Think Out Loud

Oregon caregivers are reaching a breaking point, want better conditions

By Rolando Hernandez (OPB)
March 13, 2023 4:35 p.m. Updated: March 13, 2023 8:02 p.m.

Broadcast: Monday, March 13

Caregivers in Oregon group homes are reaching a crisis. Facing long hours, low pay and concerns for safety, these state employees with the Department of Human Services are urging their bosses to listen to their concerns and address working conditions. Christina Sydenstricker-Brown is a caregiver. Ben Botkin is the criminal justice and health reporter for the Oregon Capital Chronicle and has been covering this issue. They both join us to share details of the conditions that these more than 600 employees are facing and what it could mean for the future of the field.


The following transcript was created by a computer and edited by a volunteer:

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Caregivers who work in some of Oregon’s state run group homes say they are at a crisis point. Workers for the Stabilization and Crisis Unit, which is a part of Oregon’s Department of Human Services, provide full time care to people with serious intellectual and developmental disabilities. They say low pay, long hours, and safety problems plague the unit and they’re asking for relief from the agency. Christina Sydenstricker-Brown is a caregiver. Ben Botkin has been covering this issue for the Oregon Capital Chronicle. They both join us now. It’s great to have both of you on the show.

Christina Sydenstricker-Brown / Ben Botkin: Thank you.

Miller: Christina, I understand that you’re actually taking a break from your work day right now, sitting in your car to talk with us. Can you give us a sense for what an average work day is like right now?

Sydenstricker-Brown: The average workday is 16 hours a day. When I leave my house at 6:00 a.m. in the morning to go to my regular shift, which I should be getting off at 2:00 p.m., I’m stuck. I’m mandated to work until 9:30 -10:00 p.m. every day. So my whole family knows that once I leave, I’m not coming home until late, when everybody’s in bed. I do that routine, four days consecutively in a row. So, we’re exhausted and tired and fatigued. And it’s a challenge with our individuals that can be very challenging to get all their daily needs met under the circumstances of not just myself, but it’s all employees that are getting stuck like this around the clock.

You’ll have a lot of graveyarders, when I come in, that are getting mandated onto day shift as well, and so they’re tired and fatigued, which puts the load more on yourself because you’re fresh from sleeping and coming in, and then you’re tired and fatigued, come swing shift and swing shift is getting mandated to ‘NOC shift.’ And so it’s just a snowball effect of that and it makes it really challenging to take our individuals to do the fun activities that are more of a long journey for the day, like going to the beach, going to the zoo, doing things that you need the energy, you need to be able to drive, and be recharged for to happen. So those kinds of things have been really challenging for individuals and those needs need to be met to keep our individual safe and happy. It requires us to be able to have a full battery and to be able to provide them with the service that we’re supposed to provide them with.

Miller: So, for example, today, do you already know that you’re going to have to work until 9:00 p.m.?

Sydenstricker-Brown: Yes. Today I’m working until 9:30 p.m. When NOC shift gets here, then I’ll be relieved to go.

Miller: ‘NOC shift,’ which is before graveyard shift?

Sydenstricker-Brown: It’s a graveyard shift. I’m working swing shift. And then when NOC shift gets there, I get to leave.

Miller: When you say that you’re mandated to do this, I mean, is it basically if you don’t work these double shifts, four double shifts in a row, what would happen?

Sydenstricker-Brown: We’re already short staffed. So we would just be shorter staffed, which means that none of the daily needs would be met. And that’s a real strain on us with our work because it’s our work and we need to be able to do our work with our individuals. And the individuals feel that stress which makes their maladaptive behaviors way higher, their crisis more intense, because they recognize that I’m not going to be able to go to Mall 205 up in Portland today to go to the dress store that I want to and pick out the dress I want because there’s not enough staff available to take me. Most of our individuals that we support are two-on-one, out in the community, for the health and safety of the individual, the community and ourselves.

Miller: I want to hear more about the actual work you do and the population you serve. But as I noted, Ben Botkin, a reporter with the Oregon Capital Chronicle is with us as well, and you’ve been writing about this for a few weeks now. One of the caregivers you talked to is Paula Burlington. What did you hear from her in terms of the hours that she is working?

