PCPA, in coalition with several other associations, has sponsored breakfast and lunch meetings across the Commonwealth to share information with legislators about the direct care wage issue. Barry Wyrick, Executive Director, Cumberland Valley Mental Health Center, made the presentation at the Harrisburg breakfast on February 23, 2000. His remarks, included in their entirety below, sum up the issue and potential solutions. PCPA thanks Mr. Wyrick and other members who have participated in these events during the past month.
I know that we have all been warned of the fact that there is no such thing as a free lunch, but no one said anything about breakfast. I guess we'll all have to decide how free this was after I get done talking. This morning I would like to take a few minutes to talk about issues related to mental health and mental retardation funding in the state. I want to briefly describe the services offered and how these services are funded, then I will discuss some of the problems related to that funding, then I will take a brief look at the Governor's Budget for 2000-20001, and finally, I will discuss some possible solutions to the problems described.
The community-based mental health and mental retardation treatment system is an integral part of the support systems in each of our communities. These services are varied, and include adult day services, vocational training programs, outpatient and partial hospitalization treatment, community residential facilities, intermediate care facilities, early intervention programs, family support services, family-based mental health services, crisis intervention services, case management services, and inpatient hospital care. This year, over 77,500 individuals will receive state funded mental retardation services. Of those, 24,500 will receive adult day services; 19,000 will receive family support services; and 15,200 will receive community-based residential services. Additionally, over 208,000 individuals will receive state-funded mental health services.
The funds to support services for these individuals flow to the community-based treatment system as follows. First, state and federal funds are appropriated to the Department of Public Welfare by the General Assembly. Then these funds are allocated by the Department of Public Welfare to County Government. Finally, the County Governments develop contractual relationships between the county mental health and mental retardation units and the community-based treatment providers.
In recent years, several factors have led the mental health and mental retardation provider community to become very concerned about the health, safety, and well-being of the vulnerable individuals that we serve. First, the current robust economy has significantly decreased the pool of quality direct care workers and has increased salary pressure for professional workers. Direct-care workers are those who provide daily direct care in residential and day treatment programs for mental health and mental retardation programs. These positions are entry-level or journeyman positions. The major task of these workers are to guide and assist individuals in learning to live and function as independently as possible within the community. These workers are becoming increasingly difficult to find.
According to the Legislative Budget and Finance Committee report in February of 1999, 33,000 direct care workers earn an average of $8.13 per hour or $15,854 annually, which falls below the 1998 federal poverty guideline for a family of four. 22% of these workers earn less than $7.00 per hour, which falls under the poverty guidelines for a family of three. Compare those numbers in the same report to the average direct care worker wages in state-operated mental health and mental retardation facilities, which in $14.50 per hour or $28,275 per year. The effect of the salary difficulties is turnover in these positions. The same Legislative Budget and Finance Committee report found the statewide average turnover rate to be 42%. The turnover doubly impacts the community providers, by losing trained workers and increasing costs of filling the positions, such as advertising, interviewing, and supervisory time. My personal experience has been that I advertise an average of three times before filling one of these vacancies, and the position in vacant on average for eight weeks, and in talking with my colleagues, my experience is not unique.
The second factor which threatens the quality of care is that as new services and programs are funded, little has been done to stabilize current programs. While new programs are being developed and funded, existing programs have remained at their same funding levels, with only limited Cost of Living Adjustments. Additionally, the continued effort to reduce the number of individuals in state institutions and to divert the admission of individuals to those institutions, there is increased pressure on the community system to provide services to more and more difficult individuals. As an aside, I must say that the community-based treatment system fully supports the concept of community rather than institutional treatment. However, as we expand the community treatment services to include those who previously would have been served in institutions, we must also make a commitment to preserve the health and safety of those who are currently receiving services in the community-based mental health and mental retardation programs.
