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People Need People: The Direct Service Workforce
by Amy Hewitt and Susan O’Nell
A generation ago, institutional care was the primary model for providing human services to persons with developmental disabilities. Today, most persons with developmental and other disabilities receive services within the context of typical community housing, local work settings, and neighborhood schools. Workforce issues such as recruitment, retention, and training of direct support staff have become more common as services have grown in number and decentralized, and as the demographics of the workforce pool have changed.
The movement of services from one big place (the institution) to many smaller places (small group homes, individual supports in a home or apartment) spread over a large geographic area, along with increased expectations of fully integrating people with disabilities into our communities, have created real changes for the direct support staff. It means increased isolation from peers and supervisors because these workers are often working alone and their supervisors are often responsible for more than one site. It also means that direct support staff need a variety of new skills to effectively build bridges between community members and people with developmental disabilities who receive services and supports. These changes make it even more important to unite the workforce, to share training, and to build collaborative approaches to resolve problems facing the developmental disability industry. If changes don’t occur, there is a risk that many of the goals people with developmental disabilities and their advocates have – such as full inclusion and citizenship in their communities – will not be realized.
Recruiting for the Future
Recruiting new workers is a major human resource barrier to providing adequate community services to people with developmental disabilities. It is an understatement to say that there will be a significant and sustained need for human service workers and that the ability to recruit the types of workers who have traditionally filled direct support roles will diminish. The Bureau of Labor Statistics projects a 136% increase in the number of human service workers and a 120% increase in personal and home care aides by 2005 (Kilborn, 1994).
Simultaneously, it can be anticipated that the recruitment of direct support staff will become even more difficult. While direct support staff have traditionally been women between the ages of 18-34 with limited education beyond high school, the proportion of the U.S. population in this age range is expected to drop by 19% by 2005. In addition, between now and 2005, the human service industry will be in intense competition for scarce personnel at the entry level. Service agencies in this industry will not just be competing among themselves, but also with other service oriented industries such as hotels, restaurants, telemarketing, and travel. One consequence is that the developmental disability industry can no longer depend on typical recruitment strategies such as newspaper advertising, which is costly and ineffective and which yields employees who are not likely to stay in their positions more than a few months.
Retention Challenges
Average turnover rates in private community residential settings range from 57% to 71% per year (Jaskulski & Ebenstein, 1996). Annually, an estimated 190,000 direct support staff in the United States leave their positions in residential settings alone. Add to this the turnover experienced in educational, vocational, and health services, and it seems obvious that turnover has affected the quality of services to citizens with developmental disabilities. Imagine if 50% of the people who were helping you to bathe, get dressed, brush your teeth, learn new skills and get along in the community changed every year.
In addition to affecting service quality and consumer satisfaction, high turnover rates increase costs, decrease quality of communication between staff, decrease continuity of supports, increase administrative costs, increase job stress, reduce productivity and satisfaction, and lead to staff shortages. The estimated cost in 1993 of recruiting, orienting, training, and supervising replacement staff in residential settings alone was estimated at $80-100 million dollars annually.
Nationally, direct support staff earned an average wage of $5.97 per hour in private residential programs and $8.56 per hour in public residential services in 1992 (Braddock & Mitchell, 1992). Wages varied tremendously from state to state. For example, institutional workers earned an average of $4.77 per hour in Mississippi while institutional workers averaged $13.03 per hour in California. Similarly, private agency workers earn an average of $4.38 per hour in Tennessee, while those in Connecticut earned $9.29 per hour. In 1994, the average wage for nursing assistants and personal care attendants was $7.60 per hour. At these wages, the average direct support staff does not even come close to earning a livable wage, and many earn an income below the poverty level for a family of four.
Direct support staff constitute between 80-86% of the developmental disabilities workforce, yet they have the least amount of power and visibility of all workers in the field. Direct support staff do not have professional status, and are not afforded many of the opportunities provided to career professionals who work with people with developmental disabilities, such as membership in professional associations, a body of literature describing their work and value in society, a code of ethics, standards of practice, and educational requirements.
Training Needs
The developmental disability industry requires that direct support staff have important skills, even though they are not required to have professional degrees. A recent national study reported that over 90% of all residential service providers require classroom inservice training and 80% require on-the-job training for direct service employees (Braddock & Mitchell, 1992). Although many states require training and/or certificate programs for direct support staff, requirements and certificates vary substantially and do not exist in all states (Jaskulski & Ebenstein, 1996).
Most states require training related to such health and safety areas as first aid, CPR, and blood borne pathogens (e.g., hepatitis and HIV), and on confidentiality of services. No state, however, has training requirements that cover all the skill areas outlined in the Community Support Skill Standards, a body of standards which summarizes the core skills necessary to be competent at direct support work in the community. Most agencies deliver training to their employees, with success typically measured based on the content delivered (for example, through a written test at the end of the training session) and not on the employee’s competence as measured in on-the-job performance. In addition, many employees report that they feel devalued and humiliated by the common practice of requiring them to attend the same training year after year.
Human service agencies also have difficulty in locating and providing a sufficient number of high quality training opportunities, and in securing interagency cooperation and collaboration to deliver affordable training opportunities to their workers. Literally hundreds of effective, high quality training materials exist, yet their dissemination is costly and a systematic method for getting information out to provider agencies does not exist in all states. Finding ways to deliver high quality and relevant training to direct support staff, and to ensure that workers actually learn the desired skills, is a challenge and will continue to be so in years to come.
Finding Solutions
There are a number of strategies that have been proposed to overcome the challenges of recruiting and retaining qualified individuals as direct support staff. When direct support staff are asked for solutions, they point out the need for clearer, more consistent job descriptions, better training, an enhanced public image and greater valuing of their work, supportive work environments, better pay and benefits, and recognition of their professionalism by credentialing. Central to the success of any solution is direct support professionals and individuals with disabilities working with agency administrators and policymakers to effect change. It is this partnership of all stakeholders that can ensure that persons with disabilities receive the services they desire and need to be included as full citizens within their own communities.
References:
Braddock, D., & Mitchell, D. (1992). Residential services and developmental disabilities in the United States: A national survey of staff compensation, turnover and related issues. Washington D.C.: American Association on Mental Retardation.
Jaskulski, T. & Ebenstein, W. (Eds.) (1996). Opportunities for excellence: Supporting the frontline workforce. Washington, D.C.: President’s Committee on Mental Retardation.
Kilborn, P.T. (1994). A nation at risk: The imperative for education reform. Report of the National Commission on Excellence in Education. Washington, DC: U.S. Government Printing Office.
Amy Hewitt is a Program Director and Susan O’Nell is a Program Coordinator with the Research and Training Center on Community Living, University of Minnesota, Minneapolis. Amy may be reached at 612/625-1098 and Susan at 612/624-0386.
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Resources: Web Sites Related to Direct Support Workforce Development
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Citation: Gaylord, V., Hewitt, A., & Larson, S. (1998). Impact: Feature Issue on Direct Support Workforce Development, 10(4) [online]. Minneapolis: University of Minnesota, Institute on Community Integration. Available from http://ici.umn.edu/products/impact/104/. __________ Hard copies of Impact are available from the Publications Office of the Institute on Community Integration. The first copy of this issue is free; additional copies are $4 each. You can request copies by phone at 612-624-4512 or E-mail at icipub@umn.edu, or you can fax or mail us an order form. See our listing of other issues of Impact for more information. The print design version (PDF, 448K, 28 pp.) of this issue of Impact is also available for free, complete with the color layout and photographs. This version looks the most like the newsletter as it was printed. The University of Minnesota is an equal opportunity employer and educator.