Botkin: So I’m talking to Paula. Her hours are very similar. It’s 16 hour days, but it’s not just 16 hours here and there, it’s multiple days, each week. So 16 hours, several times a week on top of a regular 40 hour shift. So it’s this idea of working so exhausted that when she gets home her first day off, she literally is so tired, she can’t get out of bed. It’s that level of exhaustion.

Miller: What is the staff vacancy rate these days, Ben? What did you hear from the Department of Human Services?

Botkin: What I’m hearing is a staff vacancy rate is about 10%. It used to be higher, but one of the homes shut down. So with those positions gone, the rate dropped from about 13% to 10% or 11%. But keep in mind, when we’re looking at the numbers, these are all homes that are scattered between Eugene and Portland. So, a vacancy of being down one or two people a shift, that’s going to be a much bigger deal than a large facility that can easily move people from unit to unit.

Miller: What did you hear from the agency about what they’re doing right now to try to improve the staffing situation, to hire more caregivers?

Botkin: What I’m hearing is, they certainly acknowledge that, ‘hey, we need to hire more staff.’ So the steps they’ve outlined for me include trying to go to job fairs more often. They’re also planning a May hiring event that would give people a job offer the same day they interview. So they’re certainly doing those steps as well as trying to do additional check-ins with new employees just to see if there are any issues they can address to keep them from leaving the job prematurely. So those are some examples of steps I’m hearing from the agency.

Miller: Christina Sydenstricker-Brown, what do you make of those efforts? Do you think that they will actually lead more people to take on this job?

Sydenstricker-Brown: Yes. And the problem with them being able to hire on the day… there’s background checks that they have to I don’t see that being a possibility, the same day. The problem is that you do get new staff that are great staff and they come in and they realize the challenge of never being at home and they’re like, ‘I could go to Amazon and I can make the same money and I don’t have to worry about dealing with crisis and maybe getting injured. Also, I won’t get mandated – so that…’

[Voices overlap]

Miller: When you say mandated, meaning you won’t be required to work double shifts over and over and over.

Sydenstricker-Brown: Yes. Forced to work. Yeah, that is what is happening. I’ve seen, time and time, great staff come in and you get them going there, maybe here, three months and then they’re out the door. And that’s what’s happening… is that they don’t want to stay and do this type of work.

I have 25 years in, and I’m invested and that’s why I’m here still today. I love my job and I love being able to take my individuals out and do the things that they need to do and be able to enjoy them and see them be successful and their goals get met. But in the last two years, it has been the biggest challenge that I have seen over my whole career of us being able to get them to where they’re successful and their goals met so that they can live out in the community or go to the private sector and be successful.

Miller: You noted that among some of the people who have been hired recently, who may leave after three months, they realize that they can get the same pay if they work at Amazon, with better working conditions. And it’s not like in the past, I mean, specifically when we’ve talked about Amazon, rarely have we heard this is a great place to work. So that says something, if we’re talking about, say a warehouse job, but what does the pay look like right now for people who are starting out?


Sydenstricker-Brown: For people that are starting out, I would say it’s about $15 to $16 an hour, start out pay. The state does provide some great benefits, which is usually the caveat that keeps people here and want to work for the state of Oregon. But in this line of work, our job is so unique with what we do, taking care of human beings and it’s forever changing. And so it’s a struggle for people to come in. It’s not like a desk job where you have the same line of work that you do every day and you know exactly how to get things done. It’s always changing. It’s a different day every day.

So that struggle’s real for new staff that are like, ‘You know what, this isn’t for me, I can’t do this. I can’t be mandated and stuck at work. I have children at home. I’m a single parent.’ I’ve seen that many times. I don’t know how they do it. Their daycare providers struggle to even keep their kids so that they have the ability to work. And so at that being said, there’s a lot of providers out there for daycare that don’t want that, as well. So it’s hard to get a single parent or if you have a husband that’s working as well to be able to do this line of work. I’ve been very fortunate, like I said, I’m invested, but I have a husband who contributes at home 100%, from maybe 5% that I do.

Miller: And taking care of the kids, say, after school,...

Sydenstricker-Brown: Absolutely.

Miller: …until they go to bed and then eventually you come home.

