Professional caregivers do essential work but often earn low wages. FatCamera/E+ via Getty Images
Social service nonprofits had high rates of staff turnover and a hard time filling vacant positions in 2022 as the COVID-19 pandemic was ending.
Low salaries, inadequate benefits, staff burnout and a shortage of qualified job applicants were largely to blame. The staffing problems were so severe that some of the people leading these organizations were afraid that they might have to close their doors.
That’s what our research team, composed of eight social work scholars, found when we interviewed 27 social service agency managers in a metropolitan area in the Southeast.
These nonprofits provided an array of services, including care for people with substance use disorders and mental health conditions, as well as housing assistance, other kinds of health care and free food distribution.
No matter their specific focus, these nonprofit managers told us that they saw heightened demand for services since the start of the pandemic.
For example, they observed an increase in the number of people who were using opioids and other substances during and after the pandemic. This led to a greater demand for substance use disorder treatment.
More people were also struggling with food insecurity and asking for help getting food. Staffing problems made it harder to meet these needs. Some nonprofits had to keep people on waitlists or turn people away – even if their needs were dire.
One substance use disorder treatment facility said that several potential patients had fatal overdoses while on the waitlist for their services. This agency was in a rural area, and the people seeking its help had nowhere else to go.
Some of the nonprofits could retain their workers if they offered perks such as flexible work schedules and the freedom to work from home. Yet, many social service agencies fill critical needs that cannot be adapted to virtual employment.
Some of the nonprofit leaders told us that they strove to improve their workplace culture to retain employees. But that was not always enough to keep employees when the salaries were very low during a period of historically rapid inflation.
Why it matters
U.S. social service nonprofits provide many critical services, including support for older adults and people with disabilities.
Many of these agencies rely on Medicare and Medicaid funding, which can be challenging because the reimbursement rates for therapy sessions, caregiving and other health service categories are very low.
The nonprofit leaders whom we interviewed said it was hard for their agencies to cover the full cost of salaries and benefits for their employees with the money they get from Medicare and Medicaid. Some of them said their organizations couldn’t afford to pay their workers enough money for them to cover basic living expenses.
Shortages of addiction and mental health counselors in the U.S. are dire. Approximately 123 million Americans – more than 1 in 3 people – live in places without enough mental health providers to see every patient seeking care.
Access to treatment is further restricted because some mental health providers are reportedly choosing to stop accepting any insurance payments at all because of the low reimbursement rates and burdensome paperwork required. This means that many people with mental health needs are having trouble getting care without paying high rates – turning therapy into a luxury.
Therapy can cost US$150 or more per session without any payments from an insurance company, compared with a copay that will probably be in the $20-$50 range per session if the care is covered.
What’s next
Our team has been training new professionals over the past 11 years. So far, we have trained 297 mental health professionals. We plan to renew the federal grants we received for this work so we can keep helping to fill this critical gap at a faster rate.
The Research Brief is a short take about interesting academic work.
Susan Neely-Barnes receives funding from Health Resources and Services Administration.
Elena Delavega receives funding from the Health Resources and Services Administration (HRSA).
Melissa Hirschi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
