MLA Information Package 2023

Crisis Costs PEOPLE E XPERIENCING

DISABILIT Y PAYING THE PRICE

ML A INFORMATION PACK AGE 202 3

The Issue Services and opportunities for people experiencing intellectual and developmental disabilities in Saskatchewan are being compromised because of a funding crisis in the Disability Service sector that is threatening service providers’ workforce and operational stability.

Workforce Stability: The 2022 provincial average for staff turnover in the Disability Service sector was 30%, and vacancies are remaining open for much longer than in prior years. Short-staffing and the revolving door of new employees is jeopardizing the dignity, health, and safety of people relying on supports.

This struggle to recruit and retain quality employees is rooted in simple math: Direct Support Professionals working for community-based organizations (CBOs) in the Disability Service sector can earn more salary and have better benefits doing similar work in Healthcare and within homes directly operated by the Government of Saskatchewan (Ministry of Social Services).

When we can recruit, we often hire and train people only to have them leave for better-paying opportunities.

While SARC Members are grateful for previous government investments toward employee compensation, these investments have not been enough to address inequities between CBO Disability Service sector wages, Healthcare wages, and Ministry of Social Services employee wages paid for roles with similar responsibilities. CBOs cannot competitively recruit and retain quality employees to provide quality services.

Operational Stability: The SARC Membership is made up of nonprofit organizations that know how to stretch a dollar.

But there comes a point when organizations are stretched so thin that things suffer.

Delivering person-centred services and supporting people to be part of their community is supposed to be foundational in the Disability Service sector. The unfortunate reality is that this is the area that is forced aside when the money has to be directed to address chronic underfunding and the rising costs of insurance; audit; sprinkler system, fire and health inspections; food; cleaning/other supplies; etc. – the bills that must be paid.

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When CBOs are struggling to pay the bills, what things aren’t happening?

• People can’t participate in physical, social, or educational activities or attend celebrations or spiritual gatherings because there is not enough money for accessible vehicles or the fuel – inclusion requires access to community and access must include transportation. CBOs need to be properly supported with transportation costs.

• Homes and facilities aren’t being properly or proactively maintained at the detriment of accessibility and safety. CBOs need to be funded appropriately for repair and maintenance costs.

• In 2023, every business requires computers and IT systems to effectively operate. This is not a want; it is a need and requirement of doing business. CBOs are wasting time and resources working within inefficient systems or without what most people would consider standard equipment and software. CBOs need to be adequately supported with technology costs.

INSTABILITY IMPACTING SERVICE DELIVERY The principles of person-centred service are rooted within The Saskatchewan Disability Strategy – People Before Systems: Transforming the Experience of Disability in Saskatchewan, which is aimed at moving the disability service system forward to better serve people experiencing disability.

Visit Person Centred Saskatchewan for more information

Since its release in 2015, the strategy and person-centred service have been central to Government direction and initiatives in partnership with CBOs toward moving the needle on community inclusion and service delivery.

The reality is, however, that community inclusion and person-centred practice rely on many factors that CBOs have to be very intentional about: • • • •

Quality staffing (in terms of skills, values, and attitudes) Staffing ratios Resource management Transportation

Through the Saskatchewan Disability Strategy and the Ministry of Social Services’ expectations and contractual obligations, the Government of Saskatchewan has established the vision of person-centred services and community inclusion for people experiencing disability and contracts with CBOs to provide these services. However, funding available through these contracts does not support service delivery.

WORKFORCE STABILITY + OPERATIONAL STABILITY

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SAFE PERSON-CENTRED SERVICES & CONSISTENT ACHIEVEMENT OF CONTRACTUALLY OBLIGATED OUTCOMES PAGE 3

Workforce Stability THE IMPACT OF INSTABILITY

Employee turnover in the Disability Service sector is at a dangerously high average of 30%.

Certain communities are even harder hit. What does high turnover look like? What is the impact?

• Unable to fill shifts — employees are exposed to health and safety risks and are sometimes forced to perform maneuvers, such as lifts and transfers, without the required number of personnel.

• Overworked staff filling vacancies, resulting in things being missed and mistakes being made.

• Employee fatigue due to overtime and/or working multiple jobs to make ends meet.

• Revolving door of new employees that require training — very expensive and time consuming.

Training also may not happen when it needs to, placing employees and the people supported at great risk.

