Recruiting direct care workers a challenge for Michigan's adult foster care homes

Natalie Visser, an assistant supervisor for MOKA, left, and Tracy share a warm embrace during a life skills session on cooking at a MOKA site in Wyoming.
Since 2020 and the beginning of the COVID-19 pandemic, just about every industry has been struggling with a worker shortage. The mental health industry is no exception to this, although recent state and nationwide mandates improving wages for direct care workers — nursing assistants, personal care aides, and anyone who provides home care services according to the US Department of Labor — are beginning to close the gap when it comes to finding more workers ready to take on the challenging yet rewarding job of direct care. 

The Community Mental Health Association of Michigan published in 2021 that the direct care workforce is facing “competitive pressure” from various retail employers in Michigan offering comparable or sometimes higher wages than direct care positions, and that current direct care work employers are “struggling to recruit and maintain workers in part due to higher wages in alternative occupations.” CMHAM data also shows that some direct care workers are able to make a living wage, but others — especially those with children — are finding it difficult to make ends meet. 

Local community mental health organizations in Northern and Western Michigan are taking it into their own hands to improve the work environments and cultures of their direct care workers in order to hang on to the employees who are already passionate about the work and want to stick with it, as well as find more workers to avoid a potential negative impact on care due to burnout.

Direct care workers can work directly with patients or clients in their homes or in residential homes such as adult foster care (AFC) homes. They provide services such as meal preparation, personal grooming or hygiene assistance, and distributing medication. OnPoint, a community mental health agency (CMH) serving Allegan County, relies on the West Michigan nonprofit MOKA to ensure adult foster care homes in the county are properly staffed.  

Visser works with, Tracy, left, and Stacy, right.
If you ask Tracey Hamlet, MOKA’s executive director, the most important service a direct care worker provides to their patients is building relationships. The primary populations that MOKA focuses on are adults with intellectual and developmental disabilities as well as those with severe mental health diagnoses.

Tracey Hamlet, executive director, MOKA “Our society doesn’t always know or understand the life people can have with the right support,” says Hamlet. “It takes relationship development and a significant amount of both hard and soft skills to help a person get from one place to another place.”

Hamlet notes that the work that goes into building relationships with patients or clients is “very difficult,” and, though wages for direct care workers have increased over the past three years, workers are still not being compensated adequately for the work that they do. Because of this, Hamlet and her team at MOKA are working on additional benefit programs for their workers, including developing and offering credentialing programs through partnerships with Grand Rapids Community College and Impart Alliance.

“We’ve been really involved in this movement to support stronger education for the position and higher wages that are competitive but compensate for the skills required,” says Hamlet. “It’s definitely not a thankless job. It’s very rewarding, but it should be reimbursed properly.”

While the fight for higher wages continues, Hamlet says that she and the rest of the staff at MOKA have been trying to provide additional support to direct care workers to ensure that they feel appreciated and hopefully prevent employee burnout. She says that upholding a workplace culture that is supportive and caring of the staff is critical to not only retaining current employees, but also keeping new hires in positions for longer than 90 days. Quarterly meetings to discuss challenges and successes in MOKA homes and an annual appreciation dinner for all employees are two more examples of how MOKA supports its workers.

“There’s a wide range that we do to support retention,” she says. “We listen to workers. We try to respond to their needs and their challenges. We support them to advocate for the people they serve.”

Life skills session on cooking at a MOKA site in Wyoming.
Hamlet and her team at MOKA aren’t the only folks working to improve working conditions for direct care workers. At Northern Lakes Community Mental Health Authority (NLCMHA), residential services administrator Dave Simpson has been working to ensure that the seven residential service sites NLCMHA operates are “happy homes.” 

“Happy homes are where people feel safe, patients are satisfied with their care, staff are satisfied with their job, families feel comfortable having their loved ones there, and they're cost effective and compliant,” Simpson explains. “Our staff loves it. Our guardians love it. My supervisors love being able to say when people visit, our goal is to have a happy home.”

Dave Simpson, residential services administrator, Northern Lakes Community Mental Health Authority Simpson says that in order to build happy homes, he continuously meets with residential home staff in order to determine issues before they become larger problems. He promotes a client-focused atmosphere in every site he overlooks, providing multiple opportunities for upward mobility and, overall, assuring employees that their work and presence is anything but disposable. 

“We include our direct care workers in everything we do so they don’t get the feeling that they aren’t appreciated,” he says. “Honoring the workforce and giving them a career path has made a huge difference in our average length of employment, which keeps rising every year.”

While Simpson seems to have found a sweet-spot in ensuring that his staff is equipped with conflict resolution skills and supervisors and administrators have open-door policies, he does agree with Hamlet that workers in this field are underpaid. NLCMHA has been fortunate to be able to provide additional benefits to employees such as referral bonuses and developing additional positions with higher hourly rates, but underpayment remains one of the top reasons the field sees such a profound shortage of workers.

“When you compensate properly, people are loyal,” says Simpson. “I want to meet the needs by whatever means necessary. Staff can reach out to me directly. We make that part of the transparency of what we do.”

Natalie Visser, an assistant supervisor for MOKA, works with, Stacy, left, and Juanita.
Both Hamlet and Simpson hope that the current and upcoming programs being developed at MOKA and NLCMHA lead not only to higher retention rates, but also higher quality care in the facilities that they operate. 

“The biggest thing with operating homes like this is keeping the operation centered around the health, safety, and welfare of the client,” says Simpson. “When that is your center, it influences everything around it in the best possible way.”

“There are good things happening despite the challenges,” Hamlet concludes. “Employees have a voice, and we are listening to it.”

Rylee Barnsdale is a Michigan native and longtime Washtenaw County resident. She wants to use her journalistic experience from her time at Eastern Michigan University writing for the Eastern Echo to tell the stories of Washtenaw County residents that need to be heard.

Photos by John Grap.
Dave Simpson headshot courtesy Northern Lakes Community Mental Health Authority.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, Mental Health Foundation of West Michigan, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.