Staffing shortages, low pay and safety concerns burn out a Department of Human Services unit that cares for people with intellectual and developmental disabilities
By Ben Botkin, Oregon Capital Chronicle, March 7, 2023
Paula Burlington has scars on her wrist from teeth bite marks. She also has a shoulder injury that will need surgery.
Burlington has endured those injuries through her work for the Oregon Department of Human Services at a residential group home program in Lebanon.
Burlington is one of more than 600 employees who work for the Oregon Department of Human Services’ Stabilization and Crisis Unit. The 24-hour residential program serves up to 95 people in 20 group homes that stretch from Eugene to Portland. Residents have intellectual and developmental disabilities, often combined with mental health issues that require close supervision and sometimes more than one-on-one care.
Their demanding workload has led to employee burnout and overwork. High staff shortages, mandatory overtime and double shifts are the norm, not the exception, data and interviews with state agency employees show.
They tend to some of Oregon’s most vulnerable people in myriad ways: cooking their meals, helping them get dressed, comforting them in the midst of crises and taking them for field trips and medical appointments.
They also toil in obscurity. The group homes, usually with about five residents each, don’t attract the same attention in the statehouse as larger, high-profile facilities like Oregon State Hospital, the state’s psychiatric hospital.
Their work is just as important, they say, and the system is breaking.
Workers say they’re exhausted and risk jeopardizing the safety of themselves and residents.
Others have headed for the exits.
The vacancy rate for staff who care for residents has grown. The vacancy rate was 6.7% in July 2021, which rose to 13.3% by August 2022, according to statistics the union compiled. That 13.3% vacancy rate dropped to 10.9% in February, but only because one group home closed and its open positions are no longer factored into the rate.
The agency, in a statement, said it’s stepped up efforts to recruit staff and is committed to safety. The agency’s hiring efforts include bringing on temporary contracted staffers and increasing its presence at job fairs, with an event planned in May.
Starting salaries are often the equivalent of about $20 an hour.
Low wages are often typical in behavioral health. State lawmakers have pushed for more pay and incentives like scholarships to encourage people to enter the workforce. Lawmakers passed a bill in 2021, for example, that put $80 million toward recruiting and retaining behavioral health care professionals. But the field still faces a shortage of workers and struggles to keep people in the high-pressure, low-paying jobs.
For an employee, staff shortages can mean multiple double shifts every week. Burlington said she often works four 16-hour shifts during a five-day workweek.
“We physically can’t keep going,” Burlington said in an interview with the Capital Chronicle. “We’re being forced to literally live at work or choose our families.”
On Saturdays, if Burlington is off work, she stays in bed all day, exhausted.
The burnout among workers is so profound that even residents are worried.
“We’re so tired that even our individuals were telling us: ‘Make sure you sleep more. We want to see you come back. Make sure you’re here tomorrow.’” Burlington said. “They feel like they’re going to be abandoned by people who are here.”
Hundreds of employees work overtime.
Records compiled by the employees’ union show:
- 301 staff worked 5,020 hours of mandatory overtime in July 2022: That’s an average of about 16 hours per employee.
- Voluntary overtime adds many more hours: 565 staff worked 19,471 hours that same month. That’s about 34 hours per employee.
- Also that month, employees worked more than 17 hours some days – sometimes close to 24 hours.
Christina Sydenstricker-Brown is another caregiver who works with the residents.
In January, she worked 132 hours of overtime. Ninety of them were mandatory, she said.
Short staffing leads to injuries, workers said.
“People get black eyes, broken noses, people get bit, hair pulled out of their head,” Sydenstricker-Brown said.
In a crisis they may spit on workers, swear, make inappropriate comments or ask personal questions.
Sydenstricker-Brown doesn’t wear her wedding ring to work.
Worker injury data show:
- In July 2022, 24 employees missed nearly 2,011 hours of work because of injuries. That’s an average of nearly 84 hours per employee.
- Staff are off work every month due to injuries. Between seven and 37 staffers missed work from July 2021 to July 2022 due to injuries.
The job is fraught with the potential for injury when staffing is short, workers said. A resident in crisis may need several employees to keep them safe and avoid harming themselves or others.
Burlington’s left shoulder was injured during one such incident last September.
“When they are in a high-crisis situation, it’s fight or flight mode,” Burlington said. “That’s the risk of the job.”
A resident was struggling and needed several people to keep her safe as she moved about. They surrounded her to keep her from hurting herself.
