Making life-or-death decisions for $10.60 an hour: Texas group homes suffer from staffing crisis

From KERA News:

Cassie Weddel can’t express herself through words, but she can express herself through her surprisingly strong grip. She’s always reaching for her mom’s hand as they sit in the family living room in North Richland Hills.

“Cassie loves to grab and hug,” her mom, Lea Ann Capel, laughed. “Sometimes to the point where she’ll pull you over.”

Almost 38 years old, Cassie needs round-the-clock care, Capel said. Her physical and intellectual disabilities mean she can’t walk, brush her teeth or bathe herself, and doctors estimate she’s at the cognitive level of a toddler.

In a family where everyone works, that type of care is impossible to provide at home without support. That’s why, in 2008, Cassie moved into a group home 10 minutes away from her mom’s house.

Group homes are normal houses where people with intellectual disabilities can live, supported by staff called direct care workers. They do just about everything: cook, clean, give out medication, and make sure residents are happy and healthy. Group homes are an alternative to living in a big state institution, and a way to keep people with intellectual disabilities in the community, closer to their loved ones.

For years, the group home was great for Cassie, Capel said.

“Until recently,” she said. “And that’s when things started to become concerning.”

Capel said during the pandemic, she saw the staff at her daughter’s group home dwindle, reflecting a crisis across the state and country. Group homes in Texas can’t hire enough workers, forcing closures and making it harder for the remaining homes to provide quality care.

Advocates, group home operators and workers blame the low pay. Group homes are funded through Medicaid, and the Texas state legislature sets the base wage for workers. Right now, it’s $10.60 an hour. That’s after lawmakers increased the wage from $8.11 an hour during the legislative session last year.

Assuming a 40-hour work week, direct care workers who make life-or-death decisions for people with disabilities can expect to make $22,000 a year.

“This is a full, total, body-mind disability that requires someone to care for them constantly,” Capel said of her daughter. “You can’t expect someone to be able to do that working $10.60 an hour, especially in this economy.”

A public health crisis in the making

More than 15,000 Texans with intellectual and developmental disabilities, or IDD, rely on group homes, according to a coalition of three organizations that represent group home providers.

The coalition surveyed its members in 2023 and found the staffing crisis — which was bad long before the pandemic — “has reached the brink of a catastrophe.”

Out of the 148 providers who responded to the survey, two-thirds reported they “struggle to deliver quality care due to insufficient staffing.” Staff vacancy rates hover around 30%, an “untenable” level. One in three homes do not have scheduled staff at a given time.

For Cassie, the staffing shortage meant no more house outings to church or dances, Capel said. She and Cassie’s sister stepped in to give the staff a break.

“Sometimes, Lindsey and I would go over there, and we’d give her a bath, give her a shower ourselves,” Capel said.

Group home closures are accelerating, too, according to the coalition’s survey. Respondents reported they recently closed almost 160 homes and planned to close almost 240 more, affecting 1,600 residents in total — potentially forcing them to move farther away from their family and friends.

And where will they move? Many group homes are not accepting new clients, the survey found.

“An exodus of providers from the system will result in loss of access to care, increased risk of institutionalization, diminished ability for the state to meet federal access standards, and a serious public health crisis,” the survey states.

Staffing crisis leads to harder jobs, worse care

For direct care workers, short staffing means harder workdays and more overtime, on top of the other jobs they have to work to stay afloat.

Princia Mabiala works at a four-bedroom group home in Grapevine, run by Champion Services. She doesn’t make enough here to support herself and her daughter, she said.

“My rent is like $1,500. I still got to eat,” she said.

Mabiala calls her clients “my ladies.” Each shift, Mabiala picks up her “ladies” from their day program, helps them use the bathroom, cleans the house, cooks dinner (her specialty), and, overall, makes sure they’re happy.

“You have to have the passion of doing it,” she said. “If you don’t have the passion, if you just take it, just like a regular job, you will not last.”

Mabiala does hair on her days off to make ends meet. She wouldn’t work a second job if she didn’t have to, she said. Her work at the group home requires focus, and it’s hard to maintain that if you’re tired or thinking of other responsibilities.

“If they increase the pay, it will be good for the client, because we would give them more attention,” Mabiala said. “And it will be good for us because we don’t have to go to a different place just to try to make a living.”

As group homes struggle to retain staff, they’re losing experienced workers who know how to deal with the hardest parts of the job.

Tarus Williams has been a direct care worker for 22 years, and she works at another Champion Services group home near Mabiala’s. She, like all group home workers, must sometimes navigate challenging behaviors — like when a resident has an outburst or meltdown.

“I understand the clients. I understand when I walk in, what I’m gonna have to deal with,” Williams said. “Whereas someone else that’s not familiar with the setting, they might get burnt out, or they might not understand that, hey, she’s going to come in here with a behavior and we’re going to have to deal with this behavior.”

