Posted on September 20, 2022

By Mary Kay Rizzolo, President & CEO, CQL

Identifying the issues affecting direct support professionals (DSPs) is the easy part – difficulties with recruitment, low retention, high turnover, insufficient wages, a lack of professional advancement, etc. The list could go on. Addressing these issues is the million-dollar question. Well, it’s actually a billion(s)-dollar question, considering the annual costs nationwide for replacing DSPs is estimated to be $2,338,716,600 (The President’s Committee for People with Intellectual Disabilities, 2018).

This is why local, state, and national leaders in the disability services sector devote so much time and energy to finding solutions that can turn things around. But it’s an uphill battle to put it mildly, considering how many complex factors contribute to the DSP workforce issues.

During National Direct Support Professional Recognition Week, which takes place every September, we’ve been partnering with the National Alliance for Direct Support Professionals (NADSP) over the last few years. Our collaborative annual campaign highlights organizational programs that work to reduce turnover, acknowledge the importance of DSP work, promote career development, and more. While we’re not naïve to think that featuring these initiatives will solve everything, they can provide some valuable ideas and guidance that agencies across the nation can replicate.

In this Capstone, I’d like to feature the various programs that were shared on CQL’s social media channels throughout National DSP Recognition Week. Then, we turn to our partners at NADSP, specifically Joseph Macbeth, the organization’s President and Chief Executive Officer. Providing deeper perspective into DSPs, Joe looks at the impact DSPs have on people receiving supports, the importance of their work, and advocacy efforts that could help confront the systemic failures that have plagued DSPs for decades.

Organizational Programs That Help Support DSPs

National DSP Recognition Week is a wonderful time to call attention to the value of direct support work and specifically the impact that these professionals have on people’s lives. We learn about all sorts of great activities that demonstrate appreciation for DSPs during the week, from car washes, to gift baskets, raffles, recognition events, and more. But for our annual campaign with NADSP, we sought out programs that have a longer-lasting impact on DSPs that continue on throughout the entire year.

Improving Recruitment, Retention And Culture In Licking County, Ohio

The DSP Employment Connections program, created by Licking County Board of Developmental Disabilities, helps recruit and retain DSPs along with providing support and resources. Prior to the program’s inception in 2018, many local organizations reported turnover rates of more than 68%. By the end of 2021, providers have seen their turnover decrease by 46% for DSPs hired through the program.

The Arc of Carroll County Lifts Up DSPs Through Project RISE

The Arc Carroll County launched Project RISE in April 2021. The certification program offers DSPs an opportunity to achieve nationally recognized credentials that acknowledge their skills and contributions, which are also tied to financial incentives. The program benefits DSPs, people supported, and the organization as a whole.

‘Buddies’ Help Improve DSP Retention At Mountain Lake Services

Pairing new DSPs with veteran DSPs, Mountain Lake Services’ Buddy Program provides new DSPs with guidance during the first few weeks and months after being hired. It helps ensure that new DSPs are equipped with the support they need from experienced colleagues who have been in their shoes.

Children’s Aid and Family Services: Recognizing DSPs Throughout The Year

To regularly recognize the critical role that DSPs play at their organization, Children’s Aid and Family Services launched The Appreciation Corner. It is a monthly newsletter that highlights DSPs who go above and beyond in the supports they provide, and among those featured in the newsletter, one DSP is randomly selected to receive a gift card.

Building Staff Morale At Community Living New Zealand

The Annual Staff Awards were established by Community Living New Zealand to honor employees, including direct support professionals who are delivering exemplary services. These awards have helped improve organizational culture, boost staff morale, and show appreciation for those who are making such a transformative impact on people’s lives.

Broader Perspective On DSPs

The initiatives summarized above certainly offer some fantastic ideas for programs that other agencies can implement. But as we all know, the issues affecting DSPs go way beyond what provider organizations have control over. To gain some greater insight into DSPs and particularly what’s happening on the national stage, we are lucky to have a national leader like Joe Macbeth provide his assessment of where we are now and what needs to happen in the future.

Direct Support Professionals & National Advocacy

By Joseph M. Macbeth, President and Chief Executive Officer, The National Alliance for Direct Support Professionals, Inc. (NADSP)

The National Alliance for Direct Support Professionals (NADSP) is an advocacy organization that was founded in 1996 by the late John F. Kennedy Jr. and the only national advocacy organization whose sole purpose is dedicated to advancing the direct support profession.

Mr. Kennedy wrote in a report to the President that “Quality is defined at the point of interaction between the staff member and the individual with a disability.” For more than 25 years, our mission has been to enhance the quality of support provided to people with disabilities through the provision of products, services, and certifications that elevate the status of direct support workers, improve their practice standards, promote systems reform and, most importantly, advance their knowledge, skills, and values.

Quality At The Point Of Interaction

So what exactly does Quality at the point of interaction mean? Well, every industry, whether it be manufacturing, technology, finance, sales, healthcare or supporting people with disabilities has a benchmark for Quality. In our work, we measure quality in terms of “valued outcomes” – helping people with disabilities achieve things that are important to them – big things like finding and keeping a job, developing meaningful relationships, living in their own homes, staying connected and included in their communities – or staying out of institutional settings. Outcomes can also be small things like preparing a meal, dressing oneself, or balancing a checkbook. Direct support professionals are always at the intersection of quality.

