Frontline Initiative

The people who provide direct supports to people with developmental disabilities are critical to ensuring the quality of those supports. Unfortunately, research shows that for every ten direct support workers in a home, between five and seven workers leave in a given year. These high turnover rates increase recruiting, orientation, and training costs, decrease communication among staff members, decrease the continuity of treatment and care, increase administrative costs and job stress, and may reduce productivity and job satisfaction among those who choose to stay. The following study was implemented to identify factors that influence whether workers will stay or leave and to develop strategies to improve direct support worker retention.

Study Description

In 1993, researchers at the University of Minnesota began studying retention among newly hired residential direct support workers in 173 group homes in Minnesota. The study examined facility practices and characteristics that affect recruitment and retention. It also examined the experiences, perspectives, and characteristics of 172 direct support workers from when they were hired until they either quit or completed a year on the job. Preliminary results from the first of two facility surveys are available. Results from the staff surveys and the second facility survey will be available in 1997.

Results

Preliminary results from the first facility survey are available for 103 houses with six or fewer residents. Forty-one of the homes operate as Intermediate Care Facilities for persons with Mental Retardation (ICF-MR), and 62 operate under the Home and Community-Based Waiver Program. On average, these homes opened in 1989 and support an average of 4.7 people with mental retardation. Of the 465 people who live in these homes, 67% walk without assistance, 61% have severe or profound mental retardation, and 53% have a specific intervention program to address challenging behavior. Approximately 17.5% of these homes use live-in staff members.

These homes employ 975 direct support workers. Of those workers, most (77% ) are female, and the mean age was 32 years. These houses experienced several recruitment and retention challenges. For example, 64% of the supervisors reported having problems finding new direct support workers to replace those who have left, 43% reported problems with staff turnover, and 40% reported problems with staff motivation. The overall turnover rate in these homes was 46%. Notably, of the direct support workers who had quit within the previous 12 months, the majority quit in the first year of employment, with 41% leaving within six months of being hired and another 25% leaving between six and twelve months after hire.

In a preliminary analysis of factors associated with turnover, a significant percentage (23%) of the differences in turnover rates between homes could be explained. Higher turnover rates were associated with lower beginning wages, higher daily per diem rates, lower county unemployment rates, having fewer direct support workers, and supporting more people with severe or profound mental retardation. Once those factors were taken into account, county population, number of years the facility was open, ICF-MR status, and the use of live-in staff members did not help to explain differences in turnover rates of different houses. A separate analysis showed that homes in which a higher proportion of workers were eligible for paid leave time (in the form of sick time, vacation, or holiday pay) had significantly lower turnover rates.

Discussion and Recommendations

Based on these preliminary results, several strategies might be helpful to reduce turnover rates and to improve retention of new direct support workers. First, most of the people who quit did so after a short time on the job. One way to reduce this type of turnover is to use realistic job previews (RJPs) to make sure that recruits have good information about the job before they decide to take it or not. RJPs use strategies such as videotapes, booklets, oral presentations, work sample tests, and interviews to present undistorted information to job applicants about the job and the organization before a job offer has been made (Wanous, 1992). RJPs for residential settings should address things like relationships with co-workers or supervisors, opportunities to do fun things, pay and benefits, hours and scheduling practices, and difficult or unpleasant tasks such as assisting with personal care, supporting people with challenging behavior, providing transportation, and paperwork responsibilities. Another useful strategy is to provide incentives to current employees to recruit new workers. Workers recruited this way are likely to know more details about the job than applicants identified through newspaper advertisements and would therefore be less likely to leave shortly after hire because the job did not meet their expectations. A final recommendation is to examine paid leave policies. It may be less expensive to increase the proportion of direct support workers eligible for paid leave time than to continue to struggle with the costs of recruitment, training, and supporting new workers.