Presentation of Idaho Reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.

Melissa Davlin: Tens thousands of Idahoans who are elderly or have disabilities rely on direct care workers to live independently.

But there's a shortage of those workers.

We take a look at the impact of that shortage and what lawmakers can do to help.

I'm Melissa Davlin.

Idaho Reports starts now.

Hello and welcome to Idaho Reports.

This week, producer Ruth Brown explores the impacts of Idaho's direct care worker shortage on those who rely on those workers for daily help.

Then Kevin Richert of Idaho Education News joins us to discuss Tuesday's election results.

But first, let's get you caught up on the week.

On Monday, Governor Brad Little announced that he has appointed Judge Cynthia Meyer to Idaho's Supreme Court after this year's retirement of Justice John Stegner.

Judge Meyer is a first district judge chambered in Kootenai County.

Governor Butch Otter appointed Judge Meyer to the first District in 2015.

Judge Meyer has been the presiding judge in recent litigation over actions taken by North Idaho College’s Board of Trustees.

This week, members of the Legislature's Joint Finance Appropriations Committee took tours of state run facilities in the Treasure Valley, including the South Idaho Correctional Institution, where officials discussed issues running Idaho's correction facilities.

Josh Tewalt: I think in a lot of historically in how we have designed prison infrastructure, if we've got that wrong.

We have taken our more secure infrastructure, we'll have two man cells, we'll make it ultra hard.

And as people demonstrate that they're doing the right things, that they're making the right decisions, we reward that behavior by putting them in an open dorm barracks style housing unit with 150 of their closest friends.

With no privacy, with, you know, everything's out in the open.

And it's a really tough living environment.

Sen. Carl Bjerke: Coming into this last half of the session with new chairs, new vice-chairs, new people on the committee.

Meeting sometimes to that first day of that, you know, first day of the session in JFAC.

And then trying to go through 108 agency budgets and potentially 150 budgeting decisions.

There was a lot to do.

Tewalt: One of the ideas the Board of Corrections considered and ultimately approved is a, is a program that we call Expanded CRC, Expanded Community Reentry Centers.

These are men and women who, within the last two years of their system.

To get into a CRC, you're low risk, you're doing all the right things.

They're employed in the community, they're working in the community all day and then they come back and sleep with us at night.

It's uh, they are the single most valuable real estate in our entire system.

In terms of preparing people for reentry.

Yeah, I think a lot of times when we talk about corrections, we're talking about number of beds.

And I think the better conversation is making sure that we have the right beds for our system.

So we certainly need more capacity, but we need a different kind of capacity.

And so for us, we have a number of people living in beds of a higher security designation than what than what we would classify them.

And so, you know, as a matter of policy, having minimum custody type beds that can that can help provide different opportunities for people, it's a good policy, but it's also better math because the right beds are cheaper to build than really, really secure and hard infrastructure that quite frankly, doesn't match the composition of our population.

Bjerke: It gives a lot of perspective.

It gives some people needed perspective.

It gives some other people a perspective they don't need.

Right.

Because they have some idea about it.

For me, what’s frustrating is that it doesn’t, that it’s really difficult to get that same perspective to the rest of the state.

You know, but for us as legislators representing them here, it's good that we know, and we come here.

We see the true, you know, facts on the ground, what we're budgeting for, you know, what we're appropriating and how that works out.

Tewalt: Corrections consumes a lot of the state budget.

A lot of people care deeply about public safety and correction’s role in it.

So I think it it really is exciting that for them to come out and see firsthand, you know, what corrections is, get to see, you know, the people who live here as well as the people who work here.

I know it means a lot to both of those groups.

But there's just it's hard it's it's really hard to describe the value in talking about something versus bringing people out where they can see it.

Davlin: On the Idaho Reports podcast this week, associate producer Logan Finney talked with Twin Falls County Jail Administrator Captain Doug Hughes about measures that jails take to address overcrowding in jails after failed votes to expand those facilities.

You can find the Idaho Reports podcast wherever you get your podcasts.

A natural gas outage shut down government facilities on the Palouse this week, including city, school and court buildings between Lewiston and Bovill.