As we’ve seen over the past two and a half years, these outcomes can be a matter of life and death – like keeping people healthy and safe during a worldwide pandemic and free of a virus that is three times more likely to cause death for people with disabilities due to pre-existing medical conditions.

You might say that direct support professionals are the ‘Jack and Jills’ of all trades – they do it all. The outcomes that define quality are never accidental, nor do they just magically happen. When you analyze these outcomes, when you deconstruct them, you will most often find a direct support professional, or more likely a team of direct support professionals who are highly intentional in their practice and can objectively demonstrate the correlation between their knowledge, skills and ethics with outcomes. Quality rests squarely on the shoulders of the direct support workforce.

The Importance of DSPs

For decades, there has been a perception across this country that direct support is unskilled work, entry-level work, or a job that just anyone can do. I can assure you that after 40 years of working with direct support professionals in many service sectors including intellectual and developmental disabilities (I/DD), aging, behavioral health, at-risk youth – nothing can be further from the truth.

The work of a direct support professional is challenging, complex, continually changing, and no day at work is ever the same. It requires high levels of acuity, responsibility, judgment and character. I would argue that the false perception around this work is why we find ourselves at the cliff’s edge where a critical shortage of qualified workers is leading to service programs closing, people and families being unserved, and highly vulnerable people at significant risk of abuse, neglect and exploitation.

We can’t blame the pandemic, in fact, in my strong opinion, COVID-19 has merely lifted a veil and has exposed our service system’s weakest link – the direct care workforce. Make no mistake, this is no longer a crisis – a crisis is defined as sudden, unexpected and temporary. We have been grappling with workforce issues for more than 25 years and, as a system, we have never adequately addressed it. Yet, we continue to collect and share data about the poverty-level wages, inadequate training, the absence of career ladders, a lack of professional identity and a lack of professional respect.

Addressing The Systemic Failure

The critical shortage of our direct support workforce is well documented, and if there is a silver lining to this dreadful pandemic, it might be that the highest levels of government are now beginning to take notice of just how “essential” direct support professionals are and infusing much needed financial resources to address the shortage.

Let’s not squander this opportunity. Let’s do it right. Let’s make careful, deliberate investments into the workforce that can address this systemic failure for long term success. If you survey direct care workers and ask them, “what is the most important thing we can do to support you,” their overwhelming answer is “give us a living wage” – a wage where I don’t have to work two or three jobs to support my family. There are many reports on direct care wages. And we know that low wages feeds high turnover and we see a revolving door of strangers supporting vulnerable people, often times with the most intimate of care. Year after year we see half of this workforce leave and that costs your state millions of taxpayer dollars.

To be sure, solving this complex issue will require comprehensive solutions – there is no one solution, no silver bullet. But here are a few ideas:

• Introduce legislation that provides a living wage to recruit new workers and at the same time address wage compression issues so tenured direct care workers are recognized for their time and not left behind in order to attract new workers.
• To reduce turnover, create rate setting methodologies with value-based payments that incentivize career ladders that lead to voluntary credentialing for tenured direct care workers. We must keep high performing direct care workers in the jobs in which they excel and enjoy.
• Encourage your members of Congress and United States Senators to sponsor H.R. 4779 and Senate Resolution 1437 – Recognizing the Role of Direct Support Professionals Act which would require the Office of Management and Budget to establish a separate category within the Standard Occupational Classification system for direct support professionals so we can begin to collect more accurate data.

You can also visit the NADSP Advocacy section on our website to learn more about the legislation listed above, our efforts to advance our policy priorities, and more.

Additional DSP-Related Resources

By Mary Kay Rizzolo, President & CEO, CQL

As I shared earlier, we know that the information, programs, and guidance detailed in this Capstone are just some examples of how we can help address DSP workforce issues. There are a lot of other ways you can learn about and help confront topics that are important for DSPs.

The NADSP has a slew of resources on its website including webinars, articles, and more, along with its nationally recognized Code of Ethics and Competency Areas. In partnership with NADSP, the University of Minnesota’s Institute on Community Integration produces the Frontline Initiative publication, which takes a deep dive into issues that matter to DSPs. There are also numerous toolkits, reports, fact sheets, etc. on ANCOR’s website.

If you’re looking for more programs and initiatives that have a meaningful impact on DSPs year-round, you can check out our 2021 DSP Week campaign and 2020 DSP Week campaign. These campaigns highlighted dozens of other examples of how organizations confront turnover, wages, recruitment, and more.

As we have now wrapped up another National DSP Recognition Week, we want to say thank you to all of the direct support professionals out there who work so hard to support people with disabilities in achieving their hopes and dreams!

References

• The President’s Committee for People with Intellectual Disabilities. (2018). Report to the President 2017 – America’s direct support workforce crisis: Effects on People with Intellectual Disabilities, Families, Communities and the U.S. economy. https://nadsp.org/wp-content/uploads/2018/02/PCPID-2017_-Americas-Direct-Support-Workforce-Crisis-low-res.pdf