The State of America’s Direct Support Workforce Crisis 2022

The longstanding direct support workforce crisis, exacerbated by the COVID-19 pandemic, has led to closures of critically needed services and a denial of access to community-based supports.
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Connections - 01.30.20

Why “More Money” Isn’t Enough to Solve the DSP Crisis

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By Scott and Craig de Fasselle, Blitz Media Design

Is there a DSP wage crisis?

Do a quick Google search, and you’ll see that—all across the country—people know the pay for direct support professionals isn’t enough.

The Report to the President 2017, America’s Direct Support Workforce Crisis, and ANCOR’s Addressing the Disability Services Workforce Crisis of the 21st Century address pay. Both state that Medicaid provider rates are inadequate, and higher wages are necessary. Some states like Ohio have recognized this and taken steps to increase pay.

On the one hand, we support any increase. Who wouldn’t want to reward the valuable work DSPs do with a fair wage?

But on the other hand, we don’t believe for a second that higher wages alone will solve the problem.

Here’s why.

Are DSPs leaving just because of money?

The work that DSPs do merits higher pay, but low Medicaid reimbursement rates handcuff the system.

And, sadly, it seems legislators are either unaware of the problem or feel it’s not a priority. Those that are looking at pay bumps are only looking at modest amounts when it comes to what the DSPs see.

These skilled workers deserve any increases they can get, but is $1-$3 per hour enough to guarantee improved hiring and retention of DSPs?

We’ve analyzed DSP turnover rates and we don’t believe so. Studies show the turnover of DSPs nationally is 45%. But according to the US Bureau of Labor Statistics, the average turnover for all jobs in all industries is 44%—a statistically insignificant difference.

Yes, that rate is unacceptably high. But before dismissing the percentage as an indictment of compensation at all levels, we need to look closer at turnover in other individual industries. Professional services in the private sector, for example, see 63% churn! Further, people are ghosting on 6-figure jobs according to sources like Forbes.

If wages were indeed a factor, one would expect a lower turnover in industries like professional services, where the pay can be higher than it is for DSPs. Instead, turnover is significantly higher—a fact which capably demonstrates that higher wages do not guarantee lower turnover.

A contributing factor: how we talk about DSPs

Interview the average “person on the street.”

Unless they know a DSP, they likely have no idea what one is—or what one does.

In part, this is because what few stories about DSPs show up in the media are of two broad types:

  1. [Random person] was named DSP of the month or year by their organization.
  2. DSP pay is horrible, and DSPs live below the poverty line.

The first of these doesn’t help attract potential DSPs to the industry—any more than a photo of a CEO in the Business section of the newspaper encourages others to become a CEO.

But at least it celebrates an employee. The second type, by contrast, drives away potential applicants. If you always read stories about how poor the pay is for DSPs, why would you care to consider it as a career? Or continue working at a job that many perceive to be a dead-end?

Further, it ignores the fact that DSPs love what they do regardless of the pay they earn. DSP stories should focus on the outcomes of the work—how DSPs help those with DD live fulfilling lives. Instead, the focus of most DSP stories is on the inadequate pay instead of the fulfillment.

These stories have a chilling effect on hiring, yes—but it also reinforces the idea of the DSP wage crisis and could negatively influence DSPs to leave.

Here’s a video example of a positive story featuring Gary LeVox, lead singer of Rascal Flats, done for DSPOhio.org.

The real reason DSPs leave

Over the last year, we interviewed more than three dozen DSPs. In each interview, we asked, “If you could request one thing from management, what would it be?”

Not one person said, “Pay me more money.”

Instead, they asked for more appreciation—or simply more understanding. A common refrain? “We wish management would spend one day working with us to see what being a DSP is like.”

We understand that providers are limited in terms of financial resources, but it’s easy to recognize your DSPs and make them feel appreciated.

Apply the same person-centered philosophy you use for those under your care to applicants and staff. DSPs are warm, caring people, but job posts for this position are often cold and impersonal.

Start focusing on your DSPs as soon as the onboarding process. The hiring requirements for DSPs (background checks, CPR training, safety training, hygiene training, paperwork) can be overwhelming. Do what you can to break things down into simple steps. Make the focus on people over paperwork.

And, above all, make retention your #1 goal. You cannot out-recruit a retention problem; it’s like trying to fill a glass with no bottom.

Remember: the stats show that higher pay is no guarantee of retention. Retention is more about appreciation and connection.

Here’s just one example: a current client learned a DSP who was approaching her first anniversary was leaving.

But rather than simply shrugging it off, our client instead drove to the DSP’s job site to have a conversation.

The DSP said she loved the work and the organization, but was frustrated by the negativity of a burned-out supervisor throwing new hires into the “deep end.” The supervisor had been giving new people the most challenging cases to see if they would sink or swim without investing much training time.

Understandably, this was creating a very negative environment. Consequently, the DSP felt she had no other option but to quit.

The provider moved the DSP to another residence—and gave the supervisor a break from training without penalty as a way of helping them come back from burnout.

Both employees are still with the company.

The takeaway? Magically “fixing” the DSP crisis will take a lot more than merely raising DSP pay.

However, we can and should focus on the things we can control. Those measures start with making DSPs feel they’re valued and appreciated for the incredible work they do.

Scott and Craig de Fasselle are marketing experts who help I/DD providers attract and retain great DSPs with communication that motivates. Their DSP Magnet™ process focuses on recruitment, retention, and culture using simple digital tools and methods to save providers time and money. To get their best advice on how to improve DSP retention and appreciation.