DHS – Aging and People with Disabilities: Consumer-Employed Provider Program Needs Immediate Action to Ensure In-Home Care Consumers Receive Required Care and Services

Report Highlights


The Secretary of State’s Audits Division found that the Aging and People with Disabilities (APD) program should take immediate action to address gaps in program design and oversight in order to improve the safety and well-being of participants in the Consumer-Employed Provider (CEP) program.

Read full report here.

Background

Oregon is a leader in providing in-home long- term care options for older adults and people with disabilities. The most used in-home care program is the Consumer-Employed Provider program, which positions consumers as employers of their homecare worker.

Purpose

The purpose of this audit was to assess the policies and processes used by APD to ensure the needs of consumers in the CEP program are met.

Key Findings

The effectiveness of the Consumer-Employed Provider program is dependent on the consumer, the case manager, and the homecare worker. If each is capable, competent, and supported in their role, the current model can be successful. Our audit found:

1. Some consumers are not receiving the support necessary to ensure required employer duties are being performed, which adds to case managers’ and homecare workers’ responsibilities.
2. Case managers are not consistently contacting consumers, or monitoring services consumers receive due to excessive workloads.
3. Agency requirements do not ensure that homecare workers are prepared to provide the care and assistance consumers need.
4. Due to current data collection and utilization practices, it is difficult for APD to determine if consumers are safe and receiving the care and services they need.
5. Current deficiencies in the program may put consumers’ health and well-being at risk and keep the program from operating as intended.

To reach our findings, we conducted interviews and case file reviews, collected and analyzed CEP consumer data, and researched federal and state standards.

Recommendations

The report includes recommendations to improve Consumer-Employed Provider program implementation and support. Recommendations include consistently following existing monitoring policies, addressing case managers’ excessive workload and responsibilities, and providing more support to consumers and homecare workers.
The Department generally agreed with our findings and recommendations. Its response can be found at the end of the report.

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Audits in the News: December

Audits in the News: End-of-year audits at DOGAMI, DHS earn media coverage

We here in the audits division are proud that the work we do makes a difference. Our work attracts the attention of the legislature, statewide news sources, and even local media outlets. Local media coverage of our audits is just another way we communicate with the people of Oregon about the work that we’re doing on their behalf to make government better. This is part of an ongoing series of posts rounding up recent instances in which the Oregon Audits Division makes a cameo in the local news.

As the year winds to a close, the Audits Division has been busy wrapping up and releasing several performance audits. We’ll cover some of the resulting news coverage in the new year. But two recently released audits — one focusing on employees’ concerns at the Department of Human Services, the other on federal funding management at the Department of Geology and Mineral Services — have received their fair share of media coverage.

You can read the entire DHS audit here, and the entire DOGAMI audit here.


The Oregonian/OregonLive – Survey: state human services employees lack resources, feel stressed and underpaid

Read the story here.

“Employees at the Oregon Department of Human Services lack the resources necessary to do their jobs and feel overworked, underpaid and stressed out, according to survey results released by state auditors on Wednesday.”


KTVZ – Audit: DHS workers feel overworked, stressed, underpaid

Read the story here.

“Workers at the Oregon Department of Human Services are largely proud of the work the agency does, but significant numbers of workers feel overworked, stressed, underpaid and under-supported in their jobs, according to an audit released Wednesday by the Secretary of State’s office.”


OPB –Oregon DHS Workers Are Stressed Out, But Proud Of Their Work

Read the story here.

“Working for Oregon’s Department of Human Services is stressful. That’s one of the findings of an agency-wide survey released Wednesday by the Oregon Secretary of State’s office. DHS runs programs that serve people with disabilities, senior citizens, low-income families and children in foster care.”


Portland Tribune – Audit: Some ‘problem spots’ remain at DOGAMI

Read the story here.

“Since its financial woes came under scrutiny in early 2015, the state’s geology department has improved its financial controls, according to a state audit report released Wednesday. But the Secretary of State’s Office recommended the Department of Geology and Mineral Industries, often referred to as DOGAMI, continue to update how it reports and records federal money.”


OPB – Audit: Oregon Agency Engaged In ‘Inappropriate Grant Management’

Read the story here.

“A new state audit says the Oregon agency that monitors natural hazards has engaged in some questionable fiscal practices. The report says the Oregon Department of Geology and Mineral Industries is also taking steps to correct the problem.”

