The Maryland Regional Direct Services Collaborative (Collaborative) is a coalition of individuals and entities committed to addressing the challenges of the direct care and services workforce in the Maryland region.

As such, the Collaborative connects diverse stakeholders and perspectives to facilitate and develop solutions that improve wages and benefits — as well as training, recruitment, retention, and career path development — for professionals who provide direct care and supportive services across long-term services and supports (LTSS) settings.

As a trusted resource, subject matter expert, and leader in capacity building, the Collaborative seeks to address the LTSS workforce challenges faced by Maryland workers and employers alike.

Join the Maryland Regional Direct Services Collaborative in strengthening our direct services workforce by contributing your voice and resources—together, we can create a lasting impact in Maryland and the District of Columbia. Get involved today or make a donation to help drive meaningful change!

The Collaborative’s Latest Report: Long-Term Services and Supports in Baltimore

A framework for improving job quality and creating a highly trained direct care and services workforce.

Through research and in-depth stakeholder interviews, the following themes emerged:

Nearly all stakeholders, including DSWs, recognize that wages are not high enough to compete with restaurant and retail wages, and many are aware that they do not meet the criteria for a living wage. Further, in some LTSS settings, such as home care, lack of benefits may be tied to the practice of misclassifying workers as independent contractors, which denies them employment benefits such as earned sick or vacation leave, extra pay for overtime hours, or even protection by workers’ compensation programs.

Because so much of the care provided in Baltimore and throughout Maryland is funded by Medicaid, the program’s reimbursement rates drive workforce dynamics. Providers and advocates consistently assert that Maryland’s reimbursement rates have not increased at a level necessary for LTSS owners and operators to offer competitive compensation to DSWs.

Nearly all DSWs in these settings report dissatisfaction with staffing ratios. Many say that these low ratios make it very difficult to provide the level of care that they want, or are able, to provide. The increased workload that results from low staffing ratios adds to burnout and exhaustion, as well as the feeling that DSWs are being asked to do the jobs of two or three people.

DSWs point to symbols of appreciation from their employers as improving their job satisfaction, which may improve retention on the margin. However, respect and appreciation will not alone solve the systemic problems underlying the workforce crisis.

Similarly, good quality training provided in conjunction with holistic supports and wraparound services can help provide DSWs with the tools they need to obtain certifications, feel supported in their workplaces, and remain in care jobs. However, training and support alone will not solve the problem.

In response to a question about what motivates, or has motivated, DSWs to leave their jobs, the majority of respondents indicated it was due low pay, followed by “not enough work hours or not consistent enough work” and “poor benefts,” and “lack of respect from management/ owner/operator.”

When asked what it would take for an employer to hire them back, the plurality of 11 respondents chose “better wages and benefts,” followed closely by 10 selecting “better staffng ratios” (more CNAs/GNAs per resident/client). Six chose “positive culture or morale among staff.”

The following excerpts, compiled by topic from the focus group interviews, offer additional insights into the realities of DSWs’ work and how to address the workforce shortage in Baltimore.

Staffng Ratios & Quality of Care

“For me, the underlying issues are short staffing, not being paid enough, and being disrespected by management.”

Respect & Appreciation

“My [home care] clients and their families appreciate me more [than] my boss [does]. What keeps me around is not the [home health] agency itself.”

Staffing Ratios & Quality of Care

“There is not a lot of accountability in nursing homes or hospitals. I work on the weekends—on the graveyard shift—where there is one GNA per 20 or more patients. They only respect you because they need your body.”

Respect & Appreciation

“I love making a difference in other people’s lives. I know what I do helps them to stay living independently in their own homes, and my clients love to see me walking in the door.”

Staffing Ratios & Quality of Care

“The [resident-to-staff] ratios are ridiculously high. On the regular, we have at least 15 to 16 people; and sometimes there are two of us to 32 or 34 residents.”

Nursing Home & Assisted Living Direct Care Professionals: Challenges and Potential Solutions

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