Recruiting, Selecting, and Retaining Direct Service Workers to Provide Self-Directed HCBS

Please review the following risk factors for DSW stress.

Social Isolation

Social isolation is common, especially for family members who are paid DSWs. Many feel more comfortable at home or in familiar environments where life is more predictable for the person they support. This can be isolating as it may require they give up friends and previously favored activities.

Financial Stress

Financial stress related to low wages and benefits is common in this type of work.

Working More Than One Job

Many DSWs work multiple jobs to make ends meet.

Working Overtime Regularly

​Working more than the typical 40 hours per week (known as overtime) and doing so several weeks in a row can lead to little down time and burnout. ​

Live-in DSWs

DSWs who live with the person being supported experience more stress. They are often on-call 24 hours a day. It is hard to find time for themselves or separate their own needs from the person they support.

Paid Family Member DSWs

Family members who are paid DSWs often come to be a DSW due to the need of their family member rather than by choice. This can cause added stress.

3. Reflect

Judy works as a personal care assistant (PCA) for three different people. She supports a woman, Kim, in her 30s who has a spinal cord injury. This is a part-time weekend job. She enjoys working with Kim because they both like movies and video games and have fun talking about the latest film or game. Her duties are assisting Kim with getting showered and dressed for the day. She also prepares a couple of meals that Kim is able to re-heat on her own after Judy leaves for the day. During the week, Judy is taking classes to become an X-ray technician. Before her classes, she supports a teenager with autism, Adam, to get ready for school.  Sometimes Adam can have difficult mornings that make getting ready challenging. Judy is always worried that she is going to be late to class. After class, Judy cares for an elderly neighbor. Judy has known Bill for years. When Bill’s dementia became too much for his wife, Clara, to manage, she asked Judy to work for them.  Judy already had a lot on her plate, but she said yes because she likes her neighbors. As Bill’s dementia worsens, he is becoming aggressive. He also will leave the house and become lost, so he has to be watched closely. Judy supervises Bill and helps with his daily hygiene needs to give Clara a break. No one has provided any support or training to Clara or to Judy about the best ways to work with someone who has worsening dementia. She feels frustrated with the situation but doesn’t want to leave Bill and Clara without help.

Once Judy is done with work for the day, she goes home to study and then heads to bed. Judy has stopped seeing her friends and family and going to the gym, and she always seems to have a cold.  Judy is burned out. 

What factors do you think might be contributing to Judy's burnout?

Judy has taken on too many things!  She has no time to take care of herself.  Judy is going to school and working as a DSW for three different people.  Supporting Adam means that is she often late to school.  She doesn't have enough training to properly support Bill and Clara.  She hasn't left much time to take care of her own needs.   All of these things can cause stress and lead to burnout.

What should Judy do?

Judy could decide if  it is possible to change one of her DSW positions.  She could talk to Adam's parents about her need to be able to leave on time to make it to school. They could come up with a plan to help her leave on time.   She could also try to connect her neighbors with resources that could help Bill get the support he needs and the training that she and Clara need to support Bill.  Judy could also prioritize her needs and goals and decide if providing supports to three different people is too much. What do you think Judy should do?