• What is a Direct Support Professional (DSP)?
• Why is recruitment and retention of Direct Support Professionals a growing crisis?
• What is the impact of turnover?
• What is the solution?

What is a Direct Support Professional (DSP)?

Direct support professionals are workers who assist people with disabilities, such as mental retardation, autism, cerebral palsy, Down syndrome, epilepsy, and other cognitive and developmental conditions, to lead self-directed lives in their communities. 

Work Expectations

DSPs support individuals with disabilities by assisting them as needed with personal care, general health care, people with severe disabilities with medications, preparing and eating meals, dressing, mobility, and handling daily affairs, life sustaining medical care such as suctioning and tube feeding, transportation, emotional or behavioral support, community participation, financial management and/or any other life areas that an individual with disabilities might require assistance or support.

The DSPs are expected to know, understand and be responsible for implementing the Individual Support Plan for each individual to whom they provide services.  Many of the individuals have a need for intensive medical and behavioral supports, which are emotionally, and physically challenging for the DSP.

Challenges

Since DSPs are among the lowest paid workers, they typically need to have another either part time or full time job to make ends meet.  The low pay and long hours needed to provide a living for their family present many life challenges.  Their level of education tends to limit upward mobility and the job of a DSP is emotionally and physically demanding.

Why is Recruitment and Retention of Direct Support Professionals a Growing Crisis?

Wages for DSPs working in the community are derived almost entirely from a combination of Medicaid and state funds.  Reimbursement rates—that include the cost of labor—are set by each individual state or county within the state.

Historically, these governmental funding streams have not kept pace with general market demands, nor have they kept pace with state employees who are performing the same job functions in state operated programs and institutions.

Nationally, the average reported wage for all DSPs working in private agencies was $8.68 per hour, compared with $11.67 per hour in state-operated facilities*. 

On an annual basis DSPs earn an average of $17,950 in comparison with the $24,273 earned by their peers in state operated programs.

Due to Medicaid under funding and soaring general liability, workers compensation and health care costs, many DSPs receive limited benefits such as paid health insurance or paid time off. 

Low Retention, High Turnover

Challenges faced by DSPs have led to high turnover and ongoing vacancies among direct support staff.  Annual DSP turnover rates range from 40% to over 75%.

There is an increasing demand for DSPs for the following reasons:

• The growing trend for supporting people with disabilities is in smaller residential settings or in their own homes
• Family caregivers are aging and individuals with disabilities are living longer, therefore increasing the demands for more DSPs
• In its Olmstead decision, the Supreme Court affirmed the right of individuals with disabilities to receive community-based services as an alternative to institutional care.  The demand for community supports and services is growing rapidly as states comply with Olmstead and continue to move more individuals from institutions into the community. 

What is the impact of turnover?

People with Disabilities

Stability is a key component in helping individuals with disabilities maintain a happy life. Every time there is a staff change due to turnover, individuals with disabilities often feel abandoned and scared.  Some regress in their development while others exhibit increased negative or otherwise aggressive behavior. 

Imagine the comfort you would personally feel in knowing how your personal assistant would help you eat, bathe and take care of your other personal needs – and then imagine how it would feel if that someone wasn't there anymore – providing the care and continuity you were familiar and comfortable with – that's how turnover affects a person with disabilities.

Families

Turnover is also very hard on parents and other family members.  Because of the revolving door of caregivers, they must continually form new relationships with staff, worry about the care their family member is receiving from new staff and upset wondering if there will be a day when no one will be available to provide the care a family member needs.

It is imperative that we fulfill our nation's commitment to the quality of services for people with disabilities.  Under the current labor crisis, "the human costs to people who receive services are significant.  People living in community settings are routinely expected to 'get used to' five or more new employees coming into their homes each year, often providing the most intimate personal care or other supportive aspects of their personal lives. This lack of continuity makes it extremely difficult to develop and sustain the trusting and familiar relationships that foster personal growth, independence and self-direction." (Hewitt & Larkin, 2001)*

Care Providers

High turnover and lengthy vacancies are requiring provider agencies to spend disproportionate amounts of time and money on recruitment, orientation and training, thereby reducing resources for actual service and support. 

Supervisors of direct support staff are working extra shifts without commensurate monetary compensation in order to cover staffing shortages.

System-wide, organizational resources are being sapped by staffing crises to the detriment of program services, clinical supports, and personal safety. 

Quality of Care

The lack of a stable direct care work force has a negative impact on the quality of services provided to individuals with developmental disabilities.  High staff turnover does not allow for DSPs who are well trained, nor have the experience needed to assure the continuity and consistency of care needed and provided to each person with a disability.

Cost of Recruitment and Training

Each provider is charged with the duty of providing a DSP workforce whose background is thoroughly screened to assure safety and trained to assure that the DSP has the ability to provide the services required.

For each new DSP hired, the employer must assure that the applicant is able to work by conducting background screening that includes at least the following:

• Criminal history
• History of abuse, neglect and/or exploitation
• Motor vehicle driving record

In addition, each DSP must be provided with approximately 40 hours of orientation that includes, but is not limited to:

• CPR
• First Aid
• Medication Administration
• Signs and Symptoms of Illness
• Behavioral Support and Intervention
• Health Care Supports and Interventions
• Understanding Disabilities
• Program Implementation
• Community Inclusion and Participation
• Specific supports needed by each individual

According to The Institute on Community Integration* the estimated annual cost of recruiting, orienting, training, and supervising replacement staff in residential settings is estimated at $80-$100 million annually.

Lower Quality Service Delivery System

In addition to affecting service quality and consumer satisfaction, high turnover rates:

• Increase administrative costs
• Increase overtime costs
• Increase worker compensation costs
• Decrease money available to provide paid health care and vacation benefits for DSPs.

Turnover also affects the DSP staff by:

• Increasing job stress
• Decreasing continuity of support
• Decreasing quality of communication between staff, individuals and families
• Decreasing productivity
• Reducing job satisfaction

These job disruptions ultimately end with dissatisfied staff who quit and staff shortages only worsening the entire situation.

What is the solution?

Congresswoman Lois Capps (D-CA) and Congressman Lee Terry (R-NE) have introduced legislation—the Direct Support Professionals Fairness and Security Act of 2007—that recognizes the urgent national workforce crisis facing our nation.  Their legislation comes at a critical juncture.  It would take the first important step in stabilizing the direct support professional workforce—a step needed to ensure that people with disabilities will receive the quality supports and services they need from private providers and that state and federal funders require.

The Direct Support Professionals Fairness and Security Act  complements the goals of President Bush's "New Freedom Initiative" and also would help states meet their obligations under the Supreme Court's 1999 Olmstead decision—both of which affirm that individuals with disabilities have the choice to live in their communities.

The legislation would make a much needed national investment and create an incentive—all through a joint federal-state-private partnership—to address one of our most pressing challenges in the 21st century.  The bill would empower our nation's governors with additional resources to help ensure quality supports and services to people with disabilities and help them to live and work in their communities.  It does so by establishing a 5-year program to provide participating states with additional Medicaid funds in order to increase wages paid to direct support professionals.

For more information on this legislation, visit the ANCOR campaign.

Speak up and tell Congress to give Direct Support Professionals a fair wage!