The success of home- and community-based services (HCBS) is often linked to the support provided by Direct Service Professionals (DSPs). The presence of DSPs, who specialize in working with individuals with I/DD and mental health disorders, enhances the ability of those receiving care to build relationships in their communities, find jobs, and live as independently as possible. In recent years, more attention has been focused on rising DSP turnover rates and what changes might help preserve this important role. Here, we explore some of the reasons behind high DSP turnover and three potential ways to respond.
The Data Behind DSP Turnover
According to the National Core Indicators (NCI) 2017 Staff Stability Survey produced by NASDDDS and HSRI, the national weighted average DSP turnover rate was 43.8% based on reporting from 19 states. The average wage for DSPs was noted as $12.09, and the average vacancy rate for full-time positions was 8%, while part-time positions had a vacancy rate of 17.3%. More recently, ANCOR reported in Case for Inclusion 2019 that the national DSP turnover rate was 46%. ANCOR also found that only 21% of DSPs stayed at their jobs for at least 6 months, and for those that left, 88% cited inadequate pay as the primary motivator.
Loss of DSPs is not only disruptive to the individuals receiving service, but also to the healthcare providers and families who rely on them. With a rise in the number of people diagnosed with autism and greater longevity rates for individuals with I/DD, the need for DSPs is expected to grow significantly—as well as the need to hire and retain more effectively. Here are three methods providers may want to explore as they look to reduce DSP turnover rates.
1. Support Legislative Efforts To Increase Pay
Because inadequate pay is so often cited as the primary factor behind DSP turnover, many advocacy groups and lawmakers have pushed to increase funding at the federal and state level in order to raise wages. Those engaged in efforts to increase pay believe that current Medicaid provider rates make it impossible for those hiring DSPs to compete with other types of business, which often require less specialized training and offer higher compensation.
Legislative bills to increase base pay for DSPs have been introduced in the District of Columbia, and Ohio. A #PayFair4DirectCare campaign in New Jersey is lobbying the Governor to include funding for DSPs in the 2020 budget, and the Governor of Pennsylvania recently signed an executive order to raise pay incrementally over five years. DSPs have even tanken to lobbying directly to lawmakers for higher wages in states such as New York. In an aid to support legislature for increased wages, the University of Minnesota produced two reports to provide state lawmakers with the data they need to make decisions that might benefit DSPs in future legislative sessions.
2. Going Beyond “Required” Training
Other issues cited by DSPs include a need for greater training and guidance, as well as limited opportunities for advancement in their careers. Unlike wage-setting, this is an area where providers may have more control over how they choose to respond to these concerns. Onboarding new DSPs could include both task-centered (e.g., documentation, planning, service coordination) and person-centered (e.g., supporting client empowerment, locating community resources, increasing client safety and health) training. It may be beneficial to provide regular check-ins or advanced training as DSPs move beyond 6-12 months on the job and provide certificates of completion or other meaningful incentives for employees.
For more seasoned DSPs, it may be helpful to consider which “standard” training modules they can skip, having already mastered those skills, and what additional training might be provided to improve their skills. More specialized training for career development or advancement could set the employee up for success in a future supervisory role and provide long-term engagement.
3. Providing Supervisory Support
DSPs generally report to Qualified Intellectual Disability Professionals (QIDPs), who sometimes were DSPs earlier in their careers. However, QIDPs often haven’t received specialized management training to best support those they oversee. Key development skills beneficial for supervisory roles include: communication, leadership, and conflict management. For QIDPs who may be lacking in some supervisory skills, additional training may help them to better maintain their workforce, which would benefit DSPs as well. This enhanced support can decrease stress and provide a more effective work environment, which could yield greater job satisfaction and increase DSP retention.
You can find more information on DSP turnover rates, compensation, and benefits in the 2017 National Core Indicators (NCI) Staff Stability Survey Report, the ANCOR Workforce Report, and the ANCOR Case for Inclusion 2019.