The University of Idaho in Moscow was also closed Thursday and Friday.

A worker on an excavator accidentally hit an underground gas pipe on Wednesday afternoon.

According to the Moscow-Pullman Daily News, the gas outage affects more than 36,000 households, businesses and schools.

While that pipe is now fixed, it will take a few more days for that gas to be restored to every customer.

Idaho Fish and Game has detected chronic wasting disease in Idaho for the first time this hunting season.

This time it's in Valley County, which is a different location than previous positive samples in Idaho County.

That changes how Idaho Fish and Game manages the disease.

Krysten Schuler: That's the hard part about chronic wasting disease is that there is a really long incubation period.

And so when they are exposed to the disease, it may be a year or more before they start showing any signs.

But during that time they're actually shedding prions, which are the abnormally folded protein particles that cause chronic wasting disease in their saliva, their feces and their urine.

So they're they're walking around, shedding these into the environment.

Davlin: A federal judge has temporarily blocked enforcement of Idaho's law prohibiting non-custodial adults from taking minors across state lines for abortions.

This comes a week after news of an 18 year old Pocatello man and his mother face kidnaping charges for taking that man's minor girlfriend to Oregon for an abortion.

The pair does not currently face charges under the anti-trafficking law.

An estimated 33,000 Idahoans rely on direct care workers for daily assistance on tasks like bathing, transportation and household chores.

Direct care workers help older adults and people with disabilities live independently and play a critical role in keeping more Idahoans out of assisted living facilities.

But there is an acute shortage of people in those jobs.

Earlier this year, the Office of Performance Evaluations released a report on the state's direct care worker shortage, estimating the state needs to fill at least 3,000 more direct care jobs.

This summer producer Ruth Brown spent time with some Idahoans who rely on the direct care workforce for their daily needs.

Caregiver: I’m gonna fill your water too.

Shiloh Blackburn: Thank you.

Ruth Brown: Direct care workers make it possible for Shiloh Blackburn to live independently in her Pocatello apartment.

Blackburn has cerebral palsy and relies on those workers for daily help.

Those workers are in short supply across Idaho.

Blackburn: They help me get up out of bed and into my chair.

And let me clarify that one part.

Once I'm in bed, I can’t get out of bed on my own.

Once I'm in my chair, I cannot get out of my chair on my own.

I have to have help.

Say if somebody does not come in for a shift.

I'm stuck.

Because like I said, I can't get out of bed or out of my chair.

So I can't take myself to the bathroom.

I can't cook.

I can’t get my medication or vitamins and whatnot.

It's really been stressful the last couple years trying to find people that are reliable and accountable and trustworthy.

Brown: Shiloh has Medicaid and Medicare and is under self-directed care.

Self-direction means a medicaid participant has decision making authority over their care, and it's a person centered care process based on their needs.

Blackburn: Up until this year, I’ve only been able to pay people $11 an hour and even then I had to go through several hoops to get a larger budget on self direction.

And my budget controls how much I can pay my caregivers and how many hours I get during the day.

Brown: The number of hours of service she gets during the day can impact many things she needs them for, such as food preparation, hygiene support, medication and companionship.

The alternative would be to rely on her parents, whom Shiloh knows are aging, or she would be forced to live in a group home.

She also argues that in the long run, a group home or a nursing home would be more expensive to the state.

Blackburn: One of the things that concerns me most is that caregivers are not paid as much as other fields of work.

Right now, my caregivers, they don’t have benefits, they don't get paid time off.

They don't get holiday pay.

Because that's not in my budget.

That's not something my caregivers and other caregivers have, you know?

They really are hardworking and they really care about me and they want to make sure I get the care I need.

But at the same time, they have their own lives to live and they have their own needs.

Rochelle Larson: Look, where are you?

You're in here somewhere.

Brown: For Rochelle Larson of Rigby, direct care workers help her family better take care of and manage the life of two children with disabilities.

Brynnle: It’s me.

Larson: Is that the governor?

So we have two children with special needs.

We have a son, Abraham, who is 14, almost 15.