• Supervisors are providing direct support rather than overseeing quality assurance and the adherence to standards and policy. They are also unable to train, coach, mentor, or monitor the people they were hired to supervise because they are working on the frontline.

• Hiring for bodies rather than quality fit.

• CBOs, as the employer, feel trapped when a performance issue arises. They need to keep the employee and are forced to “overlook” issues they would have previously dealt with.

“We have to hire almost anyone coming through the door because no one is working for these wages – can’t hire for skill or attitude.”

“We are hiring people we never would have considered a couple of years ago.”

“If they have two feet and a heartbeat, we have to hire them just to remain operational. This is not a safe or acceptable way to support people; many of whom have extremely complex behaviour and medical needs.”

“We have very vulnerable individuals that have developmental disabilities that we support. With up to a 40% staff turnover, those individuals have multiple staff in and out of their lives within a year. We teach boundaries and safety around strangers, yet they are expected to trust the people in their lives that are hired as staff.”

Statements made by SARC Members between April and July 2023

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THE NEGATIVE IMPACTS FOR PEOPLE RELYING ON STAFF SUPPORTS IS REAL: • • • • •

Service reductions/closure Increased medication errors Increased injuries Increased admissions into hospital and the involvement of law enforcement Increased crisis and behavioural incidents amongst people supported as they struggle with constant change, loss of staff relationships, and inconsistent supports • Indignity of revolving door of employees providing intimate personal care • Reduced access and inclusion in the community, limiting the right to relationships, recreation, and work “So many people are going through a person’s life. Not individual centred.”

“The participant who is completely dependent on someone to drive them to an activity and to support them for safety is not able to do the activity or job that they intended. We would never consider asking someone to be without their wheelchair, seeing eye dog, white cane or etc. Why is it ok to be without the staff support needed to be included in our community?”

“Workers are exhausted; it becomes impossible to provide anything beyond life necessity. Advocacy, inclusion, person-centredness is not able to be provided.”

“Turnover rates are causing relationship issues and trust issues with people and families; more meetings with families related to concerns regarding level of care.”

“A parent came in to talk with us about medical concerns that were occurring with her child. This parent said, many staff have left at her child’s group home and she worries that no one with any history of her child’s medical and behavioural needs will be left supporting her. She worries about the future.”

“The staffing shortages have significantly impacted our ability to provide and maintain consistent programs to adults with disabilities. These programs provide community involvement which all citizens should have access to.”

THIS SECTOR SUPPORTS A VERY VULNERABLE POPULATION – QUALITY OF LIFE, HEALTH, AND SAFETY ARE IN EMPLOYEES’ HANDS. WHAT’S IT GOING TO TAKE FOR MEANINGFUL ACTION? Statements made by SARC Members between April and July 2023

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A Direct Support Professional is a Skilled Position Delivering Essential Services.

The Direct Support Professional position demonstrates skills required in multiple other professions in order to support people experiencing disability to lead healthy, safe, and fulfilling lives in their community. This “wearing of many hats” is the reality of what is required in a community-based setting.

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DSPs are the first response of physical and mental health services in both routine and crisis situations.

DSPs identify triggers and solutions when supporting people who display challenging and potentially harmful or dangerous behaviours by utilizing techniques in positive behaviour support and crisis intervention/prevention – these skills are absolutely necessary to ensure the safety of the individual, other people experiencing disability receiving services, and fellow employees.

DSPs support people through all aspects of their lives, including challenges faced with mental health, addictions, and interactions with the justice system and are relied on by these systems to provide necessary supports.

Employees often work alone, which requires

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sound judgement and poses additional risks. They also work without the support of therapeutic or nursing teams.

DSPs’ work is physically strenuous, often involving lifting and moving people to assist with mobility and personal care.

DSPs are required to understand and convey information related to healthcare, skill development, goal progress, and behavioural analysis as part of support plans and regulatory compliance.

DSPs are highly adaptable in order to support each person’s unique needs and choices; it is an enormous responsibility to play a supporting role for people as they make very personal and sometimes complex decisions about their lives.

“Staff in our sector are doing comparable work to SHA staff with significantly less benefits and lower salaries. In the SHA there are numerous front line or team lead positions offering an array of specialized support such as Recreation/Activity Workers, Social Workers, Continuing Care Aids, Physical/ Occupational Therapy Assistants, Nurses, Dietary Aids, Janitorial, etc. In the CBO sector, these roles and responsibilities are condensed into two positions, Direct Support Workers, or Program Coordinators.” – SARC Member

CBOs need improved funding to be able to compensate their workforce for the skills, responsibilities, risk, and complexity of work required.

