State Workforce Initiatives: ARPA Spending Plan Topical Analysis
Workforce capacity is clearly a key prerequisite to expanding access to home and community-based services (HCBS). The HCBS workforce shortage has been of crisis proportions for decades and has been exponentially exacerbated by the COVID-19 pandemic. The 2019 NCI Staff Stability Report indicates that pre-pandemic, the turnover rate for Direct Support Professionals (DSPs) averaged around 43%; while post-pandemic data has not yet been validated, anecdotal evidence suggests that the workforce has been further decimated by pandemic-related issues. These challenges come at a time of escalating demand for community-based long-term services and supports (LTSS) and transition from institutional care to HCBS settings.
Out of the 49 spending plans NASDDDS examined, 44 include initiatives aimed at addressing workforce issues. These were largely focused in two main areas—increased compensation for DSPs, and staff or workforce development strategies. A handful of states propose initiatives that generally influence workforce expansion. The analysis at the link below reflects the initiatives states describe in these plans; it is important to note that CMS may request changes to some plans as they are still moving through the approval process, and also that plans may evolve through quarterly iterative updates from states
Find the full analysis here: LINK