We’ve talked about the Perfect Storm and you’re probably already aware that the Direct Support Provider (DSP) workforce has been one of the most unstable workforces nationally for over three decades.¹ While the national turnover rate for all workforces averages about 3%, annual DSP turnover rates now exceed 50%.²

There is no single answer or solution, but it starts with recognizing that measuring turnover alone doesn’t capture the significant impact that excessive reliance on part-time positions, chronic openings, call-offs, and vacation absences can have on stability. 

Our CEO, Dr. Mike Strouse, has been writing an extensive guide to GoodLife’s labor strategies (more details about his publication coming soon!) And while we are treating it like the gold it is, the initial value is found in truly understanding the “1000 paper cuts” that contribute to workforce (in)stability.  As a care provider, we are familiar with the barriers that challenge our ability to appropriately pay and offer good working conditions that meet the needs of DSPs. Unfortunately, these challenges are worsening and include:

• Better paying jobs fueled by our strong economy and growing senior care industry. We are grateful that unemployment rates are at an all-time low, but realistically this means we are competing with other care organizations–including assisted living and nursing home facilities–to hire DSP staff. 
• Inadequate funding for I/DD services that steadily loses ground to inflation. We’ve mentioned this before: state-mandated reimbursements for home and community based services have not kept up with the consumer price indices (CPI). In fact, rates are almost 20% behind current CPI and the average wage in Kansas.
• Increasingly complicated service and funding requirements. Reimbursements haven’t gone up with CPI, but the mandates for care are much more complex.  As I/DD services (day, residential, vocational rehabilitation, case management, etc.) become more complicated, segmented, and possibly delivered across multiple providers, resources for necessary infrastructure has a serious impact on providers.
• Increases in unfunded costs. Costs for adaptive housing, transportation, food, accessibility and behavioral services are high and often not addressed by HCBS Medicaid funding or state supplements. Plus, these unfunded costs of living soar when the home sizes shrink and where placement vacancies are common.
• Mandated pressure to serve increasingly challenging populations. Community provider instability further increases when few or no options exist for inpatient care for people who need short-term help. One of the greatest cost barriers for providing services for persons with greater care needs is that many of these individuals require extraordinary help for short but unpredictable periods.
• Unappealing and problematic DSP work schedules. Traditional staffing patterns (5-day work weeks, 3-shifts/day, part-time on weekends) compete with the needs of providing 24/7 care. This has massive implications! The resulting instability leads to excessive vacancies, overtime, and reliance on expensive staff pools. 
• Ineffective and burdensome recruitment and hiring strategies. The overriding problem is the length of time it takes to hire, train, and place staff in a home or program. Research shows that the quality of the candidates decreases as the days to hire (and get paid) increase.³
• Relatively poor on-the-job coaching for new employees.  In a standard 5-day work week, experienced staff likely migrate across time to work 8-3, M-F (and in programs where they can avoid working evenings and weekends). As a result new employees (with less-than-ideal shifts) often find themselves isolated and without access to a supervisor or other experienced staff when they need it most.
• The unnecessarily high number of different people involved in care. This is the big one. So many things can impact the number of DSPs involved in care: openings, call-offs, training, PTO, use of staffing pools, poor schedules, too many part-time positions, and more. Remember how we mentioned GoodLife’s residential program that has 3% turnover across 2 decades? These same clients also consistently exhibited better health factors, improved challenging behaviors, and earned higher quality and satisfaction ratings. At GoodLife we have seen that consistency cultivates better relationships, vesting, and improved outcomes.

GoodLife and its partners at KU have worked hard to identify and measure critical indicators related to workforce stability. These metrics include measuring (a) DSP recruitment and hiring efficiencies, (b) stability beyond turnover, including vacancies, number of different persons involved in care, and labor costs; and (c) the impact of pay increases, schedule improvements, time off, and other benefits for DSPs.

Our work at GoodLife is focused on creating better ways to help people live with greater independence, while also improving the lives of the DSPs who make our mission possible. Want to learn more?  We’d love to hear from you! Learn more about how to partner with GoodLife here.

¹President’s Committee for People with Intellectual Disabilities. (2017). America’s Direct Support Workforce Crisis: Effects on People with Intellectual Disabilities, Families, Communities and the U.S. Economy. Washington, DC: President’s Committee, 2017.

²Bureau of Labor Statistics (2019, December). USDL-20-0243. Job Openings and Labor Turnover. National Core Indicators [NCI]. (2019). National Core Indicators 2018 Staff Stability Survey Report.

³Strouse, M. C., Sherman, J. A., & Bowen Sheldon, J. (2013). Do good, take data, get a life, and make a meaningful difference in providing residential services! In D. D. Reed, F. D. DiGennaro Reed, & J. K. Luiselli (Eds.), Handbook of crisis intervention for individuals with developmental disabilities (pp. 441-465). New York: Springer.