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The downward trend in wages doesn’t bode well for the future, considering the increasing demand for services. A U.S. Department of Health and Human Services study in 2006 found that at a consistent rate of 50 percent turnover, the direct-care industry would have to find around 900,000 new hires in 2020 because of the country’s aging population, both “baby boomers” and people with disabilities whose life expectancies are increasing.

And turnover comes with its own cost. In 1998, researchers at the University of Minnesota found the price of replacing 50 to 70 percent of the national direct support workforce, at a rate of nearly $1,400 for training each new employee, cost the health care system between $200 million and $300 million per year. Last year, LifeDesigns hired and trained 85 new direct support professionals at a cost of $136,000.

Those costs only will go up if predictions hold true and funding continues to drop.

“You have people who are legislators who set the rates,” Hewitt said. “It’s not people who are looking at demand or quality of services. It’s fickle, because it’s at the whim of the government’s spending priorities.”

A muffled scream answers Lauren Harding’s knock. From outside the home, the sound is disturbing. But inside, it’s understood as something sweet.

Harding, pleased, knocks one more time.

“Stephanie, she loves answering the door,” Harding says.

Footsteps draw closer. The door swings open. A middle-aged woman in a red apron stares back with her mouth wide open. The greeting continues like a siren, a happy “hello” from someone who can’t use words.

The client is in the caregiver’s hands. An employee such as Harding, who knows the difference between excitement and a cry for help, is invaluable in a profession where lives are literally at stake.

One incident more than a year ago showed how important oversight is in this industry. Caregiver Ken Aker had contracted for LifeDesigns, and before that, Options for Better Living, for about a decade. State law mandated the company should have been sending employees to check on Aker and his client, Tammy West, twice a month. But no one had visited the home in three months when West, a woman with cerebral palsy, was rushed to the hospital in January with severe bedsores.

West died, and Aker is awaiting trial on a felony charge of neglect.

After that incident, LifeDesigns initiated an internal review of its oversight procedures last spring, and made changes. But not everything was caught, and residents would later lose Medicaid coverage because the agency had failed to adequately monitor clients’ finances.

No one lost medical care during the lapse, and certainly no one suffered physical harm. But it showed what can go wrong in a system where every aspect of a life is in someone else’s hands.

Keeping the best people to watch over clients is imperative. But there are no easy solutions. Wages matter, but raises by themselves would bring their own problems. The political push now is for a minimum wage of $10.10 per hour. Stone Belt’s Green would love to see it for her employees, but it would destroy her agency.

“Financially speaking,” Green said, “that would close our doors.”

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