PHI Michigan Releases First Survey Findings on Workers Serving Self-Directing Participants

PHI Michigan has released its survey findings on workers who support self-directing participants in two of Michigan’s Medicaid home and community-based services waiver programs: the MI Choice and Community Mental Health (CMH) self-determination programs.

The surveys were conducted as part of an effort by Michigan state agencies to strengthen their self-direction programs (also known as consumer direction) by learning more about the workers who are hired and supervised by the program participants. (The MI Choice program serves elders and people living with physical disabilities. The CMH waiver program serves individuals with intellectual and developmental disabilities and mental illnesses.)

“While the consumer-directed option has become increasingly preferable and grown widely throughout the nation, basic information and demographic data on workers who provide services and supports to self-directed program participants are scarce,” said PHI Michigan Senior Workforce Advocate Tameshia Bridges, who administered the surveys. “For the first time, with these surveys we are capturing information on job satisfaction, compensation, training needs and preferences and intention to stay, as well as demographic data that has traditionally been collected only on workers employed by agencies.”

Survey Findings

The surveys found that:

• More self-directed workers are family members in MI Choice than in CMH Waiver programs. In MI Choice, 49 percent of workers are family members, compared to only 27 percent in the CMH waiver programs. 
• Workers supporting self-directing participants are, overall, satisfied with their jobs. As many as 58 percent of friends and family members providing paid support services in the MI Choice program and 63 percent of all workers in the CMH self-determination program expressed interest in working for another self-directing participant when the one they currently support no longer needs them.
• The majority of CMH workers supporting self-directing participants believe that training in certain core competencies should be mandatory. While there are modest competency and training requirements for direct-care workers in both programs, survey respondents from both programs identified care skills — bathing, toileting, eating, dressing; communication skills; and first aide, CPR, and universal precautions — as some of the many topics for which they would like more training.
• Common assumptions about family members and friends working in the Medicaid self-determination programs are not reflected in the survey findings.
• For example, most family member workers do not live with the program participants. Only 35 percent of family workers live with the participant they are paid to support.
• Additionally, family members do not do this work to reap substantial financial rewards from the program. In both programs, direct-care workers with no prior relationship to the program participant earned higher wages than family members.

The workers surveyed in both programs reported that transportation reimbursement and health care coverage were lacking and problematic.

“Studies have found that securing and maintaining a workforce is one of the main barriers to delivering in-home services and supports,” said PHI Midwest Director Hollis Turnham. “With adequate data on the workers who provide services and supports to self-directed participants, Michigan will be better able to plan and build the direct-care workforce it needs to serve consumers who have chosen the consumer-directed option.”

“Findings from Surveys of MI Choice and CMH Self-Directed Workers Executive Summary” and the results of three companion surveys on the direct-care workforce that were administered to Michigan providers of Medicaid–funded HCBS programs are available on the PHI Michigan website.

The surveys conducted by PHI Michigan were supported by a grant from the Centers for Medicare and Medicaid Services (CMS) to the Michigan Office of Services to the Aging.

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

— by Deane Beebe