A typical day for Megan Arthaud starts at 6 a.m.
Arthaud and the other direct support workers at a south Bismarck group home for people with intellectual disabilities start their day by helping residents with their basic care needs. This includes getting the residents out of bed, to the bathroom, helping them brush their teeth, comb their hair and preparing breakfast.
Most of the residents have wheelchairs, so many of these tasks require a lift to get them in and out of the chair.
For direct support workers, the work is challenging, yet rewarding. At Arthaud's group home, which is owned by Enable Inc., the residents and employees have become a family.
But for organizations that provide services to people with intellectual disabilities, including Enable Inc., recruiting and retaining direct support workers has been an ongoing challenge. Scant wages have led to high turnover rates. In North Dakota, the turnover rate for direct support workers currently sits at about 44 percent.
Yet thousands of North Dakotans with disabilities rely on direct support so they can stay in their communities and outside of institutionalized settings.
State lawmakers are considering whether to give these employees a wage increase. Over the past four years, wages for direct support workers have remained stagnant due to state budget cuts. Providers say this may have caused an increase in employee turnover and forced some direct support workers to find second, sometimes, third jobs.
Gov. Doug Burgum's budget proposal includes a 1 percent inflationary increase each year of the next two-year budget cycle for community providers, but providers are seeking a 3 percent increase for each year of the biennium to "catch up," or remedy flat funding, according to Bruce Murry, executive director of the North Dakota Association of Community Providers.
Without a 3 percent increase, Murry worries that providers could see even higher employee turnover rates and quality of services for people with disabilities could be adversely affected.
Historically, the state Legislature has provided inflationary increases to providers. For fiscal year 2009, the turnover rate for direct support workers in North Dakota was 43 percent, but, over the 2009-11 biennium, the rate decreased to 33 percent when the Legislature gave inflationary increases to providers.
But, due to recent budget cuts, providers haven't seen an inflationary increase since July 1, 2015, according to Jon Larson, executive director of Enable, Inc.
"We're seeing the (turnover) trend go upward again, and we're thinking that's a correlation to, basically, our stagnant wages," Larson said.
In addition to helping group home residents with basic care needs, Arthaud and other direct support workers assign residents a daily objective, or skill, to help the residents become more independent.
Staff also ensure the residents get out into the community by taking them out to eat, to the movies, to get a haircut or volunteering.
"A normal 28-year-old goes out into the community daily. You want them to be included in society just like you and I would be," Arthaud said.
The average starting hourly wage for a direct support worker in North Dakota is $14.30, which is better compared to the national average of $10.72 an hour. Still, many direct support workers in the state are living paycheck-to-paycheck.
Arthaud, who has worked at the group home for more than seven years, said seven of the eight direct support workers at her group home have second jobs.
"It has not always been like this — probably within the last year and a half, especially because the cost of living has gone up," she said.
Arthaud attributes employee burnout and low wages to the main reasons why people leave the job.
"A lot of people don't come into it for the money, but it's really hard when you don't have an increase in wages in almost four years — to continue to do the work and help people out when you're not able to get by," she said.
Arthaud and the other direct support workers help residents such as Alex Roller, 28, who has been at the group home for four years. Roller is in a wheelchair, so each morning he rings the bell to get employees' attention to help him get up for the day.
Roller said, in addition to the employees helping him with daily tasks, they help him do activities he enjoys, including recently taking him to a Minnesota Vikings game (one of his favorite football teams).
The employees also help residents such as Ben Kilzer, 29, communicate. Kilzer has been at the group home for seven years and is lovingly known as the jokester of the house.
For Arthaud and another direct support worker, Jassmyn Magnuson, it's the residents that keep them going. In addition to direct support work, Magnuson also picked up two other jobs at a downtown Bismarck boutique and coffee shop.
Despite how much she gets paid, Magnuson said she has no plans to leave.
"They're family," she said, as she prepared chili dinner for the residents one night last week.
Thousands of North Dakotans with disabilities rely on direct support workers, as well as their families. Family members are often able to maintain jobs and are given respite with the help of these employees.
Renee Kilzer, the mother of group home resident, Ben Kilzer, said group home employees provide support to her son in ways she cannot. Ben Kilzer suffered from an anoxic brain injury when he was 11 years old after his heart stopped. For years Renee Kilzer said she and her husband took care of their son, but when he turned 18 — just like his brothers and sisters — he wanted to leave.
So, he lived at the Anne Carlsen Center in Jamestown until he was 21, Renee Kilzer said, and he's been at the group home in Bismarck ever since.
"We're really thankful for the people that have taken care of him, because we're getting older ... and we're not as strong as we were," Renee Kilzer said.
"At that (group) house, those workers take him places and do things with him," she said. "We weren't able to do the things that they're able to do here ... they're good to him."
High staff turnover can also impact residents, who have built close relationship with their caregivers.
Judy Schaefbauer is the guardian of her sister, Rosemary, 57, who has Down syndrome. Schaefbauer said there was often a change in staff at her sister's group home in Aberdeen, S.D., which was difficult for her sister, who had certain employees who were her "favorite."
'A desperate need'
Larson, the executive director of Enable Inc., gave testimony before the Senate Human Services Committee earlier this month about the "desperate need" for inflationary increases for community providers.
Each year, Enable Inc., hires about 60 new direct support workers in response to turnover. Turnover is also costly for community providers, in terms of training.
Larson said providers rely on inflationary adjustments for wage increases, which are tied to state Legislature's appropriations.
Providers receive a mix of state and federal funding, including through a Medicaid home- and community-based waiver. Tina Bay, director of the state Department of Human Services' Developmental Disabilities Division, said the waiver has a capacity to serve 5,680 people and is currently near or at that amount.
"I certainly understand the workforce concerns ... and in order to attract quality staff, I understand why there is that need for an increase," Bay said.
Kirsten Dvorak, executive director of the Arc of North Dakota, said there simply aren't enough direct support workers in North Dakota. Historically, lawmakers have supported increasing wages for these employees, by Dvorak said she's not sure lawmakers understand how these workers impact the quality of life for people with disabilities.
"I'm afraid we're going to start having really good (employees) start walking away," Dvorak said. "We think we have a problem now; without the increases ,we'll lose even more and really have a problem on our hands."