And then our daughter Brynnle, who is ten.

She has Down syndrome.

Brown: Abraham used a habilitation interventionalist, which is hired through an agency.

The family gets about 10 hours a week for services.

Both children use Medicaid's family directed support service to hire workers.

That system isn't always perfect.

Larson: In the last couple of years, we've seen an increase in turnover in workers with Abraham for sure, and agencies not like being on a waitlist to be able to even get services as well.

So we felt very fortunate when we were able to actually receive services.

And then just in this past year, he has had four different people work with him and he's had about four months without anybody being available to work.

Schedules are very important and routines and finding someone that works well with your child and they have a relationship and they start making progress on goals that they're working on.

And then the worker leaves for another job.

And then we have a transition and we're starting all over again.

And so it feels like we make a little bit of progress and then a worker changes or leaves and then, it feels like we're starting at square one again.

So it just gets frustrating as a parent to see your child make, make some progress and then regress and then feels like that cycle just goes over and over and over again.

Brown: Brynnle uses a direct care worker to help her focus on goals and offer her parents respite.

Larson: We hire the individuals that come in and we work with them to get to know her and to train them on the goals that we're working on and the expectations that we have for her and for the workers.

We've found that in our area there's a lot of college kids and so there are people that are looking for jobs, but we can't pay what other businesses are paying.

And so it's really difficult to be able to keep workers at a steady rate.

Most of ours have another job and so their hours are very limited to be able to work with our children.

We try to bring them into our family and make them part of our family, hopefully to get them to stay and work longer because we see with her as well, she's very routine oriented.

Brown: The Larson family tries to supplement their budget when they can, but Rachelle knows they can make more at other jobs.

Larson: We've taken them on vacation with us and then we have them work for a few hours, but then the rest, they're just on vacation with us.

And we try and, you know, we supplement when we can as well with our own finances and just try to make it worthwhile, hopefully, for them to want to stay, because we know it is lasting job.

But it is also very rewarding when you see your children progress and the people that they're working with, when you see them meet a goal, it is very rewarding.

And so for us, I think we just really try to make them be part of our family so they never want to leave us.

Brown: Rochelle has seen the benefits of having a good care worker and stressed that the value of that is something that needs to be reflected in their wages.

Larson: I feel like that's a big reason why we have such a shortage, and because it is an exhausting job, it's hard to work with individuals with disabilities because it's either physically hard.

You know, with our son Abraham, it's mentally and physically draining.

And so to be compensated for that work would be amazing because we value that so much.

I know our family couldn't do a lot of the things that we do, you know, typical things that families take for granted.

If we didn't have that extra support and care in our home.

I feel like sometimes maybe government and even outside, you know, just people in general feel like they're just glorified babysitters or someone there to help watch your kid.

When they're doing a lot more.

They are working on goals and outcomes and trying to help our children be able to to contribute to society.

Davlin: That same report had recommendations for how to address the worker shortage: More pay.

The state sets Medicaid payment rates, and direct care providers rely on those rates to pay their workers and provide services.

On Thursday, the Our Care Can't Wait Coalition held a legislative luncheon to address what the legislature could do to help.

Amanda Bartlett: The most direct thing that Idaho could do to support a sustainable direct care workforce is to address the Medicaid rates.

So Ryan walked through the four different components that go into Medicaid rates.

We're going to focus for a moment on specifically the decision points that are in the target hourly wages.

The first thing that we recommended was that to take a look at how we are setting what that target hourly wage is.

Right now most of the Medicaid services sort of have one occupational benchmark that they compare to.

Maybe that is a home health aide, maybe that's a personal care assistant, as reported by the Bureau of Labor Statistics.

That decision gets made during the cost survey process.

I think our suggestion was that we look at what those benchmarks are and maybe consider using a group of occupations instead of a single one.

One issue that it would address is the Bureau of Labor Statistics or the weighted average hourly report.

Neither one of those have occupations that perfectly match direct care, and so we're using a proxy of some kind.

If we grouped a couple together, that might provide some more stability and a better representation of what's going on.

