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

The movement to increase 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 $7.25 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 direct support professionals.

About Today’s DSP Workforce

Direct support professionals (DSPs) work directly with people with physical disabilities and/or intellectual disabilities. The DSP workforce includes direct care staff, home health assistants, aides, personal care attendants and other professionals who help individuals with intellectual and developmental disabilities. DSPs help individuals lead healthy and productive lives within community or the least restrictive environment possible.

Specifically, DSPs assist with activities of daily living as needed and encourage attitudes and behaviors that help individuals with disabilities enjoy self-directed, active and social lives. These support professionals also act as advocates by communicating the needs, self-expression and goals of the disabled people in their care. DSPs provide support within the home, work, school, or in other public and private spaces within the community.

While many DSPs find their jobs rewarding, they face a variety of challenges, according to information presented at The Arc National Conference in 2013. These challenges include:

  • High Turnover / Low wages
  • Limited access to training and education
  • Poor access and utilization of benefits
  • Increasingly absent or ineffective supervision
  • Status and Image

The cost of living has increased while wages for DSPs have not, and inflation is rising faster than it has in years. Direct support professionals 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 that exceeds most other job positions.

DPSs, Wages and Turnovers

The average wage of a direct support professional in the United States is $10.29 per hour, according to the salary comparison website PayScale, and the pay for this job does not change. PayScale also notes that DSPs do not generally have more than 20 years experience. This means most people leave the profession soon after entering it, thus creating a high turnover rate.

In 2006, the U.S. Department of Health and Human Services (HHS) estimated a 50 percent turnover rate for DSPs and anticipated a decrease of only 2 percent by now. While the average turnover rate for DSPs has dropped more than HHS expected, it is still quite high.

Data from the 2009 DSP Wage Study estimates an average turnover rate of 38.2 percent for direct support professionals. The study identifies several factors influencing this high turnover and low retention rates, including:

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

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 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

IOM Calls for Increased Pay for Medicaid Programs

Commercial insurance and private pay revenue sources rarely cover services for people with intellectual and developmental disabilities, leaving Medicaid as essentially the sole payer for these services. Because Medicaid is a federal agency, community providers cannot simply raise their prices or shift costs to meet higher wages. Individual states determine provider rates and must include these rates in their state’s Medicaid Plan, which is ultimately under review 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 pay and benefits to the DSP workforce, increased turnover and a tremendous disruption of services for those with disabilities.

The Institute of Medicine (IOM) says, “Direct-care workers typically have high levels of turnover and job dissatisfaction due to low pay, poor working conditions, high rates of on-the-job injury, and few opportunities for advancement. To help improve the quality of these jobs, more needs to be done to improve job desirability, including improved supervisory relationships and greater opportunities for career growth. To overcome huge financial disincentives, the committee recommends that state Medicaid programs increase pay for direct care workers and provide access to fringe benefits.”

The Future of DSPs

The number of Americans needing long-term services and supports (LTSS) 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 percent in the 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.

Despite being the cornerstone of the nation’s long-term care system, services for individuals with intellectual and developmental disabilities and the DSPs who care for them are historically underfunded. Raising the minimum wage at the Federal level may ensure the nation has a high quality, stable DSP workforce that is fundamental to the well-being of millions of people.

In response to the call to raise the national minimum wage, some big businesses have threatened to replace workers with robots rather than pay more. “It’s cheaper to buy a $35,000 robotic arm than it is to hire an employee who’s inefficient making $15 an hour bagging French fries,” said former CEO of McDonald’s Ed Rensi.

Fortunately, engineers could never design a robot to replace direct support professionals, as individuals with intellectual and developmental disabilities requires skill, experience and a deep level of empathy, enthusiasm and dedication to others that only compassionate human can provide. Raising the minimum wage for all workers will have a ripple effect, spreading outwards to help DSPs and others remain in the rewarding, essential jobs they love.

Lynn Hetzler

Lynn Hetzler has been a leading writer in the medical field for 20 years. She specializes in creating informative and engaging medical content for patients, researchers, providers, and leaders in healthcare.

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