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Advocates say the shortage of workers who help people with disabilities has become a crisis

An oxygen tank, fan and other equipment in a room.
Julia Reihs
Finding community attendants, caregivers who help people with disabilities stay in their homes, has been increasingly difficult in Texas. Workers who help people on Medicaid are paid only $8.11 a hour — a wage set by the state Legislature.

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Advocates say too little has been done to address the serious shortage of workers who help people with disabilities living at home in Texas.

These workers, known as community attendants, help individuals with disabilities do basic things like get out of bed, make meals and clean. They are key to helping people with disabilities thrive at home and stay out of institutions.

But finding these workers is increasingly difficult, especially for the large share of people with disabilities on Medicaid.

Cathy Robles Cranston, an advocate with the disability rights group ADAPT Texas, has been working to get state lawmakers and health officials to raise the pay for community attendants like her — many of whom are paid through Medicaid.

“We don’t have benefits, we have no health care, we get no vacation time,” she said. “Our median age is 50 years old and in our state we start at $8.11 an hour. If that’s not a crisis what is?”

Groups that employ community attendants are unable to hire workers at that rate, she said. So ADAPT Texas is calling for the base wage to be set at $15 an hour, which will make these positions somewhat more competitive in the current job market.

“People can go and work at Amazon or Target or McDonald’s and make $15 an hour,” Cranston said.

“We don’t have benefits, we have no health care, we get no vacation time. Our median age is 50 years old and in our state we start at $8.11 an hour. If that’s not a crisis what is?”
Cathy Robles Cranston, community attendant

But changing that base pay is up to state lawmakers, because the Legislature has to sign off on Medicaid funding.

“There is not the will of our state Legislature to put the necessary funding that is needed to increase the base wage,” she said.

ADAPT Texas and other disability rights advocates say state health officials have also not done enough to increase how much community attendants make. They're calling for the resignation of Texas Health and Human Services Commissioner Cecile Young.

In a press release last week, they argued Young “did not ask for a single cent increase for community attendants,” including in parts of the budget request set aside for “exceptional” items.

“We need someone who will recognize this problem and come up with a solution,” they wrote. “She has neither the interest, nor apparently the intention of doing anything to help.”

In a letter sent to ADAPT Texas in February, Young said she is “committed to ensuring all Medicaid clients have access to an adequate network of healthcare workers who provide essential services, including those provided by community attendants.”

She said she was working on the budget request for the 2023 legislative session and planned to “highlight the need to strengthen the attendant workforce.”

“Additionally, staff is looking at data that could be made publicly available and used to inform decision makers about attendant wages,” she wrote.

But Cranston said there is already a crisis and the issue needed to be addressed years ago. The community attendant workforce — which is about 300,000 people, mostly women and people of color — is aging rapidly.

Cranston, who is an attendant to her husband, said she herself is “aging out."

“He can’t find an attendant to do backup,” she said. “If something happens to me, then what is going to happen to my husband? There’s a lot of people in this position.”

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Ashley Lopez covers politics and health care. Got a tip? Email her at Follow her on Twitter @AshLopezRadio.
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