ARRM News and Public Relations

Commentary: Focus greater attention on structural barriers to inclusion for people with disabilities

By Sue Schettle

Published by the Minneapolis Star Tribune on 12/14/2019 (original publication here)

The latest article in the Chaotic Care series (Disabled Minnesotans Often Live in Costly Isolation, 12/08/2019) had the opportunity to continue the series’ constructive look into the current challenges Minnesotans with disabilities face in having the opportunity to live their best lives. Unfortunately, several core issues were glazed over, and some ignored, in exchange for painting a negative picture of group homes where hundreds of Minnesotans in fact do receive the support and services they need for a high quality of life.

Minnesota’s relatively large number of group homes is a manifestation of being one of the first states to close all state institutions housing people with disabilities. Beginning as early as the late 60’s and early 70’s, Minnesota led the nation in a commitment to the community integration of people with intellectual and developmental disabilities. Minnesota closed its institutions, establishing the alternative of group homes as the most individualized and community-based support setting conceived at the time. To this day, Minnesota is one of only 17 states with no state institutions.

However, this history is just for context, because progress never stops. Fifty years ago, the list of options for community-based services was short. Today, group homes are part of a spectrum of residence and support options for people with disabilities. This is a great advancement that offers the potential for people to customize the support they need with the independence they want.

I say potential because as the article calls out, too many still lack access to those opportunities. Yet centralizing group homes as the problem is a disservice to addressing the true factors preventing more people from living their best lives. 

The article failed to address the lack of affordable housing or discriminatory zoning ordinances and tenant policies which limit options even in the most progressive of counties.

It failed to discuss that direct support staff shortages covered in the article affect people in ALL housing situations, not just group homes. Access to stable staff is a key factor in whether a person can have the confidence to live in a more individualized setting.

The article glazed over the central role of counties and case managers in supporting transitions to more individualized homes. As the ultimate administrators of waiver funding, they are not being held accountable for their responsibilities to ensure people can access the most independent setting possible.

In the overwhelming majority of cases, structural barriers like these take the choice and opportunity out of the hands of people with disabilities. 

Finally, the article misleadingly states group homes are more costly than individualized services. Yet the scope of services being provided is drastically different in a group home setting. The majority of people living in group homes require some level of 24-hour support, while people living on their own are utilizing a fraction of that. Making this comparison is like suggesting that the retail store minute clinic is a better health care investment because getting a flu shot there costs less than a hospital stay for pneumonia.

This all boils down to two main points which the article had the chance to make, but instead, overly focused on a handful of negative group home experiences.

First, group homes do not deserve the overall negativity portrayed by this article. While they are not the right home and support setting for some, they are extremely positive options for others and exist on a spectrum of services designed to maximize a person’s independence and avoid more expensive and restrictive care settings.

Second, lack of public awareness, or will, to take action on systemic issues is the root cause of the fact that many who want to live in a different setting and have greater access to their community are not currently receiving that choice. It must be addressed. The services sector is shifting, with significant and growing numbers of programs supporting a variety of living situations for people, from organizations using a combination of innovative tools, above-and-beyond resourcefulness, and in some cases, pure grit. Yet, they are capped in their growth not because there are too many group homes, but by inconsistent county administration and case management, lack of affordable housing stock, and the demographics of those needing support outstripping those providing support by a factor of five to one.

We in the disability service sector have openly and deliberately communicated these concerns to both state officials and the media. Opportunities for Minnesotans with disabilities to live lives based on their abilities will continue to be limited until we as a state stop looking for where we can place the easy blame and start taking responsibility for addressing the real barriers.

Sue Schettle is the CEO of the Association of Residential Resources in Minnesota (ARRM), an association of more than 200 organizations representing the Home and Community-Based Services industry, from intermediate care facilities to individual home support.

Self-Care For DSPs (and everyone else!)

By the Integrity Living Options Hiring and Training Division (originally authored for Mental Health Awareness Month)

Self-care is not indulgent. It is a real practice that focuses our minds and bodies on relieving stress that we encounter before we are overwhelmed by it. Your health -- both mentally and physically -- can affect how well you do your job or how well you manage the stress of your job.  

