Policy Research Brief, Vol. 29, No. 1

Research Issue

The profession of direct support is one of the largest occupations in the United States. The demand for this essential workforce is growing, yet the supply of direct support professionals (DSPs) is nowhere near enough to match it. The DSP workforce crisis is well-documented and now approaching catastrophic proportions. People with intellectual and developmental disabilities are not able to receive the services they are authorized, and some providers are closing programs, temporarily or permanently, because of worker shortage.

Low wages are a major factor contributing to the workforce crisis, with an average starting hourly wage of $13.61 in 2020*. DSP wages have always been low compared to other professions, often barely above the state’s minimum wage. To help put these low wages in context, this Brief compares DSP wages to what people earn in similar professions. It also compares DSP wages to living wages – the cost of living based on typical expenses that meet minimum standards of living.

The gap between living wages and DSP wages has not decreased in recent years and with the onset of the pandemic it increased. For a single-adult household DSP with no children, the median gap between average hourly wage and living wage went from $0.54 above living wage in 2019 to $1.65 below living wage in 2020. For a family with one working adult and one child (which makes up a large proportion of DSPs), the median gap went from being $13.00 per hour below living wage in 2019 to $17.64 per hour below living wage in 2020. Such gaps between what people need to earn to live and what they actually earn are not sustainable.

* https://www.nationalcoreindicators.org/upload/core-indicators/2020StaffStabilitySurveyReport_FINAL.pdf

Study Background

This Brief uses National Core Indicators® (NCI) Staff Stability data. Each year, NCI-IDD – a collaboration between the National Association of State Directors of Developmental Disabilities Services, the Human Services Research Institute, and participating state developmental disability agencies – works with member states to implement the Staff Stability Survey. The NCI-IDD Staff Stability Survey collects comprehensive data on the Direct Support Professional (DSP) workforce providing direct supports to adults (age 18 and over) with intellectual and developmental disabilities (IDD). The goal of the survey and the resulting data is to help states examine workforce challenges, identify areas for further investigation, benchmark their workforce data, measure improvements made through policy or programmatic changes, and compare their state data to those of other states and the NCI-IDD average.

The NCI team publishes annual NCI Staff Stability Reports with their findings. Reports also include comparable wage tables from the Bureau of Labor Statistics (BLS) Occupational Employment Statistics as well as living wage tables for participating states (derived from MIT’s Living Wage Calculator ) for that year. This Brief puts data on average DSP wages collected by NCI Staff Stability Survey in the context of the supplemental information contained in the reports : BLS data on comparable professions and MIT’s living wage data.

Key Findings

Line graph showing hourly wage on the vertical axis, from $12.25 to $15.25, and tenure on the horizontal axis shown as 0 to 6 months, 1 to 2 years, and 2 to 3 years of employment for DSPs at their current employer. Four lines in different colors are shown on the graph, indicating starting wage in January 2020 as reported on the first survey, starting wage in January 2020 as reported on the 6-month survey, starting wage in January 2020 as reported on the 12-month survey, and current wage reported on the 12-month survey. Each line also is also paired with a dotted line showing what wages would be if wages kept up with a 4% annual increase. The blue line representing January 2020 wages from the initial survey shows hourly wages of $13.07 for 0-6 months of employment, $13.25 for 1-2 years of employment, $13.44 for 2-3 years, and $14.14 if there had been a 4% increase. The orange line representing January 2020 wages from the 6-month survey shows hourly wages of $13.16 for 0-6 months of employment, $13.32 for 1-2 years of employment, $13.48 for 2-3 years, and $14.23 if there had been a 4% increase. The gray line representing January 2020 wages from the 12-month survey shows hourly wages of $13.49 for 0-6 months of employment, $13.68 for 1-2 years of employment, $13.45 for 2-3 years, and $14.59 if there had been a 4% increase. The green line representing current wages from the 12-month survey shows hourly wages of $13.87 for 0-6 months of employment, $14.20 for 1-2 years of employment, $13.97 for 2-3 years, and $15.00 if there had been a 4% increase.

Line graph showing hourly wage of frontline supervisors on the vertical axis, from $16.00 to $20.50, and tenure on the horizontal axis shown as 0 to 6 months, 1 to 2 years, and 2 to 3 years of employment at their current employer. Four lines in different colors are shown on the graph, indicating starting wage in January 2020 as reported on the first survey, starting wage in January 2020 as reported on the 6-month survey, starting wage in January 2020 as reported on the 12-month survey, and current wage reported on the 12-month survey. Each line also is also paired with a dotted line showing what wages would be if they kept up with a 4% annual increase. The blue line representing January 2020 wages from the initial survey shows hourly wages of $17.30 for 0-6 months of employment, $16.71 for 1-2 years of employment, $16.57 for 2-3 years, and $18.71 if there had been a 4% increase. The orange line representing January 2020 wages from the 6-month survey shows hourly wages of $17.58 for 0-6 months of employment, $17.34 for 1-2 years of employment, $17.60 for 2-3 years, and $19.01 if there had been a 4% increase. The gray line representing January 2020 wages from the 12-month survey shows hourly wages of $17.68 for 0-6 months of employment, $16.22 for 1-2 years of employment, $17.65 for 2-3 years, and $19.12 if there had been a 4% increase. The green line representing current wages from the 12-month survey shows hourly wages of $18.64 for 0-6 months of employment, $16.86 for 1-2 years of employment, $18.72 for 2-3 years, and $20.16 if there had been a 4% increase.

Policy Recommendations

Low wages that fall far short of what is necessary for a living wage are at the root of the DSP workforce crisis. They must be addressed. Our recommendations are not new but they are urgent: 

• Create a Standard Occupational Classification (SOC) for DSPs.
• Implement comprehensive Medicaid rate reform.
• Ensure greater emphasis by the Centers for Medicare and Medicaid Services (CMS) on the need for states to set adequate rates that are high enough to recruit new entrants to the field and to retain existing staff.
• Ensure that increases in minimum wages at the local, state and federal levels are made available to DSPs and accompanied by pay adjustments to other positions and levels of experience.
• Ensure that wage increases are not limited to hiring bonuses.
• Implement regular cost of living (COLA) increases for Home and Community-Based Services (HCBS).