County in Crisis: Soaring vacancies in Sonoma County government undermine key programs, fuel employee burnout

But a deeper dive into the county’s employment rosters, reveals some departments and divisions are battling staffing shortages with vacancy rates for key positions ranging from 25% to over 41% — thresholds that are unsustainable, officials say. As a result, remaining employees struggled under immense workloads and marathon workweeks to prop up services.

Years of calamitous disasters in the county — wildfires and floods — coupled with the COVID-19 pandemic, runaway housing costs and a tsunami of employees aging out of the workforce are some of the biggest factors in what many officials and employees described as a “perfect storm” overwhelming many county departments.

“Nationwide we're all getting out of trying to dig ourselves out of the COVID situation in terms of recruitment and vacancies,” said Sonoma County Administrator Christina Rivera, the Board of Supervisors’ top appointee, who oversees the workforce and budget. “In a nutshell, what I believe is happening is that more people are separating (leaving or retiring) than what we can replace.”

Such things as land-use planning delays and depleted ranks in jail staffing, however, could swell into a worst-case scenario if the crisis continues. Rivera said that could result in significantly slower delivery of services like economic aid — the cash, food and health care assistance that the county’s most vulnerable residents rely on.

“One thing is to be slower at reviewing a permit for some huge developer who wants to monetize their investment,” Rivera said. “But another thing is to slow down somebody's public assistance … worst-case scenario is that we're slowing down the services for the (people who) most need it.”

The impact is far beyond local hospital emergency departments. The Press Democrat’s investigation found cases where county staffing shortages have:

• Swelled the roster of pending CalFresh applications for government food assistance. That list had grown to 3,300 by Nov. 30, a 71% jump since 2019, with economic assistance workers averaging nearly three months to process each of those applications.
• Fueled hefty taxpayer expenses for overtime pay, totaling $88.9 million between 2020 and 2023, when county employees logged an average 320,640 hours annually, a workload roughly equal to that of 154 full-time workers.
• Hollowed out sworn staffing in the county jail system, where vacancies among correctional deputies grew nearly sixfold in the past four years, from eight in August 2019 to 47 this past August, representing 26% of allocated deputy staffing in the jail division. Factoring in deputies on leave, the vacancy rate jumps to 43%, the August snapshot showed.
• Left jail inmates being stuck in their cells for as long as 23 hours, violating the Sheriff’s Office policy on out-of-cell time.
• Spurred the union representing key employees at the Charles M. Schulz Sonoma County Airport to sound the alarm over potential safety concerns in off-hours shifts.

The spiraling costs and employee burnout have put county administrators in a bind.

“It's not something that's sustainable, and it's my biggest challenge as sheriff,” said Sheriff Eddie Engram, who was elected in 2022 and took office a year ago.

Crisis within the Crisis Stabilization Unit

The Blue Zone at Providence Memorial Hospital, Sonoma County’s largest, averages five or six mental health patients a day, but sometimes the number can reach as high as 15, with some waiting days to be transferred to a mental health facility in or outside the county.

Psychiatric patients must be seen in a secure room, restricting where doctors and nurses can treat medical patients, said Scott Rocco, Memorial Hospital’s director of nursing, emergency and trauma services.

Dr. Omar Ferrari, medical director of Memorial’s emergency department, said there are more appropriate places to care for psychiatric patients in crisis.

“This is some of the most sacred space in the county. … It's where all our loved ones, the most vulnerable, everybody comes for care,” Ferrari said. “An acute heart attack, an acute stroke, a trauma where somebody's bleeding out, is more pressing. It needs staff resources and attention now or they will die immediately.”

The psychiatric patients overwhelming emergency departments are meant to receive care at specialized mental health facilities. But Sonoma County’s primary site, the 24-hour, 7-day-a-week Crisis Stabilization Unit, or CSU, has been hobbled by a staffing shortage that has sharply reduced or limited patient intake for years.

Kristie Badger, a senior client support specialist in the county’s Behavioral Health Division, which provides mental health and substance abuse services, said she has found herself crying on her way to work at the CSU and sometimes even at work, where people in crisis, desperate for help, treat the phone like a “psychiatric 911.”