There is no “one-size-fits-all” self-care plan, but there is a common thread: making a commitment to attend to all the domains of your life, including your physical and psychological health, emotional and spiritual needs, and relationships. We spend time in our professional lives assisting clients with goals of eating better, getting more sleep, drinking more water, appropriately navigating stressful situations - but do we take our own advice?

Basic tips for good health

These likely won’t be surprising, but let’s review and consider how much these strategies could improve your health and well-being.

Nutrition

Consider all five basic food groups when preparing meals. Preparing meals in advance is conducive to more sound choices for busy professionals who have higher travel demands. Be conscientious of portion sizes.

Hydration

Staying hydrated can greatly assist the way you feel and the caliber in which you function. A good routine to follow would be: drink a glass when you wake up, a glass with each meal, a glass in between meals, and before, during, and after exercising.

Rest

Getting adequate and meaningful sleep is imperative to solid functioning. Studies show that sleep deficiency alters activity in some parts of the brain. If you're sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Sleep deficiency also has been linked to depression, suicide, and risk-taking behavior.

Support to expect

As staff, you are working with a variety of different clients and challenges. It is imperative that all employees receive a variety of support. So what support should you expect?

• Thorough understanding of your job responsibilities
• Variety of ongoing training to assist in the success of your employment
• Necessary resources and tool to meet the demands of your job
• Regular meetings with your supervisor to discuss concerns, get feedback or problem solve difficulty you are experiencing
• A team of colleagues to debrief and collaborate with

Intense and challenging situations you may encounter working in this field can leave you with a variety of unresolved feelings at times during your career. Taking the time you need to process events with your supervisor is an important part of your self-care plan.

Refresh and renew

Lastly, there are thousands of ways to practice self-care and the Internet is filled with free resources to provide examples of ways that others apply self-care to their life.  We have provided some ideas below to start off your own brainstorming!

• Create something
• Make a budget and keep track of your money
• Splurge, a little, as a reward or a relief
• Try something new in your living space. Rearrange your furniture in a way that makes it more comfortable
• Journal
• Develop an energizing morning routine or a relaxing evening routing
• Try a new experience
• Connect with friends and family
• Read
• Garden
• Find a new hobby, or revisit an old one
• Intentionally schedule “me time” on your planner
• Use online tutorials to learn something new
• Discover your stress indicators and create plans to address them as they arise
• Listen to a podcast
• Declutter your wardrobe
• Tidy up
• Unplug from social media for a pre-determined length of time
• Learn to say no without feeling guilty
• Check your to-do list for something that you can accomplish
• Assemble a puzzle
• Make a playlist
• Cook or bake
• Practice meditation
• Exercise – even if just means walking around the block
• Spend time in nature
• Have a good laugh
• Volunteer your time for a cause that is meaningful to you
• Take a hot shower or bath

Integrity Living Options is a Twin Cities-based agency that provides a number of services and supports to individuals with a wide range of disabilities throughout Minnesota.

Direct Care Workforce Shortage in 3 minutes

A commentary from ARRM's CEO Sue Schettle was published this weekend in the Star Tribune ("Articles on worker shortages ignored direct care providers", Jan. 27) highlighting the state of concern among community-based service providers around direct care staff shortages and the need for our communities and state leaders to work with us to take comprehensive action now.

However, if you're not experienced in the Home and Community-Based Services world, it can be difficult to understand why this is a major issue or how it differs from the impacts to other industries. We try to break it down in a concise explanation on how we got here, why it matters, and what we can do, all in three minutes.

How we got here and why it's different

• Workers were plentiful for the last 50 years: The 1960s and ‘70s saw a massive increase in the workforce supply, not just from the baby boomers, but cultural changes that led hundreds of thousands of women to join the workforce. This has been sustained by several significant immigration waves, particularly in Minnesota.
• Shrinking number of caregivers, growing numbers of 'care needers': Today, the entire workforce, not just health and human services, is losing workers at a rate of five to one, and demographics studies tell us this won’t change for at least another five to ten years. There are simply not enough young people to fill entry positions, creating a spike in job openings where wages are less than $15 per hour.

