June 15, 2023
New data indicate that a Department of Health and Human Services (DHHS) initiative to fund recruitment and retention bonuses for direct support workers (DSWs) helped stabilize and grow Maine’s Home and Community Based Services (HCBS) workforce.
HCBS DSWs assist Maine people of all ages with physical disabilities, intellectual and developmental disabilities, and mental or behavioral health conditions. Their work is central to keeping people in their homes and communities while providing accessible, high-quality services to help them stay healthy and fulfil their personal goals.
In February of 2022, DHHS began distributing approximately $120 million in payments to MaineCare-funded HCBS providers for recruitment and retention bonuses targeted to DSWs and supervisors across the State. The initiative was funded with federal dollars through the American Rescue Plan Act as part of Maine’s HCBS Improvement Plan. Participating agencies had flexibility to develop their bonus policies within DHHS guidelines, had until December 31, 2022, to spend their allotments, and were required to submit reports to DHHS specifying how the bonuses were distributed. The reports also indicated what DSWs earned and how many were employed at the start and end of the initiative.
To date, DHHS has compiled data from a sample of 293 agency reports, which represents just over 80 percent of participating agencies. The data reported by these agencies suggest that the recruitment and retention bonuses helped stabilize the HCBS workforce in the wake of the COVID-19 pandemic. Agency-reported data also indicates that average regular hourly wages for HCBS workers rose between July 1, 2021, and December 21, 2022, while this initiative was in effect.
More than 24,000 DSWs and DSW supervisors in every Maine county received bonuses
The Department received bonus payment data for 24,499 individual workers. According to agency reports, the majority of DSWs who received bonuses work with individuals living with intellectual disabilities and brain injuries (9,637 workers) followed closely by those supporting Maine people with mental health and substance use disorders (9,368 workers). Workers in all of Maine’s 16 counties received bonuses.
| Population | Direct Service Worker | DSW - Supervisor | Uncategorized* | Grand Total |
|---|---|---|---|---|
| Aging and Physical Disability | 4,632 | 142 | 80 | 4,852 |
| Intellectual Disability and Brain Injury | 8,750 | 748 | 191 | 9,637 |
| Mental Health & Substance Use | 8,493 | 835 | 76 | 9,368 |
| Multiple MaineCare populations served | 662 | 46 | 92 | 799 |
| Grand Total | 22,375 | 1,816 | 449 | 24,499 |
* A subset of workers did not include enough information to determine a category distinction between DSW worker or supervisor
Workers received an average of $3,429 in bonuses over the reporting period
Provider agencies determined individual bonus amounts and were required to share their bonus policies with their workers. The Department allocated funding to agencies based on a standard percent of MaineCare HCBS payments to the agencies. Because some HCBS services are paid at higher rates than others, the per-worker bonus allocations varied by agency. Based on this formula, average bonus amounts ranged from $1,631 for workers serving those with aging and physical disability needs to $4,145 for workers who support those with mental health and substance abuse challenges. The average bonus amount across all groups was $3,429. Data also indicated that workers supporting people with intellectual disabilities and mental health and substance use disorders worked more weekly hours on average than their counterparts in aging and physical disability services.
Wages rose across DSW service population groups
Average wages for DSWs rose during the bonus period, between July 2021 and December 2022, the data show. In addition to other rate increases, the Department implemented Part AAAA of PL21, Ch. 398 during this period. Part AAAA requires MaineCare rates to reimburse for direct support wages of at least 125 percent of the state minimum wage. In 2022, 125 percent of the state minimum wage was $15.93 per hour. The data show that agencies serving all population groups paid their workers at least that amount by the end of 2022, with variation across populations served.
Average Wages of Participating DSWs Before and After the Bonus Period
| Aging and Physical Disability | Intellectual Disability and Brain Injury | Mental Health & Substance Use | Multiple Populations Served | |
|---|---|---|---|---|
| Before July 2021 | $18.47 | $15.14 | $20.63 | $16.10 |
| After December 2022 | $20.39 | $16.76 | $22.07 | $17.05 |
The workforce grew and agencies retained nearly 82 percent of their HCBS staff
The goal of the recruitment and retention bonus initiative was to stabilize HCBS staffing during the COVID-19 pandemic. Agencies reported a combined total of 20,295 workers in March 2022. By December 31, 2022, the 293 agencies included in this analysis reported a total of 24,499 workers, a gain of 3,574, or nearly 21 percent. This is likely a conservative estimate of workforce growth, since the sample represents most but not all participating agencies.
Agencies likely achieved this increase through a combination of recruitment and retention. The reports indicate that 81.9 percent of workers who received a bonus remained employed at the agency at the end of reporting period. That retention, along with successful recruitment of new workers, yielded a net increase in the workforce. Participating agencies reported paying recruitment bonuses to 5,517 newly hired workers and 18,982 existing workers.
DHHS plans to continue analysis of the bonus payment data and release more information as it becomes available in the future.
Recruitment and retention of HCBS workers is an ongoing challenge nationally, as well as statewide. Bonus payments were one means of support for the workforce. A fuller account of state measures to support DSWs can be found in the Second Annual Report on Efforts and Progress in Implementing the Recommendations of the Commission to Study Long-term Care Workforce Issues (PDF), which showed Maine is making progress in restoring access to a range of long-term support services in the wake of the COVID-19 pandemic. Earlier this year, Maine was ranked fourth in the nation by the PHI Direct Care Workforce Index for the best direct support worker policies and economic status.