Direct support workforce
Direct Support Professionals (DSPs) are the paid staff who support individuals with IDD to live their lives and enjoy the same opportunities and experiences as people without disabilities. DSPs support people in whatever ways they need to enhance inclusion and independence. In many ways, DSPs are generalists who have to be able to provide whatever support is needed across a wide range of activities throughout the lifespan of people with IDD. They provide support that promotes informed decision-making, understanding risk, and exercising rights and choices.
The direct support job is highly complex and requires sound judgment and significant skills that include independent problem solving, decision-making, behavioral assessment, crisis prevention and intervention, and communication. Many DSPs are often isolated, without co-workers, supervisors, or clinical professionals on-site to provide assistance or guidance. DSPs are interdisciplinary professionals because their job duties resemble many tasks typically completed by teachers, nurses, allied health professionals, social workers, counselors, and others. Highly effective DSPs are skilled at developing strong relationships with those they support and their families and are flexible enough to change depending on each person’s needs and abilities.
DSPs are employed in many types of settings, including family and individual homes, intermediate care facilities, small community residential group homes, community job sites, vocational and day training programs, and others. The direct support workforce includes fulltime (66%) and part-time (34%) employees. Most employers use the occupational title of Direct Support Professional, yet many DSPs may have different titles including direct support specialist, personal care assistant, habilitation specialist, job coach, residential counselor, family care provider, personal assistant, and others.
The direct support workforce is predominately made up of women (89%) with an average age of 42 years. About 50% of direct support workers rely on means-tested public assistance. The direct support workforce is racially and ethnically diverse, with 47% of the workforce being white (non-Hispanic), 30% African American, 16% Hispanic/Latino, and 7% other. Nearly one-fourth of the direct support workforce was born in a country other than the U.S., compared to 16% of the total U.S. workforce. About 45% of direct support workers have completed some college coursework or have a college degree.
Data on workforce crisis
In 2013 there were about 880,000 full-time equivalent (FTE) DSP positions dedicated to providing assistance to 1.4 million people. Given that approximately 30% of the DSP workforce is part-time, and estimating that 2.5 part-time workers are needed to fill one full-time equivalency, there were an estimated 1,276,000 DSPs supporting individuals with IDD. In order to sustain services at the current levels, given current turnover rates, every year 574,200 new DSPs need to be hired into the workforce. To provide services to the approximately 200,000 people with IDD on waiting lists, an additional 167,001 new DSPs would need to be hired. Given the high growth and demand in need for long-term services and supports, the persistent turnover rates, and a strong U.S. economy, the number of new DSPs that will need to enter the workforce is expected to grow each year between now and 2030.
Wages for DSPs pose a significant problem. At $11.76, the average DSP who works full-time makes below the federal poverty level for a family of four. Many organizations provide health insurance to employees, but most cannot afford the premiums. Most organizations offer paid time off to full-time DSPs, but part-time workers often have no paid benefits. Almost half of DSPs receive publicly funded benefits, such as medical, food or housing assistance. Most DSPs work a second (or third) job to earn enough money to pay their bills. Unacceptably low wages and limited benefits often correlate with low value, respect, and status. DSP wages are so low and their accountability so high, that far too often good people leave a highly skilled profession they love.
High turnover has been well documented in the DSP workforce for nearly three decades. The annual turnover rate in the DSP workforce is an estimated 46%, with about 38% leaving in the first six months and approximately 21% leaving within 6-12 months. Costs associated with replacing DSPs range between $2,413 and $5,200.
The health, safety, and well-being of people with IDD are at risk daily because of the workforce problems. A revolving door of strangers coming in and out of a person’s life, often required to support in the most intimate personal care routines, means that far too often they may not trust or develop a meaningful professional relationship with the DSP. Signs and symptoms of illness are missed, opportunities for community participation are lost, and people with an IDD have few choices other than congregate models, such as group homes or sheltered work settings, because community staffing is unstable.
Strategies for recruitment, retention and training
Direct Support Professionals play pivotal roles in facilitating community inclusion for people with intellectual and developmental disabilities, but the workforce is plagued with pervasive issues that result in high turnover and vacancy rates, along with unskilled, inconsistent supports. While this problem is large and often feels insurmountable to employers, strategies are available to address the challenges.
Recruitment refers to the process of attracting and selecting the best candidates for a position by understanding the qualifications needed to complete the tasks of the role they are accepting. By sharing information through Realistic Job Previews (RJPs) and utilizing behavioral interview questions, the recruitment process can provide both job seekers and employers with the needed information to make an informed decision.
Retention requires an effort to better understand the working environment and the supports an employer may use to keep staff from leaving. Understanding organizational culture and how it enhances job satisfaction, and making changes and enhancements as needed, can lead to higher levels of job retention. High-quality staff training is another effective tool in staff retention. A comprehensive employee training and onboarding plan supports employees in knowing their roles and responsibilities and in feeling confident on the job.
Advocacy is an important competency for direct support professionals. This requires speaking up and taking action to create change that improves people's lives. DSPs play an important role in advocating for and with the people they support, on both the individual and systems level.
As advocates, DSPs must be able to speak out when they see discrimination happening. This may be include something on an individual level, like a person receiving supports not being served in a restaurant, or it may include something on the systems level, such as lack of accessible transportation or access to appropriate health care. Working at both individual- and systems-level advocacy creates the social change needed to improve the lives of all people with disabilities.
DSPs always need to think about how and why they advocate, making sure to respect an individual's right to self-determination. They must support the advocacy efforts by and for the people they support while making sure you do not impose one’s personal desires or opinions. In this sense, the DSP’s advocacy role is similar to that of an ally or advisor, offering expertise, advice, and information, but not making decisions for the people supported.
Developing the skills and attitudes to support advocacy efforts takes practice. Some of the key skills and attitudes are: 1) believing in yourself; 2) being assertive without being aggressive; 3) being positive and committed; 4) being "in the know" about the issues; and 5) taking a leadership role when needed.
Advocacy is also required for professionalizing the role of the direct support professional. This may include advocating on behalf of wage increases, better training, benefits, and opportunities for career advancement.
Frontline supervisors play an important role in the delivery of services and supports to people with intellectual and developmental disabilities. Their duties many include hiring, training, and supervising staff, program planning and evaluation, advocacy, working with families, and working with community members, among other responsibilities. The role of frontline supervisors has become increasingly complex because of the movement toward individualized services in the community (instead of in group settings) and more people with IDD directing their own services. The Research and Training Center on Community Living led a national process to develop and validate the National Frontline Supervisor Competency set, an important step in professionalizing the direct support workforce.