Sydenstricker-Brown: Yes, I miss all their events. Anything. They have basketball players, I have wrestlers. I have football players. We have baseball that’s just starting. I usually miss all those games. Tomorrow, my son has his first game. He’s a senior. I’m not gonna make it for his first game of his senior year, because I’m gonna be here at work. My days off are Thursday, Friday, and so those are the only days that I’m available to do that unless I prearrange time off and at the same time, don’t want to do that either because we’re already shorthanded. And so it’s a big struggle when I have a team that I work with and I don’t want to know that on my day off that I took off that someone got hurt because they only had three staff. And we normally run with seven staff on a day shift and seven staff on swing and four staff on NOC shift.

Miller: Ben, this division, this unit, really does seem to fly under the public radar. It’s possible that one reason is we’re not talking about a huge number of residents at these homes. But why do you think it is that so few people even know about this unit?

Botkin: Well, think about it visually as well as just the number of people they serve. They serve about 100 people, give or take. But these are all small homes. They’re scattered between Eugene and Portland, about 20 of them. They each have roughly five residents or so. So they’re not necessarily going to be large facilities that you visually see and identify with medical care or the mental health system as you would if you drive past Oregon State Hospital or some other large facility. So I think that’s one reason why they really fly under the radar.

Miller: Christina, there are, I’ve read from Ben’s reporting, over 600 total employees for this program which serves under 100 residents. It’s a more than 6 to 1 ratio. What makes this population so challenging? It’s a lot of people for each resident total, and not all of those are in the homes, but overall – can you give us a sense for the population you’re serving?

Sydenstricker-Brown: So I work in a five bed home. It’s a duplex-style. So there’s a two bed on one side and a three bed on the other side. Our individuals are very challenging. They have high crisis behaviors, they can injure you in a heartbeat. And so we’re always certified trained, through the Oregon Intervention System, least to most restrictive. We do CPS, which is ‘collaborative problem solving’ to try to keep the individuals at baseline, is how we call it. That would be typically a great day if you could keep them at baseline all day.

They’re intellectually disabled, but on top of it, they have some mental illness as well. So they’re double diagnosed. Some of them are triple, quad-triple, and have five diagnoses. And then we also have some medically fragile individuals that [are] wheelchaired, and they have G tubes and they have trachs and they have to be turned every two hours so they don’t get bedsores, and things like that.

So for all of our individuals, in order to operate and be able to complete those duties, if we’re in crisis, you need at least two staff with an individual out in the community. All of our individuals are one on one in the home. They all have a staff that is assigned to them for their shift. On top of [that], we have to have a med person because we give medications and then we go to all the doctors’ appointments, all the psych appointments. On top of [that], we have to have a float to be able to provide all the meals and cook. And so it’s running a home and they have laundry and we have cleaning duties and we have yard duties. We also have a courtyard that has a basketball hoop, for entertainment to go out and play ball and we have a garden that we have to take care of. We have chickens that the individuals help take care of. So it’s running a home.

We have vehicles that have to go down and get the oil changes, or else the state dings you through the state motor pool, if you don’t get your car in by the miles that are up for an oil change and it’s all on the load of the staff. That’s all staff’s responsibility to make sure all these things get done. Management’s responsibility is to make sure that we’re doing our responsibility, but also their responsibility is the staff and making sure our times are correct and making sure they’re doing the vacations and all those things and then there’s monthly’s that have to be done with individuals. They have an ISP Team which is usually a caseworker with a guardian and then management and usually a staff that . . . and the individual and they all go to talk about changes in their plans. They all have Positive Behavior Support Plans that we have to follow.

There’s lots of guidelines, policies and procedures. There’s a lot, it’s a very unique line of work that we do. It takes special people to be able to do these duties with these individuals and be successful. And that’s one of the downfalls, trying to be able to keep those staff that are good staff because we are underpaid and because they’re not willing to . . . they acknowledge that we have a staffing crisis, they acknowledge we have a staffing crisis so much that they’ve given management a staffing crisis differential to work our shifts on the floor if we can’t meet the need. But they don’t have that in place for us staff, that are the ones getting mandated over and over and over again.

Miller: Ben, Christina has mentioned safety issues a few times and I want to hear what that has meant for you, but then you’ve talked to other caregivers as well. What have you heard about staff safety?

