessional Healthcare Institute), which works to transform eldercare and disability services, fostering dignity, respect, and independence — for all who receive care, and all who provide it. The nation's leading authority on the direct-care workforce, PHI promotes quality direct-care jobs as the foundation for quality supports and services.

Hollis Turnham, PHI Midwest Director,, (517) 327-0331

Deane Beebe, PHI Media Relations Director,, (646) 285-1039

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