For a segment of the long-term care industry that aims to be discreet, the spread of COVID-19 is driving group homes into the spotlight.

Northland operators told the News Tribune this month they are carrying on, but speaking up with concerns about being forgotten.

“This feels very much like the front lines,” Jon Nelson said. “We are working with vulnerable adults and children who have a lot of underlying health issues. We know it’s just a matter of time.”

Nelson is executive director for Residential Services Inc., in Duluth, which operates scores of group homes between Duluth, the Iron Range and as far south as Cambridge, Minnesota.

Jon Nelson
Jon Nelson

People with disabilities, brain injuries, and mental illnesses — some with underlying health conditions such as diabetes, obesity and lung ailments — populate RSI’s and other group homes to make up a network of congregate care settings blended into residential neighborhoods.

In St. Louis County, there are 307 homes with a capacity for 1,106 residents, according to ARRM, the industry’s statewide association. At last tally, ARRM said 70,000 people with disabilities received home and community-based services in Minnesota, 55,660 of them adults.

Yet even before the pandemic cast its shadow, the industry was troubled by a staffing crisis which Nelson said left it 19,000 employees short of the 90,000-plus workers needed statewide.

Adult day programs have closed, forcing full 24-hour staff coverage at the homes. Shuttered dorms have left the industry without its trusty pool of collegiate workers. Already, concessions are being made. Protocols like the usual ratio of two staff for four residents, and mandated fingerprinting as part of new employee background checks, are being relaxed. Some families are being asked if they are able to take people home, and some are approving.

“That’s happening,” Nelson said.

In an effort to retain staff, RSI raised its hourly wage by $2 per hour. Another operator in Duluth, Focus On Living, increased its pay by $1 per hour. Last week, Focus On Living co-owner Rich Heine applied for paycheck protection loans that were part of the $2.2 trillion round of federal rescue plans made necessary by stay-at-home orders that have damaged large parts of the economy.

Between Focus On Living and its companion service that sends direct support professionals into residents’ homes, the companies employ 76 people.

“It's been a struggle, but I can’t say enough about our employees,” Heine said. “They’ve really stepped up.”

But across the state, they’re doing so without adequate supplies of the personal protective equipment being rationed and hard-sought after everywhere.

Nelson described having thermometers enough for residents, but not to check staff. Even cloth masks are only trickling down to group homes. Focus On Living had 90 masks arrive last week with boxes of homemade masks on order. Face shields are sold out nearly everywhere.

"We have things in place if someone does get sick," Heine said, being creative in a hunt for face shields by going to hardware and fleet stores. "I just want a couple. We want to have protective gear for the staff."

Thankfully, attention is being paid at the state level.

“In terms of PPE, that’s a problem everywhere, not just group homes, but hospitals and for all front-line responders,” state Rep. Jen Schultz, of Duluth, said. “In terms of recruiting workers, it’s really hard, because of the (health) safety issue, and so many people can get unemployment with a federal addition of $600 (per week). That’s likely more than the wage they would get.”

Rep. Jennifer Schultz.
Rep. Jennifer Schultz.

Direct support workers make $13.55 per hour on average statewide, said Sue Schettle, chief executive officer of ARRM in St. Paul. She described average turnover of almost half the workforce annually with three and six months as key drop-off benchmarks for first-time workers.

“A lot of people don’t last a month,” she said. “It’s a really challenging, rewarding profession, but the income isn’t there to support it.”

Nelson expanded on the issue: “We don’t negotiate our rates,” he said. “We get told by the state what our rates are.”

Schultz is among the industry's allies in the state Legislature. She carried successful legislation last year that increased for providers the daily per-person rates, which are oftentimes hundreds of dollars. Another crisis-fueled effort to raise rates is underway from a colleague. It's drafted and waiting to be attached to legislation. Eighty percent of the rate increase is aimed at wages.

“We have had a shortage of direct support professionals in the state and we have wages that are below market wages that we’ve been trying to address,” Schultz said, before delivering a dose of reality. “We’re already going to be dipping into our ($2.3-plus billion) reserve fund, and we have to balance the budget. We have to be careful, because our revenues are going to be much lower than we've seen in the past few years.”

Meanwhile, inside the group homes, the specter of a disease has upended the lives of people who come to trust routine. Sheltered workshops are closed, and access to bowling alleys, restaurants and libraries closed-off. Therapy appointments have moved to video conferencing. Travel to loved ones' homes and guest visits to the group homes are suspended.

“The first 10 days we were putting out little fires,” Heine said. “Right now, we’re pushing exercise, going for walks, doing games and utilizing Zoom (for video calls).”

At RSI, contingency planning is in full swing.

"We have to have plans considering alternate sites," Nelson said.

In case it starts losing staff and can't keep homes open, RSI has started conversations with St. Louis County Public Health and Human Services about moving residents to a 16-bed facility the company owns that it can cover with fewer staff.

As the crisis hit, raising the profile of health care workers everywhere, group homes saw their status left on the sidelines in early addresses from state officials. It didn't go unnoticed by staff, Nelson said.

“They do feel like we’re the forgotten side of this thing,” he said. “Part of this is us and who we are. We try to be invisible. We try to be your neighbors. We don’t want to stand out. Unfortunately, it comes back to bite you in terms of people not recognizing or even knowing you exist.”

Northland group home totals, per ARRM:

Aitkin: 20 adult facilities/64 licensed beds

Carlton: 30/112

Cook: 0

Itasca: 40/139

Koochiching: 9/33

Lake: 4/14

Pine: 39/139

St. Louis: 307/1,106

TOTAL: 449/1,607