Sign Up to Receive PHI Alerts

SURVEY: PHI Provides First Snapshot of Workers in MI Consumer-Directed Care Program

February 23, 2012

A recent report by PHI Michigan for the Michigan Department of Community Health (DCH) provides the first demographic profile and other data on direct-care workers employed by by self-directed (SD) consumers through the Michigan (MI) Choice Medicaid Waiver Program.

The report, Self-Determination and the MI Choice Medicaid Waiver Program (pdf), is based on a survey of 624 direct-care workers in the MI Choice Program. It offers recommendations and strategies to strengthen the SD program for workers and participants.

“The survey findings should stoke what should be a growing discussion of the intersection of the paid direct-care workforce and family caregivers,” said PHI Director of Midwest Policy Hollis Turnham.

“Self-direction models across the country rely on family caregivers as well as friends and neighbors to become paid direct-care workers,” Turnham said. “As self-direction grows as a delivery option, we need to acknowledge and learn more about that intersection of individual roles and public funding — both about the challenges and the opportunities.”

The survey of workers in the SD program was designed to:

  • Collect baseline demographic information;
  • Understand the workers’ motivations, job satisfaction, and training needs; and
  • Identify strategies to strengthen and support recruitment and retention.

The report compares the findings from three types of SD workers — family, friends, and strangers — and explains that while they are “indistinguishable” in many aspects, “there are some remarkable differences among the groups.” For example, more friends and neighbors were found to be working with an individual with a disability rather than elders.

The Findings

The survey findings are summarized as follows:

Satisfaction: While SD workers are, overall, satisfied with their jobs and find the work rewarding, they indicated low satisfaction with their wages and the number of hours they work. SD workers earn wages that are among the lowest of all direct-care workers in the state, and have higher rates of uninsurance.

The SD workers — especially the SD workers who are family and friends — reported that they provided services for which they were not paid, which is an indication that the SD model is built on the informal unpaid support that these caregivers provide.

Relationships between Workers and Participants: Common assumptions about family members and friends working in the SD MI Choice Option are not reflected in the findings. In fact:

  • A significant number of paid family members do want training. Almost half of the workers expressed an interest in training in specific clinical topics and communications skills.
  • A majority of the family members (57 percent) do not live with the participant they support.

Recruiting and Retaining SD Workers: The MI Choice program — like every long-term care services and supports program — is challenged to find and retain qualified, competent workers. Only half of the workers indicated they intend to continue working for the participants for whom they currently provide support, which points to a “potentially high level” of turnover among these workers.


Based on the findings, PHI has made the following recommendations for the MI Choice program:

  • Develop mechanisms to ensure that workers have the opportunity to receive training on topics that are relevant and of interest to them.
  • Provide training opportunities and resources for participants to be effective employers in the MI Choice SD Option.
  • Offer more and continuing work to current workers to build and sustain a workforce willing to serve SD participants.
  • Explore opportunities to maximize outreach and enrollment in Medicaid and subsidized health plans under the Affordable Care Act (ACA) to secure health care for uninsured and underinsured workers.
  • Identify mechanisms and opportunities for SD workers to recognize and address workload imbalances and concerns.

The project was made possible through a technical assistance award from the National Direct Service Workforce Resource Center to the Michigan Department of Community Health and, with additional funding from the Centers for Medicare and Medicaid Services State Profile Tool Grant to the Michigan Office on Services to the Aging.

— by Deane Beebe

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.