Behind the Poor Pay and High Turnover Rates of Direct Support Professionals

The movement to increase the minimum wage to $15 per hour for all workers is gaining momentum across the nation. In response, many local and state governments are raising their lowest wages above the federal minimum wage set in 2009. Much of the discussion about raising the minimum wage focuses on workers in entry-level positions, especially in fast food. These discussions rarely include (DSPs) and their wages.

About Today’s DSP Workforce

While many DSPs find their jobs rewarding, they face a variety of challenges such as:

• High turnover/low wages
• Limited access to training and education
• Poor access and utilization of benefits
• Increasingly absent or ineffective supervision

The cost of living has increased while DSP wages have not, and inflation is rising faster than it has in years. Direct support professionals (DSPs) typically receive low wages and have limited access to health insurance and other benefits. Many DSPs find themselves in the unenviable position of having to choose between the job they love and the financial needs of their own families. The result is a turnover rate which exceeds that of most other careers.

DSP Wages, Turnover, and Their Effect on Organizational Strength

In 2020, our partners from ANCOR reported that average yearly turnover rates for DSPs had reached 42.8% while other states were seeing rates as high as 64.8%. Several factors influence these high turnover and low retention rates, including:

• DSP wages
• Organizational socialization and training practices
• The length of time that a service setting has existed
• The characteristics of the people served in the setting
• Supervisor tenure
• The perception of fair treatment by supervisors

The average wage of a direct support professional in the United States is $12.80 per hour, while the high end of the DSP pay range is only $15.31 per hour. Additionally, the longer a DSP has worked in the field, the more they tend to feel they are not fairly compensated.

In fact, 30.4% of DSPs with less than one year of experience report feeling fairly compensated for their work, while just 15.2% of DSPs with one to seven years of experience feel the same way. This leads a lot of people to leave the profession soon after entering it for careers that pay livable wages, creating a high turnover rate.

People with disabilities and their families suffer the most serious effects of staff turnover. High turnover rates mean these individuals deal with a “revolving door” of care providers. Constant training of new workers interrupts the continuity of care that allows individuals with disabilities to reach their full potential.

High turnover rates among DSPs are an enormous operational and financial burden to agencies serving those with intellectual and developmental disabilities. High turnover rates directly translate into problems assuring that services meet standards of care in that there are always a large number of new DSPs who lack the skills and experience needed to provide quality care. An unstable workforce increases underlying costs through greater use of overtime, increased recruitment and training costs, and higher workers’ compensation expenses.

Indirect costs include:

• Loss of productivity
• Lack of staff while positions are unfilled
• Increased pressure on existing staff to cover shifts, often leading to burnout
• Individuals receiving less attention
• Pressure on current staff to train and develop relationships with new employees
• Lack of knowledge with new employees regarding institutional practices, team behaviors, workplace norms, and patient knowledge, familiarity, and care experience

The State of Medicaid Programs and the Need for Grassroots Advocacy

Commercial insurance and private pay revenue sources rarely cover services for people with IDD, leaving Medicaid as essentially the sole payer for these services. Because CMS is a federal agency, community providers cannot simply raise their prices or shift costs to create higher DSP wages. Individual states determine provider rates and must include these rates in their state’s Medicaid Plan, which is ultimately reviewed by the Centers for Medicaid and Medicare Services (CMS).

Under this structure, increased expenses without the support of corresponding increased funding often results in reduced DSP wages and benefits, increased turnover, and a tremendous disruption of services for those with disabilities.

These issues bring the importance of grassroot advocacy to the forefront for DSPs and IDD organizations. Though the term ‘grassroots advocacy’ is used frequently, it can be hard for DSPs to know how to advocate for themselves. However, it is possible.

First, share your story. Talk about your work, low DSP wages, and other challenges with friends, family members, anyone really. Spreading the word on the incredible work that DSPs perform, as well as the professional struggles they endure, is a great first step.

Plus, you can amplify your voice via social media platforms and DSP advocacy groups, like the University of Minnesota’s Institute for Community Integration (ICI). Click here if you’re interested in sharing your DSP stories with ICI, as well as watching the dozens of other stories they’ve collected so far.

Secondly, engage in the system. Write to and get to know your representatives at the state and federal levels. Whether it’s emails, letters, or tweets, continue to remind them of the valuable works DSPs perform. As Mark Olson, a project manager for the ICI, advises, “become a positive nag in their ear about what they can do to make the direct support profession what it should be.”

Combatting the DSP Workforce Crisis

As DSP wages and turnover continue to affect direct support professionals and the organizations they work for, the management of these organizations needs to take action to increase DSP retention. As we’ve discussed, part of the problem is the inability to gain funds from the federal and state level. So, the ability to increase DSP wages is partially out of the hands of organizational leaders.

But there are measures that service-based organizations can take to counteract the troubling DSP retention trends.

In a 2008 study by the Institute of Medicine (IOM), researchers stated that, in order to increase the quality of direct care, more attention needed to be paid to improving job desirability by offering career advancement opportunities and improving supervisory relationships. Sadly, in our 2021 DSP Survey Report, we found that these sentiments continued to resonate with DSPs.

DSP retention and career advancement

In our 2021 survey, 65.8% of DSPs told us that they find professional development opportunities extremely valuable, and 63% reported finding new leadership/career opportunities extremely valuable. Clearly, DSPs want to take the next step in their careers, but how can their organizations aid them in this endeavor?

The most popular choice for career advancement programs was organizational opportunities to pay for education toward a degree (42%). The second most popular choice was the organization paying for a certificate program (e.g., CNA) (37%), and the third most popular choice was a professional ladder to a leadership position in the company (36%).

By providing these types of career advancement opportunities to your DSPs, you’re not only helping them become better at their job, you’re also creating a culture of respect that could have fantastic benefits for your organization. In fact, 41% of DSPs said they would be more likely to stay at their current organization if they offered strong career advancement programs.

Raising supervisory standards

Supervisors play a large part in DSP job satisfaction and, thus, DSP retention. In fact, our 2021 DSP survey found that DSPs who were satisfied with their supervisor were far more likely to stay on board with their organization. But what exactly makes a good supervisor?

According to DSPs, the best supervisors:

• Show respect for staff as individuals
• Use open and transparent communication strategies
• Demonstrate appreciation for a job well done
• Hold all staff accountable in an equal manner

To have the best supervisors, it’s important to provide them with the proper training. We find that it’s helpful to divide these trainings into three categories. First, teach your supervisors how to perform evidence-based supervision. Next, teach them to create communication plans when they are sharing important information with staff. Third, train your supervisors in leadership and management.

If you’re interested in learning more on training your supervisors, read our e-book, Improving Supervision in IDD: The DSP Retention Strategy You’re Not Using.

The Future of DSPs

The number of Americans needing long-term services and supports could more than double by the year 2050, according to a brief presented by the Department of Health and Human Services (HHS). The demand for DSPs will increase by 48% in just the next decade alone, and growth in the field will likely accelerate for many years as the baby boomer generation ages. Without a stable, committed, and well-compensated DSP workforce, meeting this growing need will be very difficult.