Another reason is sometimes the Bureau of Labor Statistics does a big reorganization and you lose your occupational target.

Another reason is there is a direct care service array that was associated with, I think they were called exercise professionals, athletic or personal trainers.

At the time it made sense to associate them with personal trainers.

But then when COVID hit, a lot of people quit using personal trainers, but they did not quit using their direct care worker.

So the BLS hourly average wage went way down for personal trainers, but did not for direct care workers.

And so using a composite might give you a better picture of what's happening inside direct care.

Another idea that we had was maybe looking for one of those occupations with comparable knowledge skills and abilities outside of direct care.

Maybe a hospitality occupation.

We didn't feel that we had enough to specifically suggest the code, but if you use something outside that is a direct competitor of direct care that might help also give you a better picture of what the market wage would be.

This might be the most important one out of all of our recommendations, and that's to adjust rates more frequently.

A lot of Medicaid services have a medicare comparable service.

A lot of Medicaid services automatically adjust when Medicare adjusts.

Direct care does not have Medicare equivalent.

So unless the department comes and asks the legislature, then there's not a budget request to tell you what's happening for these services.

It was our recommendation that the department use the information they would have about changes in wages for direct care workers.

Calculate what the adjustment would need to be to stay on par and to bring that request to the legislature every year.

Knowing that the legislature has lots of priorities and then you have appropriation authority, you could adjust that however.

But you would have the information to start with to then decide what needs to happen with those rates.

And then you would also know kind of more globally, I think now a challenge is you get a very large request once every five years and you hear lots of concerns about destabilization in the workforce and the challenges providers are facing, the challenges people who receive services are facing.

And it feels like every year you're addressing a very large issue, but we're never quite catching up.

So our suggestion would be that every single year you get information about how these rates could be adjusted.

The last recommendation we had was to consider a region specific adjustment.

Our state's very large geographically, and there's different forces throughout the state that affects the workforce differently.

So that was a consideration we gave to the Department to think about how what that would look like and then present that information.

By the way, the legislature's Medicaid Managed Care Task force is circulating a draft of its final report after meeting for the last time on Tuesday.

That report has no recommendations to directly address the direct care workforce shortage.

To see a draft of that report and learn more, see Ruth's online reporting.

You can find those links at IdahoReports.org Tuesday was election day for a number of cities and school districts across the state.

Most mayoral incumbents did well with some notable exceptions.

New Plymouth Mayor Rick York lost his bid for reelection a week after being arrested for allegedly shooting his adult son during an argument.

Declo also elected a new mayor for the first time in 30 years, with Mayor Jay Darrington losing to Lance Osterhout.

Pinehurst incumbent Mayor Russ Lowe lost as well.

And Eagle Mayor Jason Pierce is heading to a runoff after no candidates in that four way race received more than 50% of the vote on Tuesday.

He'll race.

He'll face challenger Brad Pike in December.

Joining us to discuss those school board races is Kevin Richert of Idaho Education News.

Kevin, these are hyper local elections.

What stood out to you on Tuesday?

Well, because they're so local, it's really hard to draw patterns and establish trends here because even within school districts, you get results that seem to contradict each other.

But a couple of things did jump out to me.

In a lot of the big districts and in a lot of the spendier school board races, incumbents did pretty well.

West Ada, three incumbents won.

Caldwell, three incumbents won.

You know, in districts like that where money was being put into the races, and I think the races were starting to become strident and in some cases pretty ideological.

Voters stuck with incumbents.

Now, there are exceptions to that rule as well.

I mean, you've got districts like Kuna, you had a couple of incumbents lose in that district.

That's going to change the way that district operates, I'm sure.

So, yeah, it's hard to draw an overarching conclusion from what happened in these races.

But you know, big districts, a lot of districts stayed the course and a lot of the incumbents fared reasonably well compared to last election cycle.

Just watching the results come in and seeing them on Wednesday morning, there were a couple of races that really stood out to me statewide.

Idaho Falls, there was a trustee who lost by one single vote, which is remarkable in a district that size.

Not only are these hyper local elections, but they're elections where one vote or a handful of votes can really make a difference.