What's the impact and why it matters

• Shortage impacts amplified in human services: Minnesota's overall job vacancy rate is four percent, while direct care job vacancy rates are about nine percent. The 9,000 open DSP positions alone make up more than 7 percent of all job vacancies in the state.
• Fewer support options hurts people and communities: With shortages like these, it means people seeking supportive services have fewer options and opportunities to maximize independent community living, and in some cases have no options. This ripples through communities, with more people needing more intensive emergency care and fewer people receiving the supports they need to give back to their communities.

No 'simple' solution, but action will make a difference

• Invest in better wages and more flexible rates: Direct care jobs have to become more competitive with other sectors in order to stabilize turnover rates. This can't be the only answer, but an immediate bump and policy changes to ensure rates for services move with the overall market will help give a more sound foundation to the industry.
• Explore and expand staff-supplementing supports: The reality is we need to do more with less in providing the supports to help people live safely and independently. This means investing in solutions like assistive technologies and remote support technology, which expand the ways people can maximize their abilities with less time-intensive staff supports. The more people who can use such support to reduce staff-needs, the more people with more significant needs can be supported.
• Cross-sector community partnerships: At the end of the day, all Minnesota employers are going to be competing for the same pool of workers, and facing increasing struggles if it continues to be a zero-sum game. Communities, along with policy makers need to come together to form partnerships that support mutual interests.

What ideas do you have to help Minnesota meet this coming challenge? Share in the comments below.

Top Four Uses of Remote Supervision

Most people involved in services for people with disabilities recognize a support paradigm shift is needed. Current and future workforce and financial realities require us to look for new options and innovation.

Somehow we need to find ways to support more people with less staffing intense services. The use of technology to provide remote supports not only helps achieve this but when we minimize the physical presence of DSPs, many individuals gain the independence to try and do more for themselves. That develops new skills and confidence, with technology and remote (but available) DSP assistance providing a safety and security net.

Residents in this home live without staff in their home at night, with technology like sensors and call buttons keeping staff notified if there are any potential issues.

What is remote supervision?

Remote supervision and support involves the use of various types of technology to provide DSPs critical information about what is happening with and around individuals, without the DSP needing to be in the room or in the building. If/when direct assistance is needed the DSP is informed and goes to the person, but allows individuals their independence and privacy until then.

Four top uses of remote supervision

• Alternative Overnight Supervision – Converting paid sleep staff, available ‘just in case’ a person needs something, to remote supervision with a DSP nearby and available to respond if/when needed.
• Employment and Activity Flexibility – Remotely supervise one or two people at home while others are at work or on activities, allowing individuals freedom to accept evening and weekend work and broader choice in activity participation.
• Health, Safety and Efficiency – Instead of staff doing hourly bed checks to see if someone has fallen, wandered, needs assistance to the bathroom, etc. technology can notify staff when someone’s out of bed, out of room or incontinence detected, remind staff of medications or re-position needs, and individuals can notify staff when they need/want assistance with just a slight movement.
• Lifestyle and Own Home – People needing 24-hour availability of supervision/support move from group living to their own apartments with technology to provide reminders on medications or leaving for work on time, and keeping remote, but available 24/7 DSPs informed of activity and possible assistance needs.

ARRM Technology Conference

There are many stories of individuals and agencies who have used these innovations, increasing self-determination and community integration. The ARRM Technology Conference & Showcase on November 15 is an event designed to show people in the disability services industry how technology is being used to promote independence and efficiency. Breakout sessions include individual and provider stories, plus sessions on ‘how to’ aspects of alternative overnight supervision, using technology for complex medical and behavioral needs, current DHS policy, funding, use of data and more. Whether you are an administrator, program director, DSP, Lead Agency or DHS employee, contract case manager or a parent or advocate, there will be something for you. Register before November 1 for an early bird rate.

-- Sandy Henry, ARRM Technology Sub-Committee Chair

Senator Kent Eken Receives 2015 ARRM Leadership Award

ARRM honored Senator Kent Eken (04) with its 2015 Leadership Award on Thursday, September 24, 2015.  The ceremony took place during the ARRM Leadership Conference in Deerwood, Minnesota and recognized Senator Eken for his ongoing dedication to supporting people with disabilities across the state.

The award was founded over a decade ago to recognize innovative leaders whose advocacy has significantly impacted Minnesotans with disabilities. Recent recipients include Steve Larson of Arc Minnesota, Senator John Hoffman and Representative Jim Abeler.