Botkin: Well, the interesting thing about staff safety is since these are unique individuals that they’re taking care of, who have unique needs, if you have a staffing crisis, you can easily have a situation where one individual needs several staffers to take care of them and help them work through that crisis and keep other residents safe. So if you have a staffing shortage, that just increases the risk of injury or some kind of accident. In the case of Paula, who I wrote about, she had to intervene a few months ago when there was a crisis, even though she was on light duty and not supposed to do any heavy lifting. So that’s just an example of what happens when you have a staffing shortage and an increased risk of accidents.

Miller: Christina, what have you seen or experienced at your house?

Sydenstricker-Brown: So we’ve had to reschedule appointments that are important that individuals go to meet other needs of another appointment, that’s like we have to balance, and figure out what appointment is most important to which individual. Like we have an individual that goes to school. So we have to take her to school. It takes two staff to go to school. She has to be there at 9:00 a.m. and you’re there until about 11:30 -12:45 p.m. So you don’t get back to the home until about noon. So that always takes two staff. So then you’re left with five staff at the house with four individuals, and one staff to do medication and make sure all the meals are met and then help with any other outings that are going on in any other appointments.

Like today at 11 a.m., we have an individual that has a dentist appointment. And then at 12:30 p.m., we have another individual, needs to go to Portland to OSU, because they have braces on their teeth, they have an appointment, a dentist appointment as well, that takes four staff. And so then that just leaves three staff in the home with the other three staff that are left and to make sure all those duties get done, all the cleaning gets done before the next shift, the garbage gets put out, laundry keeps rolling, dishes are getting done. There’s a lot of extra duties, you’re not just supporting your individual, you have all these other duties to make a house run and be successful and to stay clean and meet the policy and procedures.

Miller: Ben, the union representing these caregivers, AFSCME Local 1246, is currently bargaining for a new contract with the state agency. You recently wrote about a demonstration at DHS headquarters put on by caregivers and the union. Where do negotiations stand right now?

Botkin: At this point, I know they are still in negotiations, that’s been ongoing. One issue that is also in the mix is the fact that last year for a while, the workers had added hourly incentive pay and that really helped the staffing issue quite a bit as well as the vacancy rate. And that pay issue is one sticking point in negotiations. And I think Christina could certainly talk more to that.

Miller: Well, Christina, what do you most want listeners to keep in mind? If you were talking directly with management as a member of the union or just as one caregiver, what would you tell them?

Sydenstricker-Brown: That I feel like if we’re advocating for individuals to have the best days possible and to be able to get all their needs met that are on the calendar for them, we need an incentive pay. Because when I go home at night and I don’t see my kids, I miss all my kids’ games and I’m not there to support them and it’s painful. It puts a hurt in my heart, and these are kids that I’m raising to be good citizens out in our community of Oregon. And to know that I’m not being a part of that because I’m missing out because I’m stuck at work because we don’t have the staff… it’s depressing. It’s not okay, and all the staff… I’m not the only one… are all feeling this pain.

Before, when we did get the incentive, the morale was up at work. People were more happy to take an overtime and more wanting to volunteer for that because of the extra incentive pay. Now people don’t want to work overtime. They’re burnt out and they’re tired and they feel like the state doesn’t care, and that’s the saddest part. What about the workers that are doing the work? Everybody cares about the individuals and what’s going on in their daily needs and we’re coming to work with that care and they’re robbing it from us because we’re not able to energize and recharge our battery and get a good home life balance with our work balance. And it’s unfortunate and it’s causing divorces, kids to be fending for themselves, learning life skills over the phone, Facetiming mom on break, learning how to do laundry, learning how to make macaroni and cheese. My husband also works. He gets off at four every day. So it’s a benefit for me that he’s there at home in the evenings with them. But there are times where he has things he has to do as well.

So I’ve had to teach my kids over the phone how to do macaroni and cheese, how to do their laundry, because they have a game tomorrow and they need their uniform washed. So, when my days off come, I have laundry stacked up, I’m exhausted and tired and I’m more irritable and it’s not fair to my home life for me to be that way because I give everything I have to work.

Miller: Christina Sydenstricker-Brown and Ben Botkin, thanks very much.

Sydenstricker-Brown / Botkin: Thank you.

Miller: Christina Sydenstricker-Brown is a direct support crisis specialist with Oregon’s Stabilization and Crisis Units, a part of the Department of Human Services. Ben Botkin is a criminal justice and health reporter for the Oregon Capital Chronicle.

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