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DSPs, GAAs, and CCAs How do they compare?

JOB DUTIES

The work of CBO Direct Support Professionals in the Disability Service sector, Group Activities Aides in Government-operated homes for people experiencing disability, and Continuing Care Assistants in the Healthcare sector are managed through separate funding systems, but they have a lot in common.

DSP DISABILITY SERVICE SECTOR

GAA GOVERNMENTOPERATED HOMES

CCA HEALTHCARE SECTOR

LOCATION

Community Setting

Community Setting

Long-Term Care Facility

SERVICE RECIPIENTS

People experiencing intellectual/ developmental disabilities

People experiencing intellectual/ developmental disabilities

Primarily Seniors

COMPARISON OF ROLES

SUMMARY OF DUTIES

QUALIFICATIONS EXPERIENCE

Provides personal care and activities of daily living for clients/patients/ residents to encourage optimum level of functioning. Supports clients/patients/residents in meeting their physical, emotional, psychological, and spiritual needs.

Certificate preferred but not required.

No previous experience.

EMPLOYEES IN ALL THREE OF THESE JOBS ARE EXPECTED TO BE ABLE TO: • Support people with daily living as per their individual support plan • Provide personal care to people (ex.

Hygiene, eating, dressing) • Assist people with medication • Perform certain specialized healthcare procedures • Provide mobility assistance (ex.

Transferring, lifting, and repositioning) • Prepare meals

• Transport people to appointments and activities • Perform various cleaning duties • Identify triggers and address potentially harmful/dangerous behaviours displayed by people supported • Document and report on physical and psychological observations and changes in condition of people supported

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DSPs, GAAs, and CCAs How do they compare?

SALARIES AND BENEFITS

DSP

GAA

CCA

(AS PER MINISTRY OF SOCIAL SERVICES CBO FUNDING STANDARDS)

(AS PER CUPE LOCAL 600/GOVERNMENT OF SASKATCHEWAN COLLECTIVE BARGAINING AGREEMENT)

(AS PER CUPE LOCAL 5430/SAHO COLLECTIVE BARGAINING AGREEMENT)

WAGE/HOUR

$19.72*

$23.55**

$23.97***

SHIFT PREMIUM

No funding for this

$1.90-$3.05/hour

$2.75/hour-$5.00/hour

Employee Contribution: 4%

Employee Contribution: 8.6%

Employer Contribution: 4% (most common arrangement due to funding constraint) Ministry requires CBOs to provide LTD, Dental, and Life/AD&D but funding doesn't cover costs

Employer Contribution: 8.6%

Employee Contribution: 8.1% up to YMPE; 10.7% above YMPE

Disability Income Plan, Life, Extended Dental, Extended Health

LTD, Dental Group, Life, Enhanced Dental, Extended Health

EAP

No funding for this

Yes

Yes

SICK TIME

5 days/year

15 days/year

15 days/year

VACATION TIME

3 weeks/year

4 weeks/year for 8-year employees up to 6 weeks for 22-year employees

4 weeks/year for 4-year employees up to 6 weeks for 25-year employees

PENSION

BENEFITS

Employer Contribution: 9.07% up to YMPE; 11.98% above YMPE

* This is the average wage earned by a DSP. CBOs in the Disability Service sector set their own wages based on funding received from the Ministry of Social Services. The current funding standard is $22.70/hour; however, organizations must treat this like a median as they have to create a wage grid from it. Additionally, the funding standard gets diluted as organizations are forced to take some of these salary dollars to pay for various areas of employee benefits, vacation, and sick time, which are not funded adequately. ** For comparison purposes, we are using Step 3 of the 5-step grid for GAAs as per the Government of Saskatchewan-CUPE Local 600 Collective Bargaining Agreement. *** For comparison purposes, we are using Step 2 of the 3-step grid for CCAs as per the SAHO-CUPE Local 5430 Collective Bargaining Agreement.

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Funding Realities are dragging down the DSP's Wage.

