Delivery of Care/Opinion

Less is just less

The current workforce crisis in human services reflects a long-term policy failure to invest in community-based agencies

Image courtesy of Communications Department at Community Care Alliance

Benedict Lessing, Jr., CEO of the Community Care Alliance.

By Benedict F. Lessing, Jr.

Posted 10/25/21

Why is this story important?

A long-time social worker rails against what he calls the broken policies of human and social service delivery in Rhode Island.

The questions that need to be asked

Did you know that doctors at Hasbro Children’s Hospital are reporting that the facility is operating at 120 percent capacity, not from COVID, but from patients presenting with behavioral health issues? Why do insurance reimbursements for mental health and behavioral health providers continue to be so low in Rhode Island, when the unmet need keeps increasing? Will the R.I. General Assembly reconvene this fall to address proposals by Gov. Dan McKee to spend some $100 million in budget proposals from the $1.1 billion in unspent American Rescue Plan Act funds?

Under the radar screen

A six-page response letter from the Centers for Medicare and Medicaid Services to R.I. Medicaid Director Benjamin Shaffer, buried in an appendix to a national NPR story which aired on Thursday, Oct. 21, about how new federal funds were spurring the expansion of home care services for the elderly and the disabled, revealed in great detail the state’s plans around long-term services and supports, beyond anything that has ever been made “public” to date by the McKee administration.
The federal response was to a 40-page spending plan submitted by Shaffer for implementation of the American Rescue Plan Act of 2021, Section 9817. [See links to documents below.]
The apparent lack of transparency about these plans – and the CMS response to those plans – is a sign that there is a lot of “social engineering” underway to change the direction of how Medicaid is delivering long-term services and supports in Rhode Island. That, coupled with the move by the McKee administration to expand the procurement of private entities to serve as managed care organizations, or MCOs, for Medicaid services in Rhode Island, is big, big news.
That news, coupled with Gov. McKee’s desire to decrease the Medicaid population in Rhode Island by increasing the amount that low-wage workers are paid, demands that someone in the R.I. General Assembly needs to be paying more attention.

Editor’s Note: The following letter to the editor was sent to and then published by The Providence Journal on Wednesday, Oct. 20, as a guest column. ConvergenceRI is reprinting it with the permission of the author, Benedict F. Lessing, Jr., the CEO of Community Care Alliance.

PROVIDENCE – I cannot tell you over the course of a 40-plus year career in human services how often I have met with elected officials [who told me], “You are doing God’s work.”

This is typically a precursor to a conversation about limited funding. It always comes down to priorities that do not meet human needs.

Twenty years ago, Gov. Donald Carcieri took office, promoting what he referred to as the “the big audit,” which systematically stripped away human services resources. One result was eliminating planning and policy positions in state government, which is one reason external consultants flourish in Rhode Island.

Another was the weakening of the nonprofit human services sector, whereby funding salaries and infrastructure were cut and/or frozen, making the operation of these organizations challenging at best.

This is when we began to hear that we needed to think in terms of “less being more” and the importance of being efficient. Managed Care took root, particularly as a means of shifting government responsibilities to private companies [who were] paying very close attention to their bottom line.

Welcome to the workforce crisis
Rhode Island is now facing a massive workforce crisis in the human services and health care sector. Staff are leaving community organizations in droves for higher-paying salaries, generous sign-on bonuses and other benefits. Frequently, these are the staff that community-based organizations trained for years, but [now] can’t compete with the salaries offered by state agencies, such as DCYF, DHS, BHDDH or Corrections, or hospitals.

Why does this matter? First, fewer people depending on these services will receive them. I am referring to homeless individuals and families, people with mental illness, individuals struggling with substance use and addiction, children and families that fall into the child welfare system due to poverty, domestic violence, mental health concerns, etc., as well as children struggling with depression and suicidal ideation, newborns with developmental delays and/or other disabilities.

Elected officials fail to grasp that state agencies [i.e. DCYF, Family Court, BHDDH, DHS] depend on community organizations and cannot function without them.

Schools, hospitals, police and municipalities use these organizations to solve problems and address human needs they are not equipped to manage. A long-term outcome will be greater dependence on institutional care, and rationing of services [that] may include either first-come, first-serve, or those that are most acute. Expect greater utilization of police, rescue and hospital Emergency Rooms.

In other words, less is just less.

As community-based organizations shrink due to diminished funding, it will negatively impact the economy, beginning with jobs and the businesses that support the sector.

Unquestionably, local economies will suffer. Moreover, the competencies of these organizations that comprise the safety net for multiple populations will diminish without proper financial support.

Maddening to watch
As a career social worker and administrator, it has been maddening to watch this process occur. It calls into question our values, morality and common sense. The state’s fiscal and strategic approach to the delivery of human services couldn’t be more wrong-headed.

We spend way too much of our precious resources on psychiatric beds, boarding kids in need of mental health services in emergency rooms, placing children in institutions, incarcerating mentally ill people, and allowing too many people to sleep on the street while state-owned facilities that could provide shelter remain vacant.

State budgets and investments are policy statements that affect the well being of real people. Until we see the people that need our support and take tangible steps to ameliorate their suffering, whatever is left of the human services safety net will only continue to unravel.

Benedict F. Lessing, Jr. MSW, CEO, Community Care Alliance and a member of Horizon Healthcare Partners