How our Statesman investigation led lawmakers to take action on care for the disabled

After years of ignoring life-threatening problems in the state’s catastrophically underfunded system of home and community care for people with disabilities, lawmakers vowed this week to take action to improve safety for disabled clients and raise pay for the caretakers they depend on.

“It’s time to own up and get it right,” said Sen. Charles Perry, vice chairman of the Senate Health and Human Services Committee.

The underfunded and under-regulated system has endangered thousands of lives over three decades, the American-Statesman revealed in a recently published series of investigative stories. The system, comprised of six Medicaid-funded programs known as “waivers,” has been beset by widespread abuses, injuries and deaths, workforce exploitation and lapses in government oversight.

For years, the Legislature has brushed aside advocates’ and families’ pleas for increased funding and regulation. But the Statesman’s stories were met with outrage by lawmakers charged with regulating and budgeting for services. Many expressed indignation; some called for investigations.

A yearlong investigation:Abuse, neglect and death: How Texas fails thousands of disabled residents

Perry, R-Lubbock, and Rep. Donna Howard, D-Austin, said they will lead efforts to ensure adequate pay for workers and protections for caregivers and the more than 100,000 vulnerable Texans they serve.

Perry and Howard said now is the time, as the Legislature heads into its 2023 session with a $32.7-billion budget surplus.

“We’ve got to seize the moment,” Perry said.

Raising the base wage from $8.11 per hour

For more than a decade, advocates have pleaded with the Legislature to substantially raise the base wage, currently set at $8.11 per hour, for caregivers.

The base hourly pay for caregivers has grown by less than 2 cents per year since 2016. Even as staffing shortages reached record highs, threatening the safety of both workers and clients receiving care, lawmakers repeatedly failed to take action, the Statesman investigation found.

After a year of increased media scrutiny and continued advocacy, Dennis Borel, executive director of the Coalition of Texans with Disabilities, said he is “seeing new allies” support meaningful change.

He is asking lawmakers to adopt a two-year plan to raise the base wage to $15 per hour in 2024 and increment it again in 2025 to $17, at a price tag of about $2.6 billion in general revenue over the next two years.

“Permanent disabilities and chronic conditions, they're not going away,” said Borel. If the Legislature doesn’t take brisk action, “more and more individuals would be ending up in the emergency room, in the hospitals, getting unnecessarily institutionalized in nursing homes.”

The Providers Alliance for Community Services of Texas, which advocates on behalf of 45 home care providers, supports advocates’ proposals, but Executive Director Sandy Frizell Batton stressed flexibility is paramount.

“We're advocating for an average of $15 an hour,” as opposed to the minimum wage increase Borel recommended, Batton said. The approach is meant to ensure “that there's the flexibility to pay more… in more competitive markets,” such as urban areas.

Perry said he is committed to nearly doubling the workforce’s base wage to $15 an hour – a compromise between advocates’ and providers’ demands.

The measure is estimated to cost the state $2.2 billion in general revenue funds from 2024 to 2025. But the Texas Health Institute projects the investment could save the state up to $568 million in institutionalization and hospitalization costs, generate sales tax revenues of $516 million and create tens of thousands of jobs by 2027.

“It will be hard for me to support a budget that didn't get (at least) close to that,” said Perry.

Perry said he also plans to include a measure that would tie wages to inflation so that pay doesn’t fall behind in the future.

Howard has discussed similar proposals with Texas House Speaker Dade Phelan.

Both lawmakers said they expect bipartisan support.

Addressing safety and accountability

Howard has also begun preliminary efforts to address safety concerns in the waiver system.

Since 2010, state agencies have investigated nearly 80,000 incidents of abuse, neglect and exploitation of individuals receiving services. Hundreds of workers providing care have also been injured, the Statesman found in a review of thousands of pages of state and legal records.

It’s “a horrific situation, quite frankly,” said Howard.

One of the core causes of this violence, experts told the Statesman, is under-training of the workforce.

Perry expects caregiver wage increases to address at least some safety concerns. Better pay will attract more qualified workers, he said.

Howard supports a more direct approach and has begun a “fact-finding” effort to examine potential solutions. It is “obviously, extremely important” to bolster existing training requirements in the industry and ensure enforcement, she said.

In November, Howard, who is a former nurse, filed a bill to require workplace violence prevention programs in facilities that employ registered nurses. She is considering another bill to cover different waiver settings, such as clients’ homes.

Advocates and the Providers Alliance are refraining from taking a stance on the bill until it’s filed. But Batton said “providers would certainly be more amenable to (any new requirements) if the bill comes with proper funding.”

Howard also plans to begin talks with the Health and Human Services Commission, which oversees waiver services, to address systemic gaps in oversight that the Statesman identified. They include the agency’s failure to track worker injuries and deaths, and delayed facilities inspections and abuse investigations.

One possibility, Howard said, is a bill that would establish a review committee to provide independent oversight.

We “are having to respond to things that we read about in the news media, because we are not aware of (crises) within the system and the structures that we have now,” she said.

Howard said she is committed to shedding light on the internal workings of an agency that advocates say often operates in the shadows.

“A lot of trust has been lost over the years,” said Ashley Ford, director of public policy and advocacy at the Arc of Texas.

HHSC did not provide a comment for this story.

Lawmakers and disability rights advocates said with the budget surplus and increased awareness of life-threatening problems in the system, they are hopeful much-needed change is within reach.

“There is a feeling of optimism going into (this) session that something will get done,” Ford said.

This article originally appeared on Austin American-Statesman: How our investigation led lawmakers to move on care for the disabled