Improving Working Conditions and Benefits for Direct Support Professionals May Reduce Turnover and Improve Services for People with Intellectual and Developmental Disabilities

A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

People with intellectual or developmental disabilities (IDD) have lifelong disabilities originating before the age of 18 which may result from known causes, such as autism or cerebral palsy, or from unknown causes. They often require supports and services to live and work in their communities. Direct Support Professionals (DSPs) provide valuable services and supports to individuals with IDD. These DSPs may provide individuals with IDD with assistance for activities of daily living, such as dressing or bathing; coaching in the workplace; or individualized supports to help these individuals participate in social, civic, or leisure activities. Despite their important role in the lives of many people with IDD, DSPs have a high rate of job turnover. When DSPs leave their positions, this can negatively impact the clients with IDD and their families, as well as placing a great strain on organizations serving people with IDD. Past research has found that factors such as low DSP wages, a lack of promotion opportunities, or a lack of job benefits can contribute to a shortage of qualified DSPs. In a recent NIDILRR-funded study, researchers looked at staff data from organizations serving people with IDD to determine the percentage of DSPs who left their jobs in a 1-year period as well as the percentage of those DSPs who left within 6 months of hire. The researchers wanted to find out whether factors such as hourly wages, job benefits, and organizational characteristics affected DSP turnover. They also wanted to find out whether the turnover rates differed between states, and whether those differences were related to factors such as the state’s unemployment rate or the state’s level of Medicaid spending.

Researchers at the Rehabilitation Research and Training Center on Community Living and Participation looked at data from the National Core Indicators (NCI) 2016 Staff Stability Survey. This survey was completed by the directors of 1,618 organizations serving people with IDD in 20 U.S. states and the District of Columbia. The respondents were asked to report the total number of DSP positions at their organization (both filled and vacant positions) and the number of DSPs who had left their positions between January 1st and December 31st, 2016. Based on these numbers, a percentage of DSP turnover within that 1-year time period was calculated for each organization. The respondents also reported, out of the DSPs who had left their positions within the year, how many of those DSPs had been employed for less than 6 months before leaving (early turnover). Additionally, the respondents reported the organization’s average hourly wage paid to its DSPs; whether the organization offered any paid time off or health insurance benefits to DSPs; the percentage of DSPs employed full-time; an average number of overtime hours that each DSP worked during 2016; the total number of employees at the organization; and the percentage of DSP positions that were currently vacant. The researchers looked at these data in conjunction with data from the state where each organization was located, including the state’s current unemployment rate; the percentage of individuals with IDD in the state who lived in individual housing (living alone or with up to 2 other people), family homes, or larger group homes; the amount per person that the state’s Medicaid program spent; and whether or not the state participated in the state-federal Medicaid expansion program.

The researchers found that across all of the organizations participating in the NCI survey, about 25% of their DSPs had turned over within 2016. Within that total of 25%, 5% left within their first 6 months of hire while 20% left after a longer period of employment. Most of the organizations (86%) offered paid time off to at least some of their DSPs, and 76% offered health insurance to at least some of their DSPs. On average, about 35% of the DSPs worked part-time, and about 10% of the DSP positions across organizations were vacant at the time of the survey.

When the researchers looked at organizational factors, they found that the organizations paying lower hourly wages to their DSPs and those that did not provide health insurance to their DSPs had higher annual turnover rates than the organizations paying higher wages and offering health insurance. In addition, the highest percentages of early turnover rates were found in organizations that did not offer health insurance, the organizations that did not offer paid time off to DSPs, the organizations with more part-time DSPs, the organizations with more vacant DSP positions, and the organizations with smaller overall staffs. Overtime hours were unrelated to DSP turnover.

When the researchers looked at state-level factors, they found that the average annual DSP turnover rates were higher in states with a higher percentage of individuals with IDD living in larger group homes versus individualized housing with three or fewer people living there. Additionally, the average annual turnover rates were higher in states that spent less per person on Medicaid. The state unemployment rates and participation in Medicaid expansion were unrelated to DSP turnover. Among the DSPs who left their positions in the last 12 months, the percentage who left within 6 months of hire was roughly equal across states.

The authors noted that workforce conditions for DSPs may contribute to the high rates of annual DSP turnover and early turnover. For example, DSP wages have not kept up with inflation in many areas, and do not increase with accumulated on-the-job experience in the same way as other, less skilled positions, such as sanitation or hospitality. Additionally, a lack of benefits such as health insurance may drive DSPs into other lines of work. Part-time DSPs, who may not be eligible for any benefits, may be especially likely to leave their positions in favor of a full-time opportunity elsewhere.

The authors noted that organizations serving people with IDD can strengthen their workforce by offering competitive wages, opportunities for pay raises, and benefits to their DSPs. The authors also noted that turnover rates were lower in states where more people with IDD lived in individualized settings. States may be able to offer vital supports to the DSP workforce by increasing Medicaid spending and by prioritizing the placement of people with IDD in individualized community living arrangements, where they can build mutually fulfilling relationships with the DSPs serving them.

To Learn More

The Institute on Community Integration, home to the RRTC on Community Living and Participation, conducts extensive research, development, and training for the Direct Support Workforce.

  • Read their factsheet on the DSP workforce, including strategies for recruitment and retention.
  • Explore the Frontline Initiative newsletter, a series covering the issues important to DSPs and supervisors who support people with IDD and other disabilities in a variety of community settings. Each feature issue contains resources, perspectives, and strategies to advance the profession of direct support.

DirectCourse is a suite of competency-based curricula for the DSP community originally developed at the RRTC on Community Living, comprised of four colleges: College of Direct Support, College of Employment Services, College of Personal Assistance and Caregiving, and College of Recovery and Community Inclusion. The suite is now available online to organizations and agencies through a subscription model.

To Learn More About this Study

Houseworth, J., Pettingell, S.L., Kramme, J.E.D., Tichá, R., and Hewitt, A.S. (2020) Predictors of annual and early separations among direct support professionals, National Core Indicators Staff Stability Survey. Intellectual and Developmental Disabilities, 58(3), 192-207. This article is available from the NARIC collection under Accession Number J84019 and in full text from the publisher.

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