When Shariden Parks starts work, she steps into a home in Bar Harbor and gets the four men and one woman who live there ready for the day. She and other staff at the Downeast Horizons group home help them shower, shave and get dressed. Then they make breakfast. Some residents want oatmeal and eggs, others cereal or toast.
All of the residents have intellectual disabilities. Most are older and have physical disabilities, too, she said. Direct support professionals like Parks use a banal term — the “activities of daily living” — to describe the tasks that they assist residents with, such as giving them their medications or cutting up their food.
But what staff actually do is far more significant, said Jeff Jones, who oversees adult services for Downeast Horizons. They keep people alive.
“We serve a large number of adults in our group homes that, without staff in our group homes, they will die,” Jones said.
That’s why, during the coronavirus outbreak, Jones’ greatest fears don’t center on running out of toilet paper or cleaning supplies, or even where residents will go if they get sick. They revolve around losing staff, at a time when it is difficult to find workers.
The agency has 60 to 65 staff members working in nine group homes in and around Hancock County. Direct support professionals, or DSPs, “are the forgotten health care workers in Maine that are charged with caring for some of the most vulnerable people in our state,” Jones said, and they are doing it “for little more than minimum wage.”
If they become sick and have to quarantine, “I fear for the safety of the people we support in the face of this pandemic,” he said.
Agencies that care for people with intellectual and developmental disabilities are required to have 24-hour, on-call services in case of emergencies. Downeast Horizons, for instance, has two people on call at any time to fill in as needed. In addition, all residential staff are cross-trained in other homes to provide staffing relief if necessary, Jones said.
“The concern is that our pool of staffing becomes so shallow that we can’t meet the minimum health and safety staffing requirements of the homes,” Jones said.
Agencies have struggled for a long time to hire enough workers. There are currently 258 direct support professional job openings in Maine listed on Indeed.com alone. Many ads describe their need for workers as urgent.
Three issues compound the current crisis, said Laura Cordes, executive director of the Maine Association for Community Service Providers: a pre-existing workforce shortage, stagnant reimbursement rates for care from Medicaid, and the fact that many people with intellectual and developmental disabilities are at greater risk of medical complications from COVID-19.
She is encouraged that the state will be applying for an emergency preparedness and response waiver from the federal government that, if approved, could put funding toward overtime, hazard pay and help providers cover the costs of additional items, such as protective gear, child care, emergency housing and electronic devices for remote communication, she said.
Downeast Horizons closed its day centers in Brewer, Ellsworth and Bar Harbor on Wednesday and furloughed some of its workers. A handful of agency workers have quit amid concerns about exposing themselves or others to COVID-19. But so far no residential staff members have left, Jones said.
It’s hard to predict what would happen if someone in a group home fell ill with COVID-19, but the agency has options. A vacant home has been set up to house several residents if needed, Jones said. There are empty bedrooms in some homes where sick residents could self-isolate. Or the agency could isolate ill residents and staff by moving uninfected residents and staff to other homes.
But while they could figure out where to put people, “our concern is staffing the homes if/when more and more staff become exposed to the virus,” he said.
Under different circumstances, Parks, who also oversees a group home in Ellsworth, would make sure residents are participating in activities outside. Now, however, they’ve stopped going out and can’t have visitors.
Instead, they have been doing online workout programs, such as Beachbody on Demand. There are lots of arts and crafts, such as making paper chains or coloring in coloring books.
She estimated staff devote two to three hours a day to cleaning. They wipe down light switches, door knobs, the fridge, bathroom doors and cabinet doors. They wash their hands repeatedly. The agency purchases toilet paper, paper towels, sanitary wipes, gloves and medication cups for a year or more at a time, so it has enough of those items on hand, Jones said.
Staff also check their own temperature, in addition to residents’ temperatures. Residents’ health conditions may make them more susceptible to COVID-19. At the same time, it can be harder to tell when they are sick.
“They can’t come out and say, ‘I have a headache,’ or ‘I’m hot,’ or ‘My stomach hurts,’” Parks said. “You have to play the guessing game and rule things out.”
While residents can’t leave, staff still need to go home at the end of their shifts, and Parks worries someone will get sick — or will have COVID-19 but not show symptoms. There are two to three staff on duty during the day at the home, she said, with one staff member working overnight.
“It’s your worst nightmare. What if I have three staff who are quarantined for two weeks?” she said.
But part of her job is modeling the behavior she wants to see in residents, so she is staying positive, she said. “It always could be worse, especially for the residents who look up to you.”