Results of The Direct Support Workforce and COVID-19 National Survey 2020

Results of the Direct Support Workforce and COVID-19 National Survey 2020

Download a PDF version of the Results of the Direct Support Workforce and COVID-19 National Survey 2020 PDF

Introduction and Background

The direct support workforce provides an array of critical supports making it possible for people with intellectual and developmental disabilities (IDD) to live, work, and thrive in their communities. These professionals perform multiple tasks, at any given time during the course of their work, which may be similar to those of teachers, nurses, psychologists, occupational therapists, physical therapists, counselors, dieticians, chauffeurs, personal trainers, and others. There is no Bureau of Labor Statistics occupational classification for direct support workers and they are often categorized with home health aides, personal care assistants, certified nurse assistants, and others. Providing home and community-based supports for people with IDD, however, requires specialized skills and competencies that are not reflected by the low wages due to underfunded Medicaid-reimbursed rates, limited access to benefits, and lack of respect afforded to this essential workforce.

The shortage of direct support workers is well documented. Over 50% left their positions in 2018 with one-third leaving in the first six months of employment and vacancy rates are near 15% for full-time and 18% for part-time positions (National Core Indicators, 2019). As a result, many direct support workers, supervisors, and other staff consistently have to work overtime to provide supports, yet sometimes people with IDD go without supports. Family members are called upon to provide these supports which affects their availability to maintain employment. With the pandemic, social distancing guidelines and stay-at-home orders have negatively affected the lives of people with IDD and the supports they need. As such the University of Minnesota and National Alliance for Direct Support Professionals collaborated to lift up the voice of the direct support workforce. The aim of this study was to gather evidence about the experiences of the direct support workforce during the COVID-19 pandemic and to inform efforts to better prepare for future waves of this pandemic.

A direct support worker was defined as an employee who spends at least 50% of their time providing supports for a person with IDD. Almost 9,000 direct support workers from the U.S. completed the survey between April 23-May 27, 2020. At least one survey was received from every state. Nearly 60% of respondents were employed in the direct support work-force as their primary job for more than 36 months and 18% were employed less than one year. A little over 60% worked in agency/facility sites, 39% worked in individual or family homes, and 17% worked in day program or employment services. While 96.8% self-identified as an essential worker, when the pandemic hit in the U.S., states were slow to identify direct support workers as essential.

Direct Support Workforce Pay and Hours

Wages and extra pay

74 percent of respondents are primary wage earners in their household and receive an average wage is $13.63. This wage is higher than the national average because most respondents have worked in their positions for over three years. 24 percent of respondents are receiving extra pay due to COVID 19 risks. Of those receiving extra hourly pay, 21 percent received more than three dollars, 15 percent received between two and three dollars,  45 percent received one to two dollars, and 19 percent received one dollar or less.

Respondents experienced significant schedule changes

34 percent worker more hours, 18 percent worked fewer hours, 30 percent worked different shifts, 29 percent worked in different settings, and 26 percent reported they were more short staffed than before the pandemic.

Additional hours worked per week

29 percent worker one to fifteen extra hours, 10 percent worker between 16 and 30 hours, and 15 percent worked 31 or more additional hours.

Safety Measures

DSP access to personal protective equipment (PPE)

84 percent of respondents had gloves, 53 had homemade masks, 46 had medical-grade masks, and 10 percent had home repair style masks.

Safety measures put in place by employers

72 percent of employers posted signs on proper handwashing, 66 percent took employee temperatures, 66 percent provided health and safety training, 58 percent posted signs on social distancing, and 10 percent provided COVID-19 testing.

Effects on people with Intellectual and Developmental Disabilities

Pandemic effects on people with IDD supported

42 percent knew someone in the DSP workforce who left their job due to the pandemic. Of those, 34 percent feared infection, 25 percent had childcare issues, 13 percent feared infecting others, and 9 percent left after testing positive for COVID-19. Other reasons for leaving included caring for family members or laid off when a program closed, having hours cut, mental strain, or receiving more income from unemployment as compared to working.

Social distancing practices of people supported

The social distancing practices of people supported were reported as 60 percent good or very good, 24 percent fair, and 16 percent poor.

Allowed to see their family or friends in person

10 percent of people supported were allowed to see family or friends in person. 16 percent were seldom allowed to and 64 percent were never allowed to.

Consequences of isolation on people supported

The isolation of people supported resulted in 80 percent experiencing boredom, 57 percent experiencing mood swings or depression, 52 percent having increased behavior issues, 48 percent experiencing loneliness, and 47 percent sleeping more than usual. Other observed consequences included confusion over why people cannot visit, anxiety over not seeing people or going out into the community, not being able to visit medical specialists, and decreased exercise.

Moving Forward – What is Needed

Comprehensive, organized and funded response plans at national and state levels for additional waves of COVID-19 and future pandemics. This workforce needs to be officially identified as essential and have access to PPE to protect their health and safety. Establishing a standard occupation classification for direct support workers would aid these efforts.

Wage increases for essential workers commensurate with the increased level of exposure. Direct support depends largely on human interaction, placing workers at increased risk for contracting COVID-19. Only 24% respondents indicated they were paid higher wages during the pandemic and many employees were working a high number of overtime hours.

Access to career ladders. 74% of respondents indicated they were primary wage earners in their household, earning an average of $13.63 per hour. This workforce should have access to career ladders and credentialing programs that result in increased wages and access to benefits.

Increased training on health and safety. 27% of new hires during the COVID-19 pandemic were reportedly not getting typical orientation and preservice training. Comprehensive safety training needs to be provided at the onset of a public health crisis.

Access to childcare and support if schools or daycares close. Ensuring essential worker status specific to this occupation would prioritize childcare availability for these families in most states.

Professional recognition of direct support. Direct support workers have always provided critical, essential supports. The average wage of $13.63 per hour prior to the pandemic is not reflective of the skilled nature of the work.

People with IDD need education and training on handwashing, hygiene, and social distancing. This should be ongoing.

Ensure access to technology for people with IDD that allows social interaction with others.​ Invest in technologies that help people have greater control over their lives.

Develop evidence-based strategies for teaching people with IDD to use telehealth​. Work with the medical community to eliminate disparities and ensure people get the healthcare they need.

Review of policies to ensure person- and family-centered practices with informed decision-making regarding social contacts during a pandemic. People with IDD and their families should be involved in decisions affecting them.


  • National Core Indicators. (2018). National Core Indicators 2018 Staff Stability Survey Report. Retrieved from https://www.


Funded by grant #90RTCP0003 from the National Institute on Disability Independent Living Rehabilitation Research and cooperative agreement #90DDUC0070 from the Administration on Community Living, U.S. Department of Health and Human Services.

Please contact Jerry Smith with questions. The full report will be available in August 2020.

Download a PDF version of the Results of the Direct Support Workforce and COVID-19 National Survey 2020 PDF

This survey was conducted jointly between the Institute on Community Integration and the National Alliance of Direct Support Professionals