Policy Research Brief, Vol. 28, No. 3

Predictors of Annual Turnover Among Direct Support Professionals

policy research brief, institute on community integration, university of minnesota

Research Issue

Direct Support Professionals (DSPs) provide a broad range of supports to people with intellectual and developmental disabilities (IDD) to live, work, and meaningfully participate in their communities. Despite their critical role, high rates of annual turnover among DSPs have been documented for decades and are an increasingly serious issue. Defining root causes and finding solutions to address high rates of DSP turnover are critical.

This study was the first to examine trends in organizational- and state-level factors related to DSP turnover using data from the NCI Staff Stability Survey. The study showed that factors associated with higher annual turnover are not limited to the organizations for which DSPs work but also include state-level policies and factors that may be beyond the organization’s control. Solutions should likewise include both organization- and state-level strategies.

Study Background

The study used 2016 National Core Indicators (NCI) Staff Stability Survey data. NCI is an initiative of the National Association of State Directors of Developmental Disabilities Services (NASDDDS) and the Human Services Research Institute (HSRI). The NCI Staff Stability Survey was developed in collaboration with the National Direct Service Resource Center to assess critical and relevant information about DSP workforce stability, wages, benefits, and recruitment and retention strategies. It began collecting organizational-level data on the direct support workforce in 2014.

In 2016 NCI Staff Stability Survey data were collected in 20 participating states and District of Columbia. Data for this study represented over 1,600 agencies providing direct support services to adults with IDD at that time.

Policy Recommendations

This study revealed that there are several important factors affecting DSP turnover at the organizational and state levels. Therefore, any interventions must consider both state- and organization-level factors based on these findings, policy recommendations include —

  • Wages for the DSP workforce should be increased to levels commensurate with their skill levels and livable wages in their communities. Building in annual cost of living increases into rate structures at the state level is critical to keep wages aligned with costs of inflation. Increasing the wages will communicate to DSPs they are valued and essential members of the organization and more importantly it will decrease turnover.

Key Findings

Organizational-level and state-level ­factors affect staff turnover. Organizational-level factors, $1 increase in wage, 1.10% decrease in turnover. Offering of health insurance, lower turnover. Health insurance offered in 76% of organizations.
State-level factors. 10% Increase in people living in Individual or small group homes. 7% Decrease in turnover. $100 Increase in per capita Medicaid spending, 2% decrease in turnover.
  • Organizations should always offer benefits in the form of health insurance and paid time off. Rate structures must align with increased costs of healthcare benefits for providers in order for them to continue to offer these benefits at affordable costs. When DSPs receive the option of affordable health insurance through their employer, turnover will decrease.
  • States should continue investing in providing services and supports to individuals in smaller community settings and supporting people to move out of institutional settings as states with larger settings have higher turnover.
  • States should continue investing in Medicaid and home- and community-based services, increasing sustainability and at the same time decreasing turnover as more per capita investments leads to lower turnover. This investment must include efforts to address workforce shortages and retention challenges and the development of a sufficient, stable and competent workforce to provide community supports.

    Policy Forum

    Join us October  7, 2021 from 11:00 a.m. to 12:30 p.m. CDT on Zoom for the Policy Forum on this issue of Policy Research Brief. Register here.

    The Policy Forum is a monthly web-based presentation and facilitated discussion exploring research published in the most recent Policy Research Brief. Please visit the website for details and to view previous forums.

    Published September, 2021

    Editor: Quinn Oteman

    Graphic design: Connie Burkhart

    Research cited: Houseworth, J., Pettingell, S. L., Kramme, J. E., Tichá, R., & Hewitt, A. S. (2020). Predictors of annual and early separations among direct support professionals: National core indicators staff stability survey. Intellectual and developmental disabilities58(3), 192-207.

    Download a 2-page PDF of this issue of Policy Research Brief 

    The University of Minnesota is an equal opportunity educator and employer. This document is available in alternative formats upon request.

    The Institute on Community Integration (ICI), collectively acknowledges that Minnesota is located on the traditional, ancestral, and contemporary lands of the Anishinaabe, Chippewa, Ojibwe, Dakota, Cheyenne, and other Native peoples. This land holds great historical, spiritual, and personal significance for its original stewards, the Native nations and peoples of this region. We affirm tribal sovereignty and will work to hold ourselves and affiliations accountable to American Indian peoples and Nations.

    Ongoing oppression and discrimination in the United States has led to significant trauma for many people of color, immigrants, people with disabilities and other oppressed persons. At ICI, we affirm our commitment to address systemic racism, ableism and all other inequalities and forms of oppression to ensure inclusive communities.