The Implications of an Industry in Peril

There’s been so much written about the Direct Support Professional workforce crisis. The most compelling and comprehensive document was explained by the President’s Committee for People with Intellectual Disabilities in a 2017 report America’s Direct Support Workforce Crisis: Effects on People with Intellectual Disabilities, Families, Communities, and the U.S. Economy.

The report describes the implication of the crisis on our nation overall, and for this document is broken down into four segments – the DSP, the industry, the economy, and ultimately the taxpayer.



Wages and work-life balance fuel the considerable exodus in the industry, with many DSP’s paid below the poverty level and workforce shortages placing a strain on an already stressful situation. According to the poverty level guideline, a family of four would require annual earnings at no more than $25,100, which equates to $12.07 an hour. Although the poverty level guideline is one measure, the poverty level threshold is used to determine the eligibility for various services. In this context, the same family of four (assuming two adults, two children under age 18) would be measured on an annual income of $24,858.


It might seem unlikely that a DSP would receive government funded or means-tested benefits. Although, according to the Presidents Report, half of the nation’s DSPs are receiving such subsidies. Everything from food stamps, housing assistance, medical subsidy, and child care support – the same services the individuals they care for may receive. Many DSPs are forced to work second or third jobs to cover their families living expenses.


The role of the DSP is to help individuals with ID/DD, and the families make informed decisions and exercise choice by teaching, training and supporting them in all aspects of life. They are charged with the safety and health of these individuals, understanding medication disbursement, medical intervention protocols and implementation of treatments. They have job duties that resemble many other professions combined in one. There is vital importance in the role they perform yet they are not compensated with a commensurate wage.


As spoken by Randall Howard, DSP:


Randall begins his day at 7 am supporting an individual who is blind, incontinent, unable to eat solid foods nor drink pure liquids. If this individuals’ food or drink is not prepared in the right manner, he could aspirate potentially causing pneumonia or a potential fatality. He helps him get out of bed, clean the bedding, basic hygiene, and throughout the day with daily exercise activities and community integration. Randall ends his support at 8 pm then proceeds to document his day, coordinate with doctors, ensure consents are up-to-date and complete all the recording required to meet licensing requirements. Randall earns an hourly wage of $10 while his nephew earns $11 working as a cashier at Walmart.


This story mirrors many DSPs daily encounters. Is there any wonder why the crisis exists?


The Industry

Every year, there are 574,000 NEW DSPs needed to fulfill current vacancies. There is an additional 167,001 more DPSs are necessary to meet the nearly 200,000 wait listed individuals with ID/DD. Mounting vacancies place more time and money on administrative tasks to recruit and train new workers. More importantly, with reimbursement rates, they are unable to recruit staff and are forced to turn away referrals with higher support needs.


Providers turn to less qualified applicants who would not have been considered in the past. They require more training, are less dependable, and lack the commitment to the mission of helping individuals integrate into society. The time a supervisor allocates to these lesser qualified workers means that they are neglecting the support and development of their best and most valuable workers. Some the newly hired DSPs may have lower professionalism which can impact the perception of the Provider within the community.


Vacancies place demands on overtime pay and, in some situations, the supervisor filling shifts. In New York state, it was estimated annual overtime pay was $206,276,508 (Hewitt et al., 2015). Supervisors are equally problem-solving life situations for their workers, caused by related stress and lower earnings.

The industry has a propensity for high risks with potential mistakes, worker burn-out, and stress-related illnesses. Stressful situations may not be dealt with appropriately and can lead to abuse or neglect of the individual under care.

A DSP may miss important signs or symptoms of illness if they aren’t familiar with the individual, new to the field, or even filling a shift. Individuals with ID/DD rely on group homes or sheltered work settings. Families make concessions in their work and careers to ensure the care of their loved one. They want the ability to entrust the care with a skilled, committed, and known caregiver.


The Economy

DSPs help the economy in two ways – 1) helping people with ID/DD to obtain jobs and 2) enabling family members to work. Only 16% of individuals with ID are employed in competitive community jobs. Government funded and means-testing benefits are provided to individuals with ID/DD to ensure that they can experience all the communities have to offer. It is essential that they are taught basic life skills as well as learned work behavior and skills, to live life independently. As they integrate into the workforce, their earnings are discounted from the subsidy they receive, thereby reducing the amount of government funding.


Due to the DSP shortage, more strain is placed on municipal services resulting in higher costs for police, ambulance, firefighters, emergency departments, acute care, and other resources. Families find needing these services more important when they don’t receive adequate support for their family member.


The Taxpayer

Ultimately, the taxpayer money goes to fund a portion of the government and means-tested benefits on the federal, state, and local levels.


Although elections decide who gets an official office, they do not have a direct impact on helping to fix a broken industry. But, it takes a village. We are all stakeholders in ensuring the future of individuals with ID/DD, their families, and those who support them.


How Do You Fix a Broken System?

There are too many variables that play into the solution. Since these variables can’t be addressed together or soon enough, companies need to find proprietary services to help. Optonome is an optimal solution to support these systemic issues. They’ve created a system that highly supports DSPs and Providers to focus on the care of the individuals and spend less time on administrative functions.


To learn more about Optonome or how their system can help you, visit and request a free demo.


Source: Report to the President 2017. America’s Direct Support Workforce Crisis: Effects on People with Intellectual Disabilities, Families, Communities and the U.S. Economy, President’s Committee for People with Intellectual Disabilities.