Crisis for Adults wth Disabilities Pending Due to Shortage of Direct Support Professionals

National Direct Support Professional Recognition Week is September 8-14. This week recognizes a workforce that helps adults with disabilities live and work in their own communities. However, the shortage of direct support professionals has American adults with disabilities at risk.

Direct support professionals teach new skills and help with everyday tasks such as transportation, dispensing medications, making sure needs are met, assisting with grocery shopping and errands, providing job support, and making connections to community resources and benefits.

The Shrinking Pool of Providers is Putting Adults with Disabilities at Risk

Medicaid is the primary funder for home and community-based services and there are two primary employers of direct support providers, agencies contracted to provide direct support services by the state and private providers.

People with disabilities are living longer while their parents are aging. At the same time, the growing shortage of direct support professionals (DSPs) leaves the nation’s nearly 1.4 million people with disabilities in jeopardy.

The combination of more adults needing services, aging parents unable to provide care, and fewer direct support professionals means we are approaching a crisis.

By 2026, it is projected the need for home care workers will increase by 52 percent. There is also a turnover of 45-65 percent in these positions due to complexity of work, low wages (average $10.30/hr), limited benefits, minimal training, ineffective supervision and few opportunities for career growth.  

Options for people with intellectual and developmental disabilities and their families are limited. 

• There are already extremely long waitlists for services. 
• Medicare funding is at risk.
• Many families cannot afford private pay and the extra burden of the employee issues is more than families already dealing with extra issues can handle. 
• Often one parent has to leave work to provide the care and support which reduces family income and ability to meet needs.
• The least desired alternative is the even more expensive institutional models of segregated care outside the home, something we have been fighting since the days of institutionalization.

This is a profession in need of disrupting.

• Can we learn from the gig economy providers and develop a network of care and support?
• Can agencies and private companies be incentivized to offer enhanced professional development and career paths that allow for advancement in skills, positions, and wage increases?
• State Medicaid agencies can evaluate reimbursement rates and set wage pass-throughs to ensure a living wage is offered. A wage pass-through is an additional allocation of funds provided through Medicaid reimbursement for the express purpose of increasing compensation for direct-care workers.
  • According to the U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy, “21 states have implemented ‘wage pass-through’ programs with the stated expectation that doing so will help address the shortage of direct-care workers employed b,y long-term care providers.”
• The majority of direct service providers are African American women. We can reach new populations including high school students, men, veterans, retirees and even people with disabilities to encourage them to start a career path in this area.
• Improve screening and interview processes using best practices and realistic job communication to ensure a good job fit.

What you can do?

• Contact your state representatives and speak to the importance of this vital workforce and ask them to create policies allowing funding for innovative DSP retention solutions.
• Plan ahead for your child’s future. When they leave the education system it is often a shock. Spend some time with your child thinking about how they would like to spend their time as an adult? What skills might they need to live independently and how can you work toward that now? Why outside supports might they need? What expenses might you have to ensure your child has a space to live, eat, transportation, medical expenses, etc.? 
• Start a STABLE or ABLE account which can help Pay for an independent service provider or other services.