Burnout in Five Key States: The Problem Persists

High turnover rates and burnout are major problems affecting the quality and frequency of care among children, youth and family services’ providers, senior caregivers and direct support professionals. Although some states are experiencing an increase in the severity of the burnout problem, other states are using higher salaries as an incentive to reduce turnover. Fortunately, examples from five states can help your organization reduce turnover by understanding its driving forces and tested solutions.


Texas CPS Tries Broadening Educational Requirements to Reduce Burnout

Burnout among caregivers and health and human services’ professionals is on the rise in Texas. From senior caregivers to a decline in the caseworker availability, Texas is in crisis. Per The Dallas Morning News, stressful positions in Child Protective Services (CPS), specifically, child-abuse investigators, have, at 57 percent, one of the highest turnover rates in the country. Yet, high caseworker-to-child ratios of 28-to-1 in the state continue to supersede the Child Welfare League of America’s recommendation of 17-to-1.

Another problem persists as well; case studies have identified a troubling trend among CPS workers in the state. In 12 instances, case managers and social workers involved in child-abuse investigations were accused of faking case information. Last year, CPS unveiled a new plan to resolve the issue by hiring caseworkers without college degrees. This plan sets Texas apart from all other states, 45 of which require a minimum of a bachelor’s degree in a human services major.

While a plan to reduce burnout and turnover among positions involving the care of others, especially children, is needed in Texas, the GOP-led legislature of the Lone Star State disputes claims of inadequate funding. Another part of the problem goes back to salary, but since social workers and case managers routinely work for government-funded organizations, Texas lawmakers effectively set salaries for these positions.


Ohio Plans to Reduce Burnout Through Legislation Limiting Workload

Problems with burnout plague every aspect of health care services in Ohio. The problem is severe among senior caregivers. The Columbus Dispatch reports that 1.4 million Ohio residents over age 50 need caregivers, and by 2030, 20 percent of Americans will reach age 65, so the shortage of senior caregivers will grow in severity.

Among child welfare caseworkers in Ohio, turnover rates are up to 25 percent, asserts the Dayton Daily News. Caseworkers who leave may feel unappreciated or unable to truly help those in need because of changing opinions as to the role of caseworkers.

For example, some families may feel caseworkers are simply going to remove children without any opportunity to mitigate health and safety issues, such as cleaning a dirty home, and to some extent, this belief has led to greater risk and dissatisfaction among child welfare workers.

Clearly, more workers are needed, and salaries need to increase to retain those who are in the field today, but what about direct care providers, including nurses?

Ohio State Senator Mike Skindell has reintroduced legislation to help direct caregivers in the state, asserts Matt Thomas of Fox 28. The bill would define the maximum number of nurse-to-patient ratios, and language in the bill can be interpreted to place strict rules on health care organizations and hospitals requiring mandatory overtime of employees. The bill’s goal is to reduce burnout and improve safety of those receiving care, but it comes at a cost.

Organizations employing nurses and other caregivers will be forbidden from laying off personnel, including support positions, such as senior caregivers and nurse aides, to meet ratio requirements. Thus, health care organizations must hire more employees, which will reduce stress and require facilities to increase annual budgets.

This may lead to a future increase in annual compensation for caregivers as quality care standards increase. In other words, less chance for error due to fatigue or burnout will help organizations avoid spreading nosocomial infections, alluding to better payments from health insurers.


Little Government Help in Washington Leads to Company-Guided Initiatives to Reduce Turnover

Wages in Washington have remained stagnant for years. According to the U.S. Bureau of Labor Statistics (BLS), child welfare workers earn approximately $48,950 annually. However, the gap between child welfare and general social workers is slightly more than $10,000. So, more employees are turning to a third-party means of supplementing income, reports The Washington Post.

Third-party income sources are companies such as Uber and Airbnb. Children’s services providers, including social workers, use these services to help increase pay when work is unavailable or simply not paying well enough. Moreover, statistics indicate that more than 50 percent of child-care workers, ranging from daycare providers to children, youth and family service advocates, rely on food stamps. So, an alternative income source is needed.

The low-skilled nature of these third-party companies reduces barriers to entry, much like the plans for CPS in Texas, effectively reducing the chances of burnout. Yet, third-party apps do come with a caveat. If an employer continues to fail in providing living wages and opportunities for growth in careers, employees may be more likely to resign altogether in favor of working independently for another company. Meanwhile, Washington’s legislature has not taken steps to reduce burnout, so the pressure is on for employers to meet the challenge.


California Has Taken Exhaustive Steps to Reduce Burnout

The Ohio bill is a rendition of California’s 2010 legislation limiting nurse-to-patient ratios. But, subsequent efforts in California to reduce risk and turnover rates among health and human services providers have fallen short in the state senate. However, California law provides additional incentives for employers to reduce burnout from workplace stress.

As explained by the Harvard Business Review, California allows employees subject to mental stress and anguish from workplace stress to file workers’ compensation claims. Furthermore, the link between workplace stress and chronic illnesses gives courts the authority to rule in favor of claimants. In other words, employers, including health care organizations, may be required to pay for high turnover rates due to workplace stress.

This concept was the reasoning behind California’s initiatives to reduce nurse workloads in 2010. But, disparities among races in California’s major metroplexes, including Los Angeles, appear to be contributing to higher turnover rates among social workers, senior caregivers and direct support professionals (DSPs). Even social workers in school environments are experiencing high turnover rates in California, explains LA School Report. But, if legislation exists to reduce turnover in the state, why isn’t it working?

The problem goes back to salaries. Some organizations continue to pay minimum salaries, which remain lower than degree cohorts. Essentially, salaries of social workers and caregivers in California are less than the salaries of other people who have similar degrees, such as a bachelor’s degree, explains the California Child and Family Services Review.


New York Puts Salaries First, and Employers Act

Employee burnout and high turnover rates are not new concepts. In the early 1070s, New Yorker Herbert Freudenberger coined the term “burnout,” explains NPR.org. As a successful psychologist, he worked 14-hour days, but most of the time he spent “working” was in non-paid positions. Soon, he realized that he was drained of his ability to live because of his role in caring for others, and that concept would soon threaten to paralyze New York. Thus, action was needed.

New York stands out from the crowd of states facing severe turnover among HHS workers. Although the problem remains, social workers in New York make significantly more than their counterparts in Washington, reports U.S. News. In fact, New York children’s social workers make $56,010, reports the BLS. Meanwhile, general social workers in the state make rates similar to those in Washington.

In other words, the higher entry-level pay for social workers in Washington in children, youth and family social organizations provides an extra level of protection against high turnover rates.

New York companies have also had a hand in reducing turnover rates. Support programs, including training in dealing with secondary traumatic stress and health initiatives in the workplace, help reduce stress and depression associated with work. The pairing of these initiatives and higher wages has propelled New York to the top of the list in terms of highest wages and fewest problems with turnover. Of course, continued efforts to reduce turnover will be needed to stop it from rising again.


Final Thoughts

Washington, Ohio and Texas are amid a crisis over health care and social worker burnout or high turnover rates. Both Ohio and Texas are taking steps to reduce the incidences, and in some cases, these states may be on the verge of a breakthrough. Meanwhile, California law and New York wages are helping to reduce turnover in their respective states. Your organization can leverage the experiences and attempts of other states to reduce turnover in your company. Essentially, the adage of learning from history rings true in this discussion more than ever.

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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