Too often, she has to deliver a painful message that she can’t help them because of scarce resources and the division’s struggle to meet mandatory staffing ratios necessary to offer space in all 16 beds. It’s a message that grates on her and goes against her reason for working in behavioral health care in the first place.

“It hurts you on a human level because we have the resources in this county, we're a very well-off county,” Badger said. “People in need, people who are struggling with illness or disability, get the short end of the stick and it's really not OK. And it's very difficult to face that on a day-to-day basis.”

At the county department that runs the CSU, Health Services, one of the county’s largest and most strained agencies, the equivalent of 159 full-time positions were vacant last summer — nearly a quarter of the department’s roughly 678 jobs budgeted at the time.

Health Services is responsible for public health, programs for homeless people and mental health and substance abuse services for most vulnerable residents.

Its Behavioral Health Division is supposed to have 105 mental health specialists who oversee care for thousands of low-income residents in need of services such as case management, medication and housing support and referrals to crisis residential or secure mental health facilities. They are also key members of the staff at the CSU.

In early August, the division had the equivalent of 63 clinicians, a roughly 40% vacancy rate, according to county records.

“This particular vacancy rate was exacerbated by COVID,” said Tina Rivera, the Health Services director. “What we've seen is high case loads for (staff) when our vacancy rates are high because the work is spread across a smaller number of individuals.”

Rivera has publicly and repeatedly sounded the alarm about the need for more staff in her department, particularly in behavioral health roles.

She said her department is working with employment agencies to provide some relief for her workers. “It can be tasking for staff to carry these heavy workloads.”

Snapshot in time

The county’s vacancy and leave data is constantly in flux, as positions are filled and staff leave or take time off. Staffing shortages within the past three years have been exacerbated by leaves and furthered the strain on remaining employees trying to plug staffing gaps while also filling in for colleagues taking time away, county employees and their labor representatives said. In January 2023, 295 employees were on leave, 67 more than in January 2020 when 228 employees were on leave, according to county data.

The biggest jumps in leaves of absence were among staff in the Human Services Department, Department of Health Services and the Sheriff’s Office, the county’s largest agencies.

The Sheriff’s Office vacancy rate of nearly 12% in January 2023 shot up to 23% when employees on extended leave were factored in; at the Department of Health Services, the 22% vacancy rate grew to 25% with extended leave figures, county records show.

The leave data illuminate an alarming pattern within the workforce, employees and officials acknowledge. Job strain and “cumulative stress” mounts for remaining employees, undermining their ability to fulfill their duties, said Hasmig Tatiossian, a social worker in the Child Protective Services division of the Human Services Department and steward for SEIU Local 1021.

“That leads to emotional and physical drainage and burnout. That leads to a lot of people going on leave … which then burdens everybody else,” Tatiossian said. “Because then they're carrying all those cases that were being carried by the folks who went on leave.”

Seeking help but on hold

Seeking public assistance is daunting enough. Now with fewer, more stressed employees available to help, it can be almost impossible, pushing some residents to give up.

Donna Helwig, 86, has been self-sufficient for most of the 23 years she’s been living in her Windsor mobile home. But two years ago, after she was diagnosed with breast cancer and began having other health issues, day-to-day tasks became increasingly difficult.

Now she relies on her neighbors to bring in her mail and the trash bins. She also has trouble getting to doctor’s appointments, preparing meals and doing the laundry.

Last year, at the recommendation of her doctor, Helwig applied for benefits under Medi-Cal, the state’s version of Medicaid, in the hopes it would allow her to get some help through the state In-Home Supportive Services, or IHSS Program. Medi-Cal eligibility is required for participation in the program, which pays for home-based care workers for eligible seniors and disabled people.

Her daughter, Robin Baum, has been helping where she can, when she can.

“I work full time; I don't have any brothers or sisters; I have an autistic son,” Baum said. “I'm very limited on what I can do for her.”

Helwig’s Medi-Cal application was initially denied; a small annuity pushed her over financial eligibility requirements. Then, in January a gastrointestinal bleed sent Baum to Kaiser Permanente Santa Rosa Medical Center.

