RESULTS IN BRIEF
The Lanterman Developmental Disabilities Services Act (Lanterman Act) charges the State of California with overseeing services to assist all people with developmental disabilities (consumers) who wish to become a part of their communities. The Department of Developmental Services (department) uses a statewide network of 21 independent, nonprofit regional centers to coordinate these consumer services. Case managers at the centers assist consumers with individual program plans that outline all services consumers need to achieve their desired goals, ranging from transportation to training in job or life skills. To carry out the plans, regional centers contract with organizations (providers) in the community for certain services. The providers hire the direct care staff that work directly with consumers.
The State's system was designed to provide optimal service to consumers, but its success has been undermined by insufficient state funding and more than $106 million in budget cuts over a four-year period. The cuts occurred in the early 1990s and have not been fully restored, preventing the program from paying rates that reflect current economic conditions. Some providers did not receive any rate increases for more than six years. Only within the last year has the State granted $33 million to increase rates for these providers.
Insufficient state funding figures prominently as one of the major obstacles that program providers report in delivering quality services to consumers. Providers we surveyed unequivocally agree that funding keeps them from effectively competing for qualified direct care staff in California's flourishing job market. On average, direct care staff make $8.89 per hour. Fewer than 40 percent of the providers we surveyed offer benefits such as health insurance or sick leave. Providers find it difficult to attract candidates who could easily make the same or more money in equivalent positions with seemingly less stressful duties. Once providers hire direct care staff, they find it difficult to retain them: The average turnover rate for the last approximately 3.5 years was 50 percent, with most staff staying not quite two years.
Lengthy job vacancies create further disruptions in services. Providers need almost three months to fill openings and new direct care staff require time to get to know the consumers and learn their needs. Continually establishing new relationships affects consumers as well; they regularly experience the loss of continuity in their services as well as the personal loss of familiar staff who assist them.
The regional centers we surveyed also report difficulties with hiring and retaining staff. The turnover rate for case managers was fairly low (14 percent) during the same period, and they remained in their positions three years or longer. However, these positions also have fairly lengthy vacancy rates. It takes about 2.5 months to fill the openings. The regional centers cite numerous causes for these delays, such as an unavailability of qualified personnel, the stressful nature of the work, and their inability to offer competitive salaries and career opportunities. Lengthy vacancies create further stress for the remaining staff, who must handle increased caseloads. The regional centers do not have sufficient state funding to hire enough case managers to relieve other case managers' loads. As a result, the managers are squeezed for enough time to properly address the consumers' needs, which can delay or disrupt services.
We found that direct care staff in the developmental centers serve a different, more profoundly needy population, so their duties generally do not compare to the provider's direct care staff. Therefore, we compared the wages of direct care staff and case managers under contracts with the department to those in comparable programs, specifically providers working for the Departments of Aging and Rehabilitation. Direct care staff under all three departments earn an average wage ranging between $8.60 and $9.10 per hour. Case managers under the department earn an average of $17.50 per hour, while those under the Department of Aging make about 40 cents per hour less. However, our survey indicates that there is no correlation between wages and required experience for either position among the departments. We further found that case workers in public and private businesses performing comparable duties earn an average of $18.55 per hour, more than case managers for the two state departments.
Although we found it difficult to assess the direct impact that insufficient state funding and staffing difficulties have on individual consumers, our survey indicates that the State must improve this delivery system so consumers can receive consistent services, maintain long-term relationships with direct care staff, and thus integrate successfully with their communities. The department is taking some steps to improve the existing system, such as examining ways to revise the method it uses to pay certain providers and engaging a consultant to evaluate its budget process for the regional centers. However, until the State commits to ensuring that sufficient funding is available for this program, it will never be able to realize the spirit of the Lanterman Act.
To ensure that consumers receive optimal services from the State in accordance with the Lanterman Act, the Legislature must take interim measures to align state funding with program costs until the department improves the existing service delivery system and implements a new budget process for the regional centers. Any additional funding should be earmarked specifically for increasing compensation for qualified direct care staff and reducing the caseloads for regional center case managers.
To ensure that providers continuously receive funding that reflects current economic conditions, thus allowing them to compete for qualified direct care staff, the department should expedite the completion of its service delivery reform efforts.
Finally, to effectively oversee consumer plans at the regional centers, the department should carefully consider its consultants' recommendations for the regional center budget process and implement those it deems beneficial as quickly as possible.
The department shares the concerns expressed in our report regarding the importance of ensuring the availability of qualified and competent direct care staff for all programs serving persons with developmental disabilities. However, it believes that expenditure decisions should be made in the context of the needs of its service delivery system as a whole.