The Results Are In, and America’s Direct Support Workforce Crisis is Only Getting Worse

By Lydia Dawson, ANCOR

For decades, the United States has witnessed a significant shortage of direct care workers due to stagnant reimbursement rates and the inability of providers to offer competitive wages with industries such as fast food restaurants and retail and convenience stores. We know that these shortages can be tied directly back to decades of underinvestment in the direct care workforce, evidence for which can be seen in turnover rates that hover near 50 percent nationally.

We also suspected—though couldn’t say for certain—that the onset of COVID-19 brought new pressures and hazards of providing essential, close-contact services during the pandemic that further exacerbated and accelerated the workforce crisis.

Unfortunately, we now have stark evidence to confirm what we believed was true: the direct support workforce crisis has been made much, much worse by the COVID-19 pandemic.

Although there are some outstanding sources of data in our field documenting the scope of the direct support workforce crisis, we wanted to know the impacts of the crisis. What impossible choices were providers confronting? How were they responding? And what did it all mean for the people and families they support?

And so, in February 2020, we set out to survey providers of community-based I/DD services to glean a deeper understanding of how they experience the human and financial impacts of the DSP workforce crisis. The pre-pandemic results of that survey revealed what at the time felt like staggering findings: at alarming rates, providers were discontinuing services, turning away new referrals, delaying the launch of new programs, struggling to adhere to quality standards and more.

As the COVID-19 pandemic created new challenges to hiring and retention, ANCOR realized the need to further quantify the impact on the DSP workforce, resulting in an updated survey of providers, responses to which we began fielding in August 2021. The State of America’s Direct Support Workforce Crisis 2021 summarizes the findings of ANCOR’s latest survey, which garnered 449 responses. The survey measured the same dimensions we asked about in 2020, along with additional measures targeted specifically to the impact of COVID-19 on DSP hiring and retention.

Though we wish we could say the results are shocking, the findings illustrate the grave reality community providers have been reporting to ANCOR just about every single day since the public health emergency was declared. With the new public health and economic pressures of COVID-19, the very infrastructure of supports and services is held by a shoestring of dedicated providers nationwide. Without significant investment in the DSP workforce, it is only a matter of time before people with I/DD and their families completely lose access to the options and resources needed to remain in their homes and in the community.

We invite you to review our findings by downloading The State of America’s Direct Support Workforce Crisis 2021 today. We also encourage you to visit the ANCOR Amplifier for opportunities to take action to support investments in community-based I/DD services and the DSP workforce.

Download the State of America’s Direct Support Workforce 2021 issue brief today.