Staff at the hospital suggested Baum reach out to a third-party patient assistance service, with the hope of her qualifying for Medi-Cal’s Share of Cost program, which is similar to an insurance plan deductible.

That led to months of paperwork, faxes and telephone calls to the patient assistance program that ultimately went unanswered. Despite working with a private client assistance specialist, and repeated calls to the county help line that is often at maximum capacity, Helwig’s application sat among the backlog of applications submitted to the county’s economic assistance division.

“Every time she had any communication with them, it was always the same thing,” said Helwig of her daughter’s efforts. “She called me and she said, ‘Well, we need new documentation again.’”

Baum said the county has twice denied her mother’s application for Medi-Cal, informing her that she may instead qualify for the Share of Cost option. But that’s what’s she’s been applying for, Baum said.

“At this point, we’ve just given up,” Baum said. “We just don't have the time to go around and around.”

Helwig, whose late husband worked for the county water agency, feels let down by the system.

“You feel like you've done your part, you've contributed, you've tried to do what you could do and then when it comes time that you need help, it's not there,” Helwig said. “You can't even get a hold of anybody to explain to you what you're supposed to do.”

Residents left in limbo

The limbo faced by Baum and many others seeking public health care, food or other economic assistance was partly the result of a hiring freeze while the Human Services Department switches to a new public benefits enrollment system. That required training of current employees and delaying the hiring of new ones.

The dilemma of diminished services is also fueled by rising demand.

During the pandemic, county employees on the front lines addressing public need faced a surge in applications as more people turned to the county for help. Eligibility specialists, the employees tasked with enrolling people in economic assistance and government health care, faced some of the longest lines even as their ranks dwindled.

The department hired dozens of new eligibility specialists this past fall, but complex training on the benefits programs means they will not be ready to work on live cases for months.

Sonoma County households enrolled in Medi-Cal reached 137,065 in June 2023, a 30% increase since 2019 when 105,372 residents were enrolled, according to county data.

By early December last year, household enrollment in CalFresh, the state food assistance program, reached the highest it’s been in a decade or more: 23,480, a 71% jump since 2019, when pre-pandemic enrollment was at 13,696 according to state data.

As of Nov. 30 last year, there were 3,300 pending CalFresh applications in Sonoma County with workers averaging 83 days to process those applications. Human Services, the department in charge of processing those cases, has seen its vacancy rate grow from 8.27% in January 2020 to 12.43% in January 2023.

In August, before the department hired a new wave of eligibility specialists, 43 positions in that job classification were vacant out of 147 budgeted positions, equating to a 29% vacancy rate.

Because they are entry level positions, eligibility specialist slots typically see higher turnover as employees move up through the department, said Angela Struckmann, the county’s human services director. The strain of the COVID-19 pandemic and a state-mandated switch to a new welfare eligibility system impeded hiring, causing vacancies among eligibility specialists to rise, she added.

In July, the embattled department was so stressed the county put out a public statement: It sought patience from people like Baum seeking help with aid programs and announced plans to hire a new staff to fill shortages that the county said have contributed to slow service. The new state-mandated system and a rise in electronic benefits theft were other factors, the county statement said.

Struckmann said dwindling numbers of candidates are further hindering hiring and adding to the strain on the department.

“It hasn't been as much of a Great Resignation as it has been difficulty hiring — hiring when we do have vacancies,” Struckmann said. “So we've just had a harder time getting the large candidate pools that we used to have, and we're having a harder time getting candidates that have the level of skills and experience that we need for many of our positions.”

Why they’re leaving

Though the need for more government workers only grows, Sonoma County department heads tasked with filling empty jobs are getting fewer applicants.

Jobs that for so long have been associated with good pay, ample vacation and holiday leave and excellent health and retirement benefits are no longer regarded as such, many county employees said in interviews.

“When you think county job, you think career, you know, golden ticket,” said Ellie Campbell-Brown a child protective services social worker and vice president of SEIU Local 1021. “Which it's not anymore.”