“She was just really, really wildly just flinging and flailing and whatever she could do because that is when fight or flight kicks in,” Burlington said. “We’re trained to help hold and keep them safe.”
Burlington injured her shoulder. “It’s like a WWE match in some instances where we’re just trying to literally hold them but they’re trying to kill us,” she said.
People get hurt when staffing is short. Burlington’s five-resident home is supposed to have seven workers during the day and evening – one per person and two to give them breaks, cook meals and provide other relief.
Often the home runs with only five workers. That creates “very dangerous situations” when a client has a crisis, Burlington said. One day, she was on restricted duty due to her shoulder injury. But an incident erupted involving an autistic man who needs several people at times to help him.
“I was in the kitchen, prepping dinner, and then I hear some shuffling,” Burlington said. “I looked out and this individual who was nonverbal had another staffer by the hair, yanking them around.”
Despite her injury, she had to help.
“We had to keep my name out of the paperwork,” Burlington said.
The employees union, the American Federation of State, County and Municipal Employees union Local 1246, is bargaining for a new contract with the agency. Employees want better compensation to attract workers.
A job posting for caregivers in the unit – called direct support crisis specialists – advertises a monthly pay range of $3,264 to $4,911 for full-time employees.
The hourly range: $19.24 to $27.48 for part-time employees.
The posting also tells applicants they’ll need to work “occasional overtime.”
Employees say the pay isn’t enough to attract or keep people for the long term.
The job requires workers to navigate stressful situations with people who have endured hardships in life.
Some have passed through Oregon State Hospital, spent time in jail or lived on the streets. Others were in the foster care system as children.
They enter the homes through referrals, the Department of Human Services said. Elisa Williams, a spokesperson for the agency, declined to answer how long people stay in the group homes, whether there’s an average length of stay or whether stays are for a set period of time.
It’s “highly variable,” based on the person, she said.
Some residents go to school or have jobs. With a full staff, employees can take people to the beach.
But when staff is short, residents might have to skip school because no one is available for transportation, Sydenstricker-Brown said.
“It makes you feel even worse about coming to work because you’re not able to get all the needs met that you want to,” she said. “You’re not energized. You don’t have a fully-charged battery because you’re tired.”
Effect of extra pay
From November 2021 to April 2022, employees received pandemic pay: an extra $6 an hour during the week and $14 an hour during the weekend. For a full-time employee, that quickly added up to an extra $1,000 or more a month.
The extra money helped morale and attendance, said Sydenstricker-Brown, president of the union for her unit.
“People had more incentive to come to work, even though they were exhausted and tired and at least the morale was up more because you were making this extra money,” she said. “I could put money away for my kids’ college fund. I could take them to do some special things on the weekends because I had extra money to be able to afford that.”
She said the pay structure has affected her at work. Her Salem home usually has about seven staff on a day shift. But sometimes it has fewer.
If residents are out for appointments with other staff, two staff members might be in charge of three residents. If one resident needs constant supervision, that leaves just one staff member in charge of two people who might live in different parts of the home.
“So it puts a real strain on it and you can’t get a break when everybody’s gone,” Sydenstricker-Brown said.
Williams said the agency has taken steps to increase staffing like hiring more than 120 contracted workers for an eight-week period in the winter of 2021. She also said it has streamlined the hiring process. The union and agency plan to have a “rapid hiring event” in May, Williams said, and offer applicants a chance to get an offer the same day.
The agency also works on retention, Williams said. Managers periodically check in with new staff to address challenges, see how they’re doing and give feedback. She said the agency tries to support new staff and get them off to a good start.
“We are continuing to explore new ways in which we can recruit and retain employees,” Williams said.
Williams didn’t address employee safety concerns. She said the agency is committed to adequate staffing for the safety of staff and residents, and that homes are required to maintain safe staffing levels at all times.
Burlington said she’ll be scarred for life.
“I have teeth marks that belong to an individual permanently on me, she said.
Only 37, Burlington, may not be able to do her job when she’s older: Her doctor has said her shoulder injury likely will end her career early.
But with no other options, Burlington has delayed surgery while working double shifts.
“I’m in pain every day because of this, but there’s nothing I can do at this point because this is how I provide for my family,” Burlington said. “And if I left my job, there’s literally no way I could provide. We’d be on the streets.”
FEATURED IMAGE: Paula Burlington, a worker with the Oregon Department of Human Services, has been injured on the job. She takes care of people in a 24-hour residential program that is understaffed. (Ben Botkin/Oregon Capital Chronicle)
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