The final factor which is threatening the quality of care provided is the consistent under-funding of the community-based treatment system. The level of funding has been a persistent worry for many years. Inflation has outpaced the Cost of Living Adjustments given to the counties by the Commonwealth for the operation of these programs. Over the last ten years, the difference between the Cost of Living Adjustment and the rate of inflation is approximately 10%. My own experience, during the last year where we saw a 2% Cost of Living Adjustment, I also saw a 20% increase in my agency's medical insurance premiums, and 30% increase in my advertising costs, and a 10% increase in my vehicle operation and maintenance costs, not to mention the fact that I had to give a 3% raise to my staff in order to prevent turnover. As the Cost of Living Adjustments provided to the community-based treatment systems falls further and further behind the real costs of operation, the provider system is forced into hard choices of limiting the quality or quantity of services being offered.
The Governor's Budget for Fiscal Year 2000-2001 offers some significant expansion in the community-based mental health and mental retardation treatment system. First, the Governor has made a major commitment to increase funding over the next several years to move individuals from state centers for mental retardation and to decrease the waiting list for those services. We are strongly supportive of the Governor's multi-million dollar, five year plan; however, there are some concerns. The new programs under the Governor's initiative will be funded at higher levels than current programs, which is likely to cause a migration of direct-care workers from current positions to those with higher salaries. If something is not done to increase the funds available to staff salaries in current programs, one of two outcomes is likely. Either the health and safety of the individuals now being served will be threatened, as direct care workers move to work in the new programs and the vacancies created will be very difficult to fill, or the new programs will not be adequately staffed.
The second major new initiative in the Governor's Budget calls for an increase of approximately $5.5 million to expand community based alternatives for persons currently residing in state mental hospitals (the Community/Hospital Integration Projects Program, also know as the CHIPPs program). Again, however, the program is being expanded with no increase in funding for current participants in the program, so the result is that the system offers more people an under-funded program.
The final comment about the Governor's Budget is that the Cost of Living Adjustment for the community-based mental health and mental retardation treatment system is again 2%. As I indicated previously, the 2% adjustment is insufficient to meet the real increases in cost that are being experience by organizations providing the service.
I promised that the last thing that I would talk about is the recommendations for correcting the problems that I have outlined today. The first of these recommendations is that the General Assembly provide an infusion of funds to stabilize the current community-based mental health and mental retardation systems. Specifically, we are requesting that the 10% difference between the state Cost of Living Adjustments and the rate of inflation be made up over the next two years. It is our recommendation that two thirds of this difference be made up this year, and the final one third be made up next year. These increases would amount to an additional $45 million dollars for mental retardation programs and $22 million dollars for mental health programs. The increases would be one-half of these amounts for next year.
The second recommendation is to allow the counties to keep unspent funds from all initiatives to contribute to the improvement of the mental health and mental retardation programs that are currently being operated. While the use of any such unspent funds would not likely be sufficient to eliminate the need for additional community program funding, it could reduce the amounts discussed previously.
In conclusion, the health and safety of some of Pennsylvania's neediest and most vulnerable residents-its mental health and mental retardation consumers-cannot be compromised. More money needs to flow into the current programs in order for these programs to provide the necessary care to the people they serve. In her written response to the Legislative Budget and Finance Committee's February 1999 report, Secretary of Public Welfare Feather Houstoun stated, "We agree that improving the salaries of direct-care workers is a worthwhile and important effort. There is no question that average annual salary levels falling below the federal poverty guidelines need to be improved." We know that the General Assembly and the Administration want to continue to provide high quality care and services to the Commonwealth's residents. By appropriating the requested funds to ensure that the current system can continue to provide high-quality care, the Commonwealth can rest assured that consumers in the mental health and mental retardation community will continue to be cared for in the most appropriate manner.
I want to thank each of you for attending today's presentation. I want to extend a special thank you to legislators and the legislative staff personnel who took time out of your busy schedules to be with us this morning. We appreciate your support of our concerns, and we will continue to be in contact with you as the budget is debated this spring.
We do have time for questions, so if any has any questions, please feel free to ask.
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