If we were simply comparing the Ministry of Social Services’ funding standard provided to CBOs to pay DSP wages to the wages paid to Group Activities Aides in Government-run homes and Continuing Care Assistants in Health, we would require a top-up but we would not be that far off: $22.70 vs. $23.55 vs. $23.97 - the gap is about $1.00/hour The problem is that we can’t look at these numbers as straight wages in all cases. For CCAs and GAAs, we can – those dollars are what the employees earn. In the Disability Service sector, employees don’t get to have the full funding standard passed on to them as a wage, so they earn less – quite a bit less: $19.72/hour. $19.72 vs. $23.55 vs. $23.97 – the gap is now about $4.00/hour

Why is this happening?

• CBOs are forced to take salary dollars and up with legislative requirements and what put them towards the true cost of employee it states as the minimum requirements benefits (benefits packages and mandatory for employee benefits (LTD, Dental, Life/ employment related costs – CPP, EI, WCB).

AD&D) and it fails to recognize the reality • The Ministry of Social Services funds that most employees are expecting to see CBOs for benefits at approximately 16% of Health coverage as part of their employee salary funding, and this rate has remained benefits package. relatively unchanged for close to 20 years. • Benefits aside, CBOs are also underfunded • Today’s typical benefits costs are in the for employee sick and vacation time, so the neighbourhood of 21-23%, making the salary funding standard gets further diluted funding gap 5-7%. to try to address legislative requirements • The Ministry’s funding struggles to keep and labour market competitiveness.

The Disability Service sector cannot have comparable base wages until the other areas of employee benefits that are underfunded are addressed.

Because of all the skills employees in the CBO Disability Service sector have, they are wellequipped and sought out to take better paying jobs in Health and in homes directly operated by the Government of Saskatchewan (Ministry of Social Services). They get a better base wage, shift premiums, better pension and benefits packages, more sick time, and more vacation time by choosing similar work outside of the CBO Disability Service sector. It’s an easy choice.

The inequities that exist between CBOs and the Health sector and even within the Ministry of Social Services (as funders to both CBOs and their own homes) make no sense.

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how do we achieve workforce stability?

THE CBO DISABILITY SERVICE SECTOR NEEDS THE GOVERNMENT OF SASKATCHEWAN TO: • Increase the Ministry of Social Services CLSD CBO salary funding standard for the DSP position • Provide corresponding percentage increases to other Ministry of Social Services CLSD CBO salary funding standards (to maintain integrity of funding/wage grid structure) • Increase employee benefits funding to better recognize true costs and eliminate the need to dilute the salary funding standard in order to pay for benefits • Fund a multi-year public relations/recruitment campaign for the Disability Service sector • Commit to a predictable process and long-term strategy for equitable pay across comparable positions funded by Health and Social Services • Support a third-party evaluation of Ministry of Social Services CLSD CBO salary funding standards (Including shift premiums, vacation, sick time, and benefits)

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operational stability THE IMPACT OF INSTABILITY

Several Ministry of Social Services funding standards have been insufficient to cover CBO operating costs for years. They have not kept up with the rising costs of operational realities or regulatory compliance (ex. insurance, audit, inspection fees).

To make ends meet and pay for the things that must be paid for, CBOs sacrifice other things.

Sadly, some of these sacrifices have direct impact on people experiencing disability. As per a resolution passed by SARC Members at SARC's 2023 AGM, we are highlighting the following areas: It’s extremely difficult to meet contractual obligations for person-centred services and community inclusion when you can’t afford to get people to the places they’d like to/need to go. CBOs aren’t supported adequately to have and maintain vehicles or pay for the gas to drive people to appointments, community services, or recreation, physical, social, spiritual, or educational opportunities.

While we need to acknowledge the recent increase of 9% to the Transportation TRANSPORTATION funding standard, that only funds a group home at $2,117.96/year plus either $271.96/year/client (rural) or $183.45/year/client (urban). That's simply not enough to cover accessible vehicle payments, licensing, maintenance, or mileage rates for employees using their own vehicles.

MAINTENANCE

INFORMATION TECHNOLOGY

CBOs need more support to maintain the group homes and day program locations that the Ministry of Social Services has invested in. When the unexpected happens, when you are trying to extend the life of assets by performing routine maintenance, and when you are wanting to make spaces more accessible and safer for the people who are using and living in them, you need a reliable and predictable repair and maintenance fund.

The world of work relies on technology to maximize efficiency. While the Ministry of Social Services has CBO funding standards for ‘telephone’ and ‘telecommunications’, they are inadequate, and there is no funding recognition for computer systems, licenses, HR or accounting software, or network/security infrastructure. There is no funding available for client file management systems or to ensure the security of this digital information. The funding standards have failed to evolve and do not reflect technological realities, expectations, or general business IT support needs.