It’s a crisis that in many cases has led to a generational shift in the relationship between the county and its employees. The longtime, unspoken contract founded on longevity and loyalty — where employees pursued 30-year careers with the county in exchange for reliable and rewarding work that offered a healthy work-life balance — is shattered.

Now, employees are leaving “when the time suits them,” Balzarini said.

“There's just a ton of turnover going on in these departments,” Balzarini said, adding that services suffer while new hires are trained. “It's just a compounding problem on top of the workload growing.”

According to a sampling of exit interviews conducted in the past five years, 15 of 97 outgoing employees listed retirement as their reason for departure. More than half — 52 people — left for a better job or had issues with workplace culture, workload, lack of advancement opportunity or because of some issue with management or their superiors.

Demographics and governance experts have long warned public and private employers of the “silver tsunami” of retirements that would destabilize offices, factories, hospitals and classrooms.

The pandemic ushered in that wave with a vengeance, as many workers who had put off retirement accelerated their departures, said Liss-Levinson, the MissionSquare Research Institute senior manager.

“Some of it could have been anticipated,” Liss-Levinson said. “But I think that the degree to which this is happening, it’s something that is hard to predict and continues to increase in terms of the number of employees that are eligible to take retirement.”

In one exit interview, a Department of Health Services employee who retired in May 2022 after 22 years with the county cited workload that was “too great.”

A behavioral health clinician who left in August 2021 said in an exit interview that an “unrealistic” workload and “family/personal reasons” led to their departure. “Going into private practice — not enough staff to handle the work,” the notes said.

Another behavioral health clinician who left in April 2022 also cited workload as a reason for leaving and described “dissatisfaction” with their salary and benefits — including that bilingual staff members were underpaid. They accepted a job in the private sector, according to exit interview notes.

Raises not enough to boost morale

This past summer marked a new low point in the slow moving employment emergency, union representatives and county workers told The Press Democrat in interviews.

For Balzarini, the SEIU official who joined the county 13 years ago in the wake of the Great Recession, the staffing gaps are the worst he’s ever seen.

The fifteen years that Campbell-Brown has worked as a child protective services social worker, facilitating adoptions have always been demanding. At the start of December, though, she felt more overwhelmed than at any other time in her tenure.

“It just keeps getting harder,” Campbell-Brown said.

She was juggling 25 adoption cases, each requiring she meet with the children, their families or guardians and respond speedily to any needs that arise, such as helping a child find a new placement and get settled there, while also juggling court-driven deadlines. The responsibilities sometimes require her to visit clients who live hours away.

The job has always been hard, Campbell-Brown said, but with the demands of the workload, have become impossible.

“At this level there’s this constant nervousness and worry about what I’m not doing and what I’m missing,” Campbell-Brown said.

She said she keeps reminding herself that “it will get better.”

Caseloads for social workers vary by role, Struckmann, the human services director, said in an email. Adoption specialists average 25 cases at a time, according to county data.

Earlier this year SEIU Local 1021, the dominant county union, ratified a new contract with the county that includes annual pay hikes over the next three years and one-time increases to bring some salaries closer to those in comparable counties and cities.

That new contract — one of 11 labor agreements the county approved this year — set the path for other unions negotiating with the county. It also addressed higher pay for fluent bilingual employees.

Tatiossian, the Child Protective Services employee who is represented by SEIU Local 1021 and sits on the county-employee labor committee, said she is grateful for what the union was able to secure for the county workers it represents, but called the new contract “one piece of the puzzle.”

She said the raises helped address cost of living for employees, but the contract did not resolve more immediate concerns or “necessarily boost morale.”

“Has it helped in the day-to-day?” Tatiossian said. “For me personally, no. Because that doesn’t take care of my caseload, it doesn’t take care of my day-to-day stress.”

You can reach Staff Writer Emma Murphy at 707-521-5228 or emma.murphy@pressdemocrat.com. On X (Twitter) @murphreports

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On X (Twitter) @pressreno.

Editor's note: This article has been revised to clarify the change in Sonoma County overtime costs between 2020 and 2022. Those costs were up over that three-year period but did dip between 2020 and 2021.