People can go almost anywhere else and make more money than direct care workers, said Susan Garnett, the CEO of My Health My Resources of Tarrant County (MHMR).

“Every time I go through a Taco Bell or a McDonald’s or a Chick-fil-A, I see signs for $14 to $18 an hour,” she said.

MHMR runs its own group homes and helps coordinate care between others in Tarrant County.

Inexperienced workers are more likely to call the police on residents for behaviors they don’t know how to manage, Garnett said. They can also miss signs of illness or fail to follow health instructions, with fatal consequences.

“It can be a person who didn’t understand the level of supervision necessary for somebody in bathing, and a person drowns,” Garnett said. “It can be the person who didn’t understand the pureed diet that was required, and somebody chokes.”

Sometimes, MHMR has to move residents around to other group homes when a staff member doesn’t come to work, Garnett said. Multiple times, MHMR has responded to calls from police departments, who report that a group home has been left unattended.

Garnett gave the example of one worker who needed to go pick up their own child from daycare, and no one came to relieve them, so they left.

“I get where the person says, for $10 an hour, I’m not staying,” she said.

The staffing shortage is happening while demand for direct care workers of all kinds is rising, not just in group homes — especially as Americans age.

Both Mabiala and Williams pointed out that no one knows when their family members, or even themselves, might need the kind of help they offer.

“I believe in karma,” Mabiala said. “If one day something happened to me or to my child, I would like somebody to take care of her.”

‘We’re barely surviving’

Denise Gasmire is the founder and CEO of Champion Services, where Williams and Mabiala work. The company operates 12 group homes in northeast Tarrant County. Gasmire got into the business because of her son, who is disabled and is now a resident of one of her group homes.

Group home providers are “on life support,” Gasmire said. She watched the legislature last year, hoping for a wage boost to $13 or $14 an hour, at least. Instead, she got $10.60.

“You want to talk about a gut punch? It literally took the wind out of me,” she said. “I’ve never been so deflated in my life.”

Gasmire relies on the state’s Medicaid reimbursement rate to operate. Before the pandemic, Champion Services’ residents went out to eat once a month, went to the movies, the zoo, and the aquarium. Now, she can’t afford the gas — and she doesn’t have enough staff anyway, she said.

Gasmire called staffing her number one problem. Like other providers across Texas, she’s running her four-bedroom group homes with 30% staff vacancies. Her employees regularly work double shifts.

Then there’s the staff turnover. Residents get to know and trust workers who are there one day, but then they’re gone the next, she said.

“We are just trying to survive,” Gasmire said. “We’re not thriving, which means, quite frankly, our individuals really can’t thrive.”

Gasmire raised her pay to $12 an hour, above the state reimbursement rate, because of COVID-era federal funding — but that funding has ended, she said.

“We feel — quite frankly, we feel abandoned,” Gasmire said. “And it’s very hard to keep morale up and keep pushing forward without proper funding, because we want to do our job, we want to do it well, but it’s making it very difficult to do that.”

When asked if she’s thought about shutting down some of her group homes, Gasmire paused for a long time.

“At some point, I will have to make that decision to start closing group homes, if something doesn’t happen,” she said. “I have no choice.”

A bipartisan group of 51 Texas House members — just over a third of the chamber — sent a letter to the state Health and Human Services Commission (HHSC) in November, urging the department to ask the Legislative Budget Board for an emergency appropriation to bump the base wage to $15 an hour.

Democratic Rep. Chris Turner, who represents Arlington and Grand Prairie, signed the letter. Last year, he introduced and passed legislation increasing oversight over group homes.

“We should insist upon higher standards, to better protect people in group homes. At the same time, we should give those providers the resources they need to better compensate the employees that we’re entrusting to do this important work,” Turner said.

KERA News reached out to HHSC for comment. The commission is prohibited from “increasing reimbursement rates in excess of available appropriations,” spokesperson José Andrés Araiza wrote in an email to KERA News. “HHSC will implement any future decisions by the legislature to adjust rates.”

When asked if HHSC plans to ask for the emergency appropriation, Araiza referred back to his original statement.

HHSC is working on this problem, Araiza wrote, pointing to the commission’s online career portal for people interested in direct care jobs and its survey of direct care workers in 2023.

The next legislative session, where lawmakers could raise the base wage, doesn’t start until 2025.

Cassie recently moved out of the group home where she lived for 16 years. Cassie’s dad is retired, and he can take care of her full-time. He and Capel were worried about the staffing situation, Capel said.

“What if they all quit?” she said. “It’s like, better for us to go ahead and make that move.”

Capel is on the board of MHMR, and group home worker pay is a frequent topic of conversation at their meetings, she said. She wonders what it will take to “wake up the lawmakers.”

“It’s dangerous. It is an accident waiting to happen,” she said. “Or it could be a complete, horrible, tragedy waiting to happen.”

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