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Department of Human Services: To Better Achieve its Mission, Vision, and Goals, DHS Must Increase Efforts to Address Employees’ Concerns

Executive Summary


The engagement level of employees can directly influence their ability to do their job and thrive professionally and personally. In April 2016, we conducted a survey of Department of Human Services (DHS) employees to help DHS management identify work environment factors positively or negatively affecting employee engagement.

Survey respondents generally reported they know the agency’s mission vision, and goals and are proud to work there. But their responses also highlighted areas within DHS that need improvement. These included tools and resources to accomplish the work, compensation, hiring practices, recognition, professional development, stress and workload distribution, and communication. Addressing these issues will help DHS improve employee engagement and better achieve the agency’s mission, vision and values.

Read the full report here.

Overview of DHS

The Department of Human Services’ (DHS) mission is to help Oregonians in their own communities achieve safety, well-being, and independence through services that protect, empower, respect choice, and preserve dignity. The agency’s biennial budget is about $10 billion with 7,897 full time equivalent staff.

The agency serves over a million Oregonians each year through two support services units and five program areas. The five programs provide services through numerous field and local offices throughout the state. Central Services, which includes the Director’s office, and Shared Services, provide support and leadership to the following programs: Aging and People with Disabilities, Child Welfare, Intellectual/Developmental Disabilities, Self-Sufficiency, and Vocational Rehabilitation.

Employee engagement is important

Engaged employees are passionate, energetic, and dedicated to their job and organization. One study indicates that a higher level of employee engagement correlates with higher rates of success in achieving strategic goals, higher employee retention, and fewer days of sick leave and lost time.

Work environment surveys can help an organization measure its level of employee engagement. DHS has been conducting an employee survey since 2012 that consists of seven questions designed to measure employee engagement.

Our survey was designed to measure the factors that influence employee engagement. DHS management could use the results of our survey to identify areas to improve, and set priorities for action.

Core knowledge and respectful work units given high ratings among respondents

Survey results indicate that DHS is doing well in four areas that influence engagement: mission, vision, goals; job suitability; respectful work units and reporting of harassing and discriminating behavior; and teamwork.

Nearly all respondents reported they knew the mission, vision, and goals of the agency; and how their work relates to these goals. Furthermore, over 85% of respondents reported they are proud to work at DHS. Almost all of the respondents reported they found their work to be meaningful.

Survey highlights concerns DHS management should address

DHS management should address perceived deficiencies that influence employee engagement. We surveyed 7,426 DHS employees and received 4,580 completed surveys, resulting in a 62% response rate. Employees rated their level of agreement with survey questions regarding factors that influence employee engagement. The response benchmarks we used were based on the existing DHS metrics, which are as follows: 85% and above means the respondent perceives DHS as doing well for that factor; between 66% – 84% means a factor that needs some improvement; and 65% and below means a factor that is in critical need of management attention.

Survey respondents identified seven factors in need of improvement – tools and resources, compensation, hiring practices, recognition, stress and workload, professional development, and communication.

Only 55% of respondents felt they had sufficient tools and resources to do their job. At least 50% of respondents across two units and five programs reported a high level of stress. Many respondents reported concerns about the fairness and competitiveness of hiring practices, and a lack of recognition for the work they do.

Another key factor related to employee engagement and organizational success is communication. For an agency as large as DHS, with offices all over the state, communication can be particularly challenging. However, according to a Newfoundland and Labrador Statistics Agency’s work environment survey, direct and timely communication from senior leaders can go a long way in making employees feel informed and connected.

Leaders also need honest feedback from employees who provide services to clients, in order to help them make the best decisions. Overall, less than half of the respondents felt that communication and information flows effectively between the central office and the field offices.

Recommendations

To better achieve its mission, vision, and goals, we recommend DHS management develop and implement a plan to address the seven areas needing improvement: tools and resources, compensation, hiring practices, recognition, professional development, stress and workload, and communication.

To gauge whether efforts are improving engagement, we recommend DHS management administer a work environment survey at least annually that includes the factors we identified that influence engagement.

Last, we recommend management use the future survey results to revise the plan, as needed.

Agency Response

The agency generally agreed with our recommendations. The full agency response can be found at the end of the report.

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