Idaho OPE: direct care workers need better wages

A woman with short, blond hair sits facing toward the left in profile of the camera and looking through dark-rimmed glasses. In the background are green trees out of focus in golden sunlight.
Becca Ewing-Ford, pictured in October of 2022 at at East City Park in Moscow, was one of the clients Milestone Decisions discharged due to a lack of staffing during the pandemic. (Credit: Rachel Sun / NWPB)



Idaho’s direct care workforce isn’t being paid enough to sustain the needs of people with disabilities and seniors, according to a February report by the legislature’s Office of Performance Evaluations.

Direct care encompasses a range of workers assisting people with disabilities and those 65 or older. They include caregivers, community support workers, developmental therapists, home health or home care aides and certified nursing assistants.

The report estimates there are 33,000 people in Idaho who rely on direct care workers, and only 23,000 people doing the job. 

The problem is nothing new, said Sarah McClure, executive director of Milestone Decisions, which serves people with intellectual and developmental disabilities in Moscow and Coeur d’Alene. During the pandemic, staffing reached a crisis level statewide, she said.

“It was always a problem of being short staffed and having a lot of hours open,” she said. “When the pandemic hit … it was just unbearable.”

According to the report, Idaho lost 2,642 direct care employees between a staffing peak in 2020 and a sharp decline in the second half of 2021.

Workers in direct care saw their wages stay the same as other jobs increased wages and cost of living rose. Staff who were already stretched thin were forced to decide between spending days with their clients or with their own families. Those who chose their families left, McClure said.

“They got out,” she said. “It really just left a group of dedicated people to figure that out the last two years,” she said.

The biggest reasons for that staffing shortage, according to the report, were low wages. Workers reported making an average of $14 an hour and were able to earn a roughly 36% to 39% raise by leaving the industry.

Compensation for direct care is determined by a Medicaid rate set by the state. According to the report, over 75% of employees surveyed said higher pay would keep them from leaving their jobs. Other issues that were listed, but ranked lower in reasons for leaving, were a lack of benefits and limited opportunities for training and advancement.

Idaho’s House Bill 369 would provide more funding for those services, though McClure said there’s still a lack of funding for related services, including certified family homes and service coordinators who help families navigate the system. 

Of the staff her company has left, McClure said most have one or two other jobs, or a roommate or spouse with whom they share living expenses. Staff may care more about their direct care work, she said, but it doesn’t pay the bills.

“I have a lot of staff that we have to schedule around other jobs, because that one has to be the priority because it brings in more money,” she said. “It’s especially bad in the Coeur d’Alene area.”

The state does not provide direct care services but only funds them, according to the report. Quality care is reliant on consumers having the option to switch to another provider. However, OPE found people who rely on direct care services felt they had to settle for low quality service or care at a more expensive institution.

Businesses, meanwhile, felt they had to settle for applicants with fewer qualifications or keep poor-performing workers longer than preferred, according to the report. Workers reported feeling they have no choice but to leave direct care because of low pay.

That staffing crisis, paired with delays in emergency funding, forced some agencies that provide direct care to close offices. Others, like Milestone, had to drop clients with care needs beyond what they could staff for.

Milestone discharged four clients, McClure said, and still hasn’t been able to recover enough to bring them back. 

One local client, Becca Ewing-Ford, became her mother Lorie’s full-time ward during the pandemic. 

In an October interview, Ewing, who’s been retired since 2016, said she was overwhelmed by the work to take care of her daughter. 

Becca needs help with toileting, showering and feeding, Lorie Ewing said, as well as regular trips to the doctor and daily medication maintenance. 

“I carry her up the stairs every night to put her to bed. I take care of her all day long. It’s pretty much my life,” Lorie Ewing said. “I am happy to do things for her, but I just need a break now and then, and it’s hard. There are no options out there for a break.”

Lorie Ewing now plans to move to Oregon, McClure said, which provides more funding and support for families of people with intellectual and developmental disabilities. 

“It’s sad to think that she has to move out of state to get care for her daughter,” McClure said.

In the report, the OPE recommends the state Division of Medicaid work to set more competitive wage targets, including by using similar and competitive occupations as a guideline for reimbursement, adjusting rates more frequently and considering region-specific rates.

The report also recommends supporting efforts to make training and certification programs more accessible, and developing a career ladder for direct care workers.

Direct care workers would also benefit from getting a Bureau of Labor Statistics categorization to set a standard for wages in the field, McClure said.

“It would give the states so much less leeway in underpaying [workers], because it would have the average right there,” she said. “Right now, they’re just taking little pieces of different jobs from different categories, and they get to pick and choose which ones they want. And they’re choosing ones that are a lot lower than what should be paid.”

Seeing the problem being recognized by the legislature was a huge relief, McClure said.

“The fact that there are people in higher places that can make these changes, it was just like, we could breathe,” she said. “What we’re doing to advocate for our services, and for our clients —  people are starting to listen.”

This report is made possible by the cooperative agreement with NWPB, the Lewiston Tribune and the Moscow-Pullman Daily News.