What’s a DSP? And Why Do Their Wages Matter?

By Jennifer Enderson

Jennifer Enderson is the president of the Tennessee Community Organizations and is the president of the Emory Valley Center, an agency in Oak Ridge, TN, that provides services to adults and children with intellectual and developmental disabilities, including residential programs, personal assistance, supported employment and early intervention services.

Elizabeth is a 35-year-old, single mother of a 4-year-old son she loves fiercely. Over the years she has held a variety of jobs, but none she loves more than the one she currently has as a direct support professional (DSP) at an agency for people with intellectual, developmental and physical disabilities.

A direct support professional is a person who assists an individual with a disability to lead a self-directed life, assisting with activities of daily living, if needed, and encouraging behavior that enhances community inclusion. A DSP also can act as an advocate for the individual with a disability.

Among the tasks a direct support professional may perform are:

  • Help person with getting in and out of bed, eating, bathing, dressing, grooming and taking medications.
  • Maintain records of the person’s care, progress, or problems to report and discuss observations with supervisor or case manager.
  • Change bed linens, wash and iron the person’s laundry, and clean the person’s quarters, home or apartment.
  • Entertain, converse with, or read aloud to the person to keep him or her mentally healthy and alert.
  • Take the person out into the community for leisure or recreational activities, work or volunteer opportunities, faith activities, and shopping.

Elizabeth gets along well with her co-workers and has received glowing remarks from her supervisors each year on her job performance reviews. She has formed very close relationships with the people she supports. Since all of her biological family, with the exception of her son, lives out of state, the people she supports are like family to her, and she cares very deeply for them. She and her son often spend personal, non-working hours with them.

Her job is not the highest-paying one she has ever had, but the emotional rewards are so much greater, and this is what she feels she is called to do in life. Since securing her current position six years ago, she has received only a very minimal increase in pay that has not even kept up with the inflation rate. She knows the agency is doing the best it can with its increasing costs, but Elizabeth has difficulty paying her bills with what she makes, particularly since having her son. The past couple of years, she has started a second part-time job just to pay for necessities. Luxuries are not an option. Often, other DSPs she works with leave for higher-paying jobs, and she has to assume additional responsibilities while the search is on for their replacement. Lately, it is taking her agency longer to find people to fill these positions. This rapid turnover in staff is also difficult for the people she supports.

Elizabeth is often very tired and stressed about what she will do if she experiences some kind of financial emergency. She hopes she never has to face this dilemma, but she worries it may happen one day.

This high turnover rate and the shortage of needed personnel is not just an issue in Tennessee. Nationwide, there are approximately 1.4 million individuals who require the help of direct support professionals in order to live and work in their own communities rather than an institution, according to the American Network of Community Options and Resources (ANCOR). There is a critical shortage of DSPs to support people with disabilities in living full, meaningful lives. That shortage is partly due to low wages, ANCOR reports.

And, we, in Tennessee, are facing a public health crisis. Approximately 20,000 direct support professionals assist, care for and encourage more than 8,000 people with intellectual, developmental and age-related disabilities who receive services through Tennessee’s Medicaid home- and community-based waivers. These are difficult and often “thankless” jobs, but they are critical to the safety and well-being of the people the DSPs serve. We are thankful people are living longer today than in the past (due to medical advances), but this can also produce additional health challenges for them and therefore create more demands for our industry and employees. DSPs make a positive difference in people’s lives each day and are the mainstay for service providers by giving the care and support that each person needs. These direct support professionals are critically important to the people they serve, and, as a result, many form mutual, incredibly close bonds.

Unfortunately, our industry is losing these dedicated workers at an alarming turnover rate of 46%, due to the enticements of higher-paying jobs with less responsibility and stress. It is becoming increasingly difficult to retain current employees and interest new ones when most major retailers and other local industries are able to offer better pay. Because Tennessee does not reimburse the DSPs at a competitive rate, the people we support are losing the services they need.

ANCOR issued a Direct Support Professionals Wage Study in 2009, and found the nationwide average wage for private provider DSPs was $10.14 an hour, compared to $15.53 for state-employed DSPs.

Currently, the state of Tennessee pays its contracted providers $8.73 per hour for direct care workers’ salaries. If this rate had kept up with inflation, it would have increased to $10.16 (since 2006). While small increases in rate reimbursements in recent years have been helpful, they have only increased a total of 48 cents in the past 10 years. However, the industry’s operating costs have continued to rise. At the same time, employees at state-operated facilities, such as the Greene Valley Developmental Center, have received a 17.24% wage increase, which is about $10 -$15 per hour compared to an average of $9 per hour for DSPs who work with community provider agencies.

“Direct Support Professionals are the backbone of the Home and Community Based Services system for people with intellectual and developmental disabilities,” said Cara Kumari, director of communications for the Tennessee Department of Intellectual and Developmental Disabilities. “These jobs are not easy jobs, and as the economy has rebounded, we know that providers have had to compete with many other companies and businesses to recruit and retain these employees.”

To that end, Kumari said, in 2013, the legislature approved a 0.9% rate increase for providers. In 2014, DIDD asked for and received a 1.1% increase, which was targeted to the rate for direct support professionals (DSP) pay.

“Finally, in 2016, the legislature approved an approximate 1% non-recurring increase intended for DSP pay,” she said. “DIDD is committed to working with its providers to address this issue, as we all strive to provide the best and most person-centered supports possible to people with intellectual disabilities across the state.”

Because of these pay issues, Tennessee Community Organizations (TNCO), a professional trade organization for home- and community-based services providers in Tennessee, has been working hard, meeting with Tennessee legislators and Gov. Bill Haslam. TNCO is requesting that the 2017 budget include a $1.00-an-hour increase in the Department of Intellectual and Developmental Disabilities’ rate methodology for all residential, personal assistance, day services and family-based services funded by the state. Since Medicaid funding in Tennessee consists of approximately $2 in federal money for each $1 of state funding, this approximately $20 million investment by the state would bring in $40 million more in federal Medicaid funding for a total of $60 million to help increase the pay and perhaps encourage more people to take and keep jobs as DSPs. All of which would have a positive impact for Tennessee communities.

You can help promote this positive investment for everyone by contacting your legislators and expressing your support for this budget increase. Your actions could help ensure stability for Tennessee’s most vulnerable citizens by making wages more competitive for the people, like Elizabeth, who care for, support and empower those citizens each day.

You can find your legislators at http://www.capitol.tn.gov/legislators/. On the right-hand side is a box that says “Find My Legislator.” You enter your address, and you will get the contact information for your state senator and your state representative. Let them know about the need for this investment.

For those of you who may not be familiar with TNCO, its member organizations provide a full array of services such as residential, day services and supported employment to approximately 8,000 Tennesseans with intellectual and developmental disabilities. There are nearly 13,000 people employed by TNCO member organizations, working from frontline direct support professionals to supervisors, managers and directors as well as a variety of other qualified professionals including nurses. TNCO members provide services to 79% of the people receiving waiver services from the Tennessee Department of Intellectual and Developmental Disabilities.

TNCO’s main purpose is to collaborate with the efforts of our member agencies to ensure Tennesseans with disabilities receive quality services.