You know, these you know, even when you had reasonably good turnout, as we saw in in parts of the state, you still have these are still races because they’re by zone within the school district, you know, a few hundred votes in a lot of these school board elections, you know, every vote counts.

There was pretty remarkable turnout for an off year election as well.

I know that in both the mayor races and school board races, turnout was notable.

Yeah, I think there was a lot more interest in these races, I think there was a lot more engagement in these races.

And I think that that bodes well for the process.

Let's talk a little bit about spending from the candidates.

I know that was something that you were tracking in some of these major races.

It's something we're tracking and we're going to have to continue to track because under state sunshine laws, candidates and campaign treasurers don't really have to turn in that big campaign finance report until after the election.

So even as we were getting ready to go on this morning, I was looking at some of the sunshine reports that were filed after the election.

Some things we do know, in West Ada, you had a trustee candidate, Tom Moore, who loaned his campaign $50,000.

It turns out it doesn't look like he spent it all, according to the report that he filed after the election, he spent about $10,000.

That's still quite a bit for a school board election.

He didn't win.

I think he only got about 34% of the vote, if I remember right.

Coeur d’Alene open race for trustee James McAndrew won that race over Kootenai County Republican Central Committee endorsed candidate.

McAndrew spent more than $20,000.

This is quite a bit of money to start to see going into school board elections.

I mean, this is starting to get to be what we would normally expect to see in a legislative election.

To be clear, these are volunteer positions, unlike the legislative positions which are paid, although modestly.

Right.

I mean, these are unpaid positions, except if you count that trustees are paid in agony, because they get so much grief from their patrons.

So it is kind of strange to see this kind of money going into these elections, but I think that's the trend that we're going to see in the future.

I think the price of admission for trustee races is going up.

It's pretty remarkable.

Let's talk a little bit about some of the bonds and levies, that we have about 2 minutes left.

You were keeping an eye on a handful around the state.

Some passed, some failed.

Right.

And I think here you do see some patterns that we've seen before.

It's tough to pass a bond issue.

Any time you run a bond issue, whether you run it in May or August or November.

The two that were on the ballot on Tuesday, both failed.

Pocatello, this was the one that was really interesting because a lot of the work that was proposed for this $45 million bond issue would have been to renovate and mitigate some of the damage from that fire at Highland High School in April.

That bond issue failed.

They got 56% of the vote, but you need 2/3rds.

Shelley had almost a $70 million bond issue for a high school.

They didn't even get a majority.

Now, the supplemental levies, almost all of those passed.

10 of 12 passed around the state.

We've talked about this so many times over the years, but the fact that you need a supermajority, 66.9%, to pass a bond in this state means that you can get a good, solid majority of voters supporting a bond issue like we saw with the Ada County jail, 65%, almost 66% of voters, less than 1% of voters made a difference in that Ada County jail bond.

And that's what we're seeing with some of these school bonds.

And I think what you will see with those two districts, quite likely, quite possibly, is that they're going to come back with something maybe as early as May.

Pocatello, already talking about perhaps running another bond issue in May, because I think school officials will tell you that the need isn't going to go away between now and spring.

And we have about 30 seconds left, but let's talk about some of those needs and how school districts might have to correct course moving forward.

Yeah, I think that's going to be really interesting to see what does Pocatello do?

Because they're already kind of scrambling to accommodate students after the fire at Highland High School.

You know, and what does a district like Shelley do when they were looking for a new high school?

And it's hard to make those changes along the way.

And on the flip side of that, Nampa said it would have to cut, if its measure didn't pass.

It did pass.

Right, that was the largest supplemental levy of the night, and it did pass.

All right, Kevin Richert of Idaho Education News, thanks so much for joining us.

And thank you for watching.

We have more online at IdahoReports.org We'll see you next week.

Presentation of Idaho Reports on Idaho Public Television is made possible through the generous support of the Laura Moore Cunningham Foundation, committed to fulfilling the Moore and Bettis family legacy of building the great state of Idaho.

By the Friends of Idaho Public Television and by the Corporation for Public Broadcasting.