The ability to provide person-centred services hinges on the Disability Service sector’s overall ability to function effectively. The Ministry of Social Services’ non-salary funding standards are flawed and inadequate. They do not acknowledge today's legitimate operating costs and require a comprehensive review.

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how do we achieve operational stability?

THE CBO DISABILITY SERVICE SECTOR NEEDS THE GOVERNMENT OF SASKATCHEWAN TO: • Increase the Ministry of Social Services CLSD CBO non-salary funding standards • Support a third-party evaluation of non-salary funding standards to assess the current structure’s ability to support Disability Services

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Imagine Where We’d Be without the Disability Service Sector.

We are an essential service serving a vulnerable population.

For thousands of people experiencing intellectual and developmental disability across the province, SARC Members are providing direct, daily supports in all areas of a person’s life, including but not limited to personal care, medical care, behavioural support, independence, relationships, and decision-making.

We are a bridge to community – from the physical standpoint of transportation and access and the standpoint of facilitating opportunity and inclusion.

What would quality of life for people experiencing disability be if the CBO Disability Service sector no longer existed? Imagine what it would be like if the sector became so unsustainable due to funding struggles and workforce instability that service organizations couldn’t continue to operate: • The serious and negative impacts for people would be many when it comes to physical and mental health.

• We would see many families in crisis, as their loved one no longer had a home to live in or support staff to help them throughout their day.

• Peoples’ needs wouldn’t go away, but they’d end up being dealt with in ways that don’t fit, don’t help the individual, and have a high cost to taxpayers – incarceration, hospitalization, mental health facilities, etc. People would fall through the cracks.

CBOs are in the best position to understand and support the needs of people and their communities.

But the reality is that CBO funding has not kept pace with the Ministry of Social Services' expectations for service delivery, contractual obligations, and rising costs, and our system is under duress – this puts people experiencing intellectual and developmental disabilities and our communities at great risk.

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The Disability Service sector needs solutions.

WORKFORCE STABILITY: •

$21.6 million that will: • Increase the Ministry of Social Services CLSD CBO salary funding standard for the DSP position to $23.84/hour • Provide corresponding percentage increases to other Ministry of Social Services CLSD CBO salary funding standards (to maintain integrity of funding/wage grid structure) • Increase employee benefits funding to 22% to better recognize true costs and eliminate the need to dilute the salary funding standard in order to pay for benefits

• $750,000 over 3 years to support a public relations/recruitment campaign for the Disability Service sector • Commitment by the Ministries of Health and Social Services to a predictable process and long-term strategy for equitable pay across comparable positions • A third-party evaluation of Ministry of Social Services CBO salary funding standards (including shift premiums, vacation, sick time, benefits)

OPERATIONAL STABILITY: • 10% funding increase for CBO Transportation, Maintenance, and IT costs • 3% funding increase for remaining Ministry of Social Services CLSD CBO non-salary funding standards • A third-party evaluation of Ministry of Social Services CLSD CBO Non-salary funding standards to assess the current structure’s ability to support Disability Services WORKFORCE STABILITY + OPERATIONAL STABILITY

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who are sarc members?

Over 50 Saskatchewan communities.

Over 4000 employees.

In many rural communities, SARC Members are among the largest employers. They are part of the fabric of the community, with their employees paying taxes, volunteering with community groups, and supporting local businesses.

Supporting over 6000 people experiencing disability.

SARC Members are active contributors to their local economies by paying taxes, providing employment, and believing in ‘buying local’ when it comes to their operational supplies (ex. groceries, medical supplies, office supplies).

The SARC Member Network has over 100 non-profit organizations, with over 75 of them providing essential, daily supports to people experiencing intellectual and developmental disabilities.

SARC Members are in over 50 communities across Saskatchewan, making it possible for people to receive services in or near the same community as family and friends.

SARC Members value community relationships, volunteering at community events and partnering with other nonprofits to deliver services.

IMAGINE WHERE OUR COMMUNITIES WOULD BE WITHOUT SARC MEMBERS. IMAGINE WHERE PEOPLE EXPERIENCING INTELLECTUAL AND DEVELOPMENTAL DISABILITIES WOULD BE WITHOUT THEM. PAGE 15