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“I would say some of that was related directly to some of the turnover we had at some key positions,” Rinne said. “We lost some historical perspective and some of the people who were really good at the day-to-day supervision.”

Dixie Chaney, a client at a Stone Belt group home, rocks back and forth on an easy chair and watches SpongeBob SquarePants.

She’s a gentle soul who came to Bloomington in 1993 from Muscatatuck, protective of her food and afraid of water. She perks up when reminded of Easter, putting her hands by her ears to croon about a bunny that hop-hop-hops.

Some clients are young at heart. Some things these ears aren’t meant to hear.

One Sunday, a Stone Belt employee erupted into a profanity-laced tirade, “yelling and screaming nonstop,” according to a state Department of Health surveyor’s interview with a client. She used a four-letter word to complain about cleaning things up. She cursed the day as she wished for its end.

The employee was fired last March.

“Totally unacceptable,” Stone Belt CEO Leslie Green said.

Green’s organization screens applicants to try to root out potential abusers. Interview questions psychoanalyze prospective hires about why they want a job, in which an answer that uses “taking care of” a person rather than “supporting” may be enough to eliminate a candidate.

Amy Hewitt, director of the Institute on Community Integration at the University of Minnesota, says LifeDesigns and Stone Belt are “two of the good ones.” Stone Belt, which she worked for in the 1980s, has averaged 29 percent turnover during the past three years.

Turnover can range wildly, from 15 percent to 300 percent, Hewitt said. It depends on whether staff have training opportunities and can feel competent in a high-stress job. It also depends on whether care providers are honest with applicants about the reality of the job.

Still, wages matter. And, nationally, shrinking funding has forced agencies, mindful of potential overtime costs, to hire less qualified people to bring up staff numbers.

“Employers feel pressures to fill vacancies. Over the years, they have lowered the bar of who they will hire in their organizations,” Hewitt said. “They are less careful about who they will bring in to the organization because they are desperate to fill shifts.”

Every year since 2009, a byproduct of lower tax collections during the economic downturn, the share of Medicaid dollars Indiana has allocated to care providers for group homes and supported living has decreased - 3 percent per year for group homes and 7 percent for supported living. This year, the rate of reduction fell to 1 percent and 5 percent.

That means serving more with less. In 2008, Options’ revenues were $8.4 million and the agency served 273 people, according to Rinne. By 2011, before the merger, Options’ funding dropped to $7 million for 285 people.

LifeDesigns was able to reduce costs and add buffer between revenues and expenses by cutting administrative staff in the Options-Christole merger, but the combined organization’s revenues continued to dip from 2012 to 2013 by more than a million dollars. Stone Belt, facing similar cuts, reduced pay and benefits for much of its workforce.

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