Tennessee Tackles Workforce Challenges

Sheena (right), a woman receiving supports, in the arts supply store where she works in Nashville, Tennessee. On the left is her direct support professional, Chelsea Toombs, from the Progress, Inc. provider agency in Tennessee.

A multi-year collaboration between Tennessee’s managed Medicaid agency and the Institute on Community Integration is helping address dire shortages in professionals supporting people with disabilities. ICI’s partnership with TennCare, begun in 2018, created four annual workforce surveys and analytics, a workforce toolkit, realistic job previews employers can share with candidates, marketing materials, public service announcements, and training.

“We’re really proud that we didn’t start this work in 2021 in response to the pandemic, but proactively started surveying our workforce in 2018,” said Shannon Nehus, program director, intellectual and developmental disabilities, within TennCare’s Long-Term Services & Supports (LTSS) division. Tennessee Community Organizations (TNCO), a service provider association, also collaborated on the work. “We now have a workforce community of practice in Tennessee that, even through the public health emergency, has made changes that will result in higher staff satisfaction levels. Ultimately, that means people with disabilities will have more stable and higher quality services,” Nehus said.

While no one action will fix the shortage of direct support professionals (DSPs), coming together with service providers throughout the state to share information and create the tools designed through the partnership will produce long-lasting results going forward, said Anna Lea Cothron, TennCare’s LTSS system transformation director. In just one example, Cothron shared the story of a provider who previously would only consider hiring full-time DSPs. After multiple data-driven conversations, the provider agreed to hire part-time professionals.

“You really can’t make good decisions without the right data,” Cothron said. “It is so worth the effort. We can’t prove positive outcomes without it, and ICI was a dream partner to help make it happen. Their national reputation lends credibility, but day to day, the researchers were smart and competent without being lost in theory. They understood the practical side of how providers work.”

The four annual statewide surveys of the Tennessee support workforce generated data that can be analyzed on a state, regional, or individual provider level to pinpoint problem areas and illuminate where recruiting and retention dollars will best be spent, said Sandra Pettingell, research associate at ICI.

“TennCare is a great example of the types of consultation and support we’re able to provide organizations,” said Barbara Kleist, who led the ICI team that worked on the project. She also is a lead consultant for ICI’s Direct Support Workforce Solutions , a consulting group. “Using data to drive decision-making on recruitment, retention, and training can bring organizations some stability amid the devastating labor shortages that worsened during the pandemic.”

Those ideals helped propel Core Services of Northeast Tennessee to win the 2022 Moving Mountains Award, which recognizes organizations using leading practices in direct support workforce development. The National Alliance for Direct Support Professionals, along with ANCOR and ICI, bestow the awards.

“We’ve used the same person-centered concepts with our employees that we use with the people we support, and that has put us where we are today,” said Susan Arwood, Core Services’ executive director. “We design work schedules that fit their needs, we’ve given personal loans during hardship issues, given away vehicles and even had a school for some DSPs’ kids during the pandemic.”

Arwood praised Tennessee’s track record of innovations in supporting people with disabilities, including several technology initiatives in remote monitoring that allow people to live more independently.

Within the TennCare Workforce Initiative, Core Services participated in the Quality Improvement in Long-Term Services and Supports Initiative (QuILTSS) survey and took advantage of one-on-one consulting to supplement what the agency was already doing.

“We implemented several new things that just took us a step further,” she said, including redesigning a website to be more transparent and incorporating video storytelling to attract new hires. “We also started a mentor program for new hires and by the end of six months they usually had formed a relationship with the mentor. That’s helped us keep people who in years past would have just walked off the job. They felt comfortable now bringing up issues.”

In a realistic job preview video created during the TennCare project, Patti Killingsworth, retired chief of long-term services and supports for TennCare and a longtime family caregiver, says frankly that sometimes, walking away can be the right move for a new DSP, and the people they support. For others, finding work that matters can make all the difference.

“If you decide to embark on the journey of becoming a DSP, buckle up; it’s going to be an amazing journey,” she says in the video. “You’ll know that what you’re doing really matters and you’ll make such a difference in the lives of the people you support.”