Dana Lawrence:

While raising provider rates is necessary to address staffing issues facing that industry, I can say without hesitation that unless Oklahoma requires provider agencies to account for how that money is actually spent via “pass through” provisions, I’m afraid the State of Oklahoma will later discover that much of the millions of dollars it has now committed to improving the lives of those with disabilities will prove to be wasted. 

The recent case of taxpayer funds used to enrich the owners of Swadley restaurants through the Oklahoma Department of Tourism and Recreation is a case in point, since many of the provider agencies that contract with the State of Oklahoma to provide services to developmentally disabled individuals are for-profit entities – some of them owned by a single individual.  Grandiose ideas aside, they are in the business of making money, and the source of that money is Oklahoma taxpayers.

Since I’ve had many years to observe the workings of provider agencies and their employees, I will say that, among other things, I’ve seen provider agencies hire people known to me to be meth users.  I met one staff person who had trouble getting her client’s wheelchair in her car because she was homeless and living out of her car.  I was told by the director of one agency that she would never allow one of her family members to end up in a group home, partly because the staff routinely steals from the residents.  When I told the director of a different agency I sometimes have trouble telling the difference between the staff person and the service recipient at events, she told me “the residents are better dressed.”  One of my son’s friends who lived in a group home died after being left alone in the bathroom and hitting his head on a sink while having a seizure, in spite of the fact his IP specifically stated he was not to be left alone in the bathroom because of his seizures.

As with many other social issues, money, by itself, is not going to solve these problems. 

While it’s clear that some provider agencies are better than others, steps to improve the work culture at provider agencies is sorely needed.  It’s evident that for-profit agencies have historically been “reimbursed,” whether or not they have any commitment to the welfare of their employees, and thus to their “clients.”  As a long-time, front row observer of provider agencies, I believe that unless the state holds these agencies more accountable for how they’re actually spending the millions of dollars they’ve just been promised, the end result will NOT be quality care for the developmentally disabled, but rather just more developmentally disabled clients that the agencies are being reimbursed for at additional expense to Oklahoma taxpayers.  In addition, whether or not the state requires more accountability from provider agencies about what they’re actually required to pay employees, I think taxpayers and advocates for the disabled will increasingly be requiring more accountability from our government about the lack of quality care we’ve observed for years, even as the state has, every year, spent millions of dollars for that purpose and has failed to achieve.

The reality is that at every agency, there is a committed minority of staff workers who shoulder the majority of the workload, working 80 hours a week to make up for the vast numbers of bodies hired by agencies who come and go through a revolving door. 

In addition to work culture issues, I strongly suggest that those who are working on the implementation of this initiative look at “pass through” provisions in other states, as well as taking some other measures aimed at actually addressing these issues by increasing the level of accountability for quality of care outcomes on the part of provider agencies.

Some provisions, based on requiring provider agencies to “pass through” funding in the form of raises to employees which have been implemented in some other states have included:

*Requiring each provider receiving rate increases to track and report how those increases were spent – specifically, how that provider used the rate increase to increase the wages of all direct care professionals, beginning within 60 days of receiving the increase and annually thereafter; *Setting out requirements for the notice that providers must give to the direct care professionals they employ on the wage increase; *Creation of a mechanism by which direct care professionals may report an employer who has failed to pay the required wages and require investigation of such reports.

I’m a strong supporter of free enterprise.  However, there is a world of difference between making a profit when manufacturing widgets and making a profit from being entrusted with taxpayer funds to provide for the welfare of society’s most vulnerable.   For too long, the State of Oklahoma has increased reimbursement rates for provider agencies without requiring those agencies to “pass through” increases to employees who literally hold the lives and welfare of vulnerable adults in their hands.  

OHCA Response:

The Developmental Disabilities Services service rate increases do not include any pass through provision requirements.  However, given the current market forces, primarily the direct support professional workforce crisis and higher wages in industries that compete for the same workforce, providers will have to provide an increase in pay and/or benefits to recruit, hire and retain staff.  Thank you for your thoughtful and insightful question.