ARRM CEO Bruce Nelson presented the award and commended Senator Eken for his strategic legislative efforts including rate reform and authorship of The 5% Campaign’s senate bills in 2014 and 2015. Sen. Eken's strong advocacy was instrumental in securing a five percent rate increase for Home and Community-Based Services in 2014; these essential services support more than 90,000 people with disabilities and older adults in Minnesota. The bill helped address a crisis, with the bulk of the funds going to underpaid direct care workers. 

In his acceptance speech to over 220 disability service leaders Senator Eken shared, “I got involved in politics to make a positive difference in the lives of others. Strong unity is so vital to our success.”  

He urged disability providers in attendance to continue advocating for needed reform and funding by telling their personal stories to legislators and Governor Dayton during the 2016 session. He also emphasized the importance of engaging family members in grassroots efforts. “A lot of people don't realize the severity of the workforce crisis we are in,” he noted. “Surpluses give us the opportunity to make up for cuts to Home and Community-Based service in the past.”

--Amy Wartick, Communications Director

Introducing ARRM's Technology Position Paper

In 2014 ARRM's Service Innovations Committee developed ARRM's Position Paper on Technology and Disability Services. 

This vision for the future outlines ways that technology can be used to improve disability services and make them more person-centered, address workforce issues, and reduce costs.  The paper was presented to the Minnesota Department of Human Services in the summer of 2014.

ARRM's Technology Position Paper includes a 'Resolution for a Person-Centered Approach to the Use of Technology in Disability Services'.  It also offers a compilation of real-life of examples that illustrate how providers in Minnesota are currently utilizing technology.

Read the full Technology Position Paper

DSP recognition week begins September 11

We hope you take time to celebrate direct support professionals during DSP week, which begins September 11, 2011. This is a great opportunity to demonstrate -- in a variety of ways -- how much you appreciate these invaluable employees:

Host a party or community enrichment event
Throw a party, host a reception or have a BBQ to show your DSPs how much you appreciate their work and commitment to providing quality supports. Consider having a potluck with company leaders serving the hard-working DSPs! Or gear up for ARRM’s Community Enrichment Week October 23-29 by inviting family, friends, clients, colleagues and journalists to participate in a combined DSP celebration and community event, such as a food bank drive.

Raise money for your agency or favorite charity
Schedule a fundraising event, such as a run, walk and roll. Ask participants to solicit pledges to support your agency or a local cause.

Offer tangible, daily reminders of your gratitude
Each day, give your employees something to remind them how much you appreciate their contributions. For instance, one day could be “Lifesaver Day,” in which you give your staff lifesaver candies to remind them that they're lifesavers to others. Another day might be “Refill the Caregiver Day,” where employees receive a bottle of water, reminding them to “refill their cups” and take care of themselves.

Give your DSP a token of your appreciation
If your agency has discretionary funds in its budget, present your DSPs with a small, meaningful token of appreciation from senior leaders. If funds are limited, help the people you serve create meaningful homemade totems of thanks.

Have an employee “fun day” or retreat
Bring employees together for a day of fun, thoughtful team-building activities. Ask them what activities would inspire and motivate them, and deliver a day of relaxation or casual collaboration.

Create a scavenger hunt
Plan events for the entire week in which staff search for unique objects around the program site or office. Include a photo hunt for the best picture of the staff engaged in a fun activity, and offer the winning team a pizza party and one-hour grassroots advocacy training (training courtesy of ARRM).

Leverage owned and earned media
Post pictures of DSPs with the people they serve (with the consumers' consent, of course) on your company’s website and Facebook page. Include information about the important work they do and the impact that they have on others. Or post notices in community papers to recognize exemplary DSPs, such as past winners or nominees of ARRM Cares Awards.

Gather and promote testimonials from the people you serve
Ask self-advocates to tell stories about your DSPs. Help them put their thoughts into words and share why they enjoy working with your staff, then post these testimonials in public places for all to read.

Simply say “thanks”
Make it a point to visit each program site throughout the week and personally thank your staff for their dedication and commitment. If you can’t visit everyone, send a personal letter of gratitude to each employee.

--ARRM Workforce Development Committee