Human services agencies face staffing crisis, delaying services for those in need

Joanna Bunker has had an up-close view of the strain the pandemic is putting on people’s mental health. The clinical social worker saw clients over Zoom who were isolated and felt hopeless, many without support systems or the ability to get around on their own.

“It’s just a lot of suffering to witness and to have to hold together,” said Bunker, who specializes in eating disorders and trauma. “I felt like I was starting to drown.”

Bunker, 35, worked for a nonprofit in Marlborough serving mainly lower-income, high-risk people, as she’d done her entire career. But the difficulties of helping them through the pandemic, coupled with the growing pressure of living paycheck to paycheck, drove her to accept an offer in April to join a private practice, where she makes three times as much as she did before.

A steady stream of workers have left community-based human services jobs like Bunker’s during the pandemic, and many jobs are going unfilled, leading to a staffing shortage that has reached emergency levels, providers say. Some programs are facing vacancy rates as high as 60 percent. At the same time, the need has increased, particularly in behavioral health, and the wait for services — ranging from addiction treatment to day programs for people with developmental disabilities, to youth and elderly support — is growing.

Nearly every sector in the state is experiencing labor shortages. But in these mainly nonprofit human services jobs, the effects are far-reaching. Workers dealing with COVID-induced stress are pulling double shifts to make up for staffing shortages. And with so many jobs going unfilled, vulnerable populations aren’t always able to get the vital services they need.

Bunker is distressed about leaving the people she long served with so few resources as she makes the shift to clients who, for the most part, have private insurance or can afford to pay out of pocket.

“I feel guilty,” she said. “And then I get angry because, why are these people so undervalued? And why are the services that they need and the service providers so undervalued?”

The low pay in the human services field is a major factor in the workforce crunch, according to a coalition of the state’s human services professional associations. Median wages are slightly more than $27,000 — which includes part-timers but not most licensed clinical staff, such as nurses — well below the $40,500 median for all other industries in the state, according to a 2019 report commissioned by the Providers’ Council, which represents 200 agencies in Massachusetts. Average pay for people who provide daily care for clients at group homes and day programs is just $15-$17 an hour.

Pay rates are largely determined by the state, providers say, which is the main source of funding for human service agencies. And with a staffing crisis in full effect, a coalition of human services associations is appealing to the state for hundreds of millions of dollars more to retain and recruit staff over the next five years and to create a student loan repayment program for existing employees, as they work toward a more permanent solution.

Of the 180,000 human services positions in the state, ranging from workers assisting developmentally disabled clients to licensed clinicians with master’s degrees, 8 out of 10 are filled by women, according to the Providers’ Council, and the sector is twice as likely to employ Black workers and 1.5 times as likely to employ Latinos.

The state did not respond to questions about job vacancy rates, wait lists, or requests for extra funding, but noted several temporary pay bumps for front-line human services employees and overall funding increases it provided during the pandemic. The latest supplement — a 10 percent rate increase to monthly provider reimbursements intended to give workers bonuses or short-term raises — was slated to end in December but may be extended for six months.

Raising wages permanently is crucial, said Diane Gould, president of Advocates in Framingham, one of Greater Boston’s largest human services agencies, especially now that Amazon and other corporations are offering higher pay than many of her direct-care workers make. In Advocates’ employment program, some clients with disabilities are landing jobs with private firms making more money than their coaches do, she said. This is gratifying, given their hopes for their clients, but demoralizing as well.

Advocates has lost so many licensed clinicians at its mental health and substance abuse clinics — 16 in the past year — and the need has grown so much, that the wait list has ballooned to 250 people, Gould said. “They’re coming with significant problems that have been exacerbated by the pandemic,” she said, including alcohol and drug use, depression, and domestic violence.

Lifeworks, based in Westwood, has 60 job openings on its 345-person staff, which greatly limits its ability to serve people in need, said president Daniel Burke. Lifeworks’ Abel Therapeutic Center, an adult day program for people with autism, epilepsy, cerebral palsy, and mobility and sensory impairments, is operating at half capacity due to staffing needs at the center and at companies that transport clients there.

Families without a place to send their loved ones are being forced to take over, disrupting their lives and their ability to work. “It’s a tremendous burden of care,” Burke said.

Benette Guerrier’s 22-year-old daughter, Benshyana, who has autism, has been stuck at home in Randolph since she aged out of her residential school in August and was put on a wait list for a day program. A personal care attendant comes to help her during the day, but the attendant isn’t trained to assist people like her daughter, said Guerrier, who works as a surgical technologist at Brockton Hospital. “She’s just sitting doing nothing. ... It’s not good for her.”

Increasing the pay of human service workers would go a long way toward alleviating the staffing crisis, said Peter MacKinnon, president of Service Employees International Union, Local 509, which represents 8,000 private-sector human service workers at state-contracted facilities. But increases in state funding needs to be tied to workers’ pay, with a set share designated to raise wages, to solve the problem, he said.

“While the rates have increased by hundreds of millions of dollars, and that’s good, the CEO pay, the administrative pay, have gone up disproportionately compared to wages for the people who are actually doing the work,” he said. “And this is incredibly important work that is literally about people’s lives and making sure that these individuals are cared for, that they’re able to thrive. If you value that as a job, then you need to pay the folks that do the work fairly.”

Michael Weekes, president of the Providers’ Council, said efforts to link funding to wages are a “distraction.” No matter what share of the budget goes to wages, he said, agencies won’t be able to attract the best workers if there isn’t enough money to begin with.

The main priority is alleviating the staffing shortage, he said: “Our workforce crisis means people are denied services that really affect their health and safety.”

Mental health needs in particular have skyrocketed during the pandemic, said Anne Pelletier Parker, executive director of Behavioral Health Partners of MetroWest. Calls to the agency’s hot line shot up 46 percent this year compared with 2020, she said. Wait times also increased, with the number of people waiting three months or more for services rising 13 percent between fiscal years 2020 and 2021.

The shortage of licensed behavioral health clinicians is especially alarming, she said, because many of them are going to practices that don’t always take insurance. “There’s high demand from people who can afford to pay out of pocket,” she said.

Rosewood Day Services in Danvers is serving half the number of autistic adults it did pre-pandemic due to staffing shortages, according to a service manager, who asked not to be named to protect her job security. Clients who would normally go on outings and learn independent living skills at the center are stuck at home, causing some of them to regress or lose skills they had previously mastered, she said.

It’s a difficult job, without a lot of monetary rewards, said the service manager, who makes just over $20 an hour after 16 years in the field. And as the agency scrambles to fill jobs, she’s concerned the quality of care could suffer.

“They’re just hiring people for bodies, not experience,” she said. “We want people who want to be here.”