Frontline Initiative: DSPs Responding to Crisis

Direct support professionals (DSPs) provide many types of critical supports. This makes it possible for people with intellectual and developmental disabilities (IDD) to live, work, and thrive in their communities. The COVID-19 pandemic impacts this work. The purpose of this survey was to understand how the pandemic has impacted DSPs’ work. The results will help people make decisions about preparing for future waves of the pandemic. This survey was initially completed in April-May 2020 by 9,741 DSPs from all 50 states. A six-month follow-up was conducted in November-December 2020 by 8,846 DSPs. You can read the full reports of both surveys, which are available here . This article is a summary of key findings and recommendations for supports and policy changes for the direct support workforce from the six-month follow-up survey.

DSPs reported on their wages before the pandemic and on whether they received extra pay for pandemic-related risks.

These findings show the percentage of DSPs who self-identified as essential workers (97%) and those who received COVID-19 extra pay (30%). While some DSPs received extra pay, most did not. Depending on states and employers, DSPs had varying levels of access to additional dollars to compensate essential workers.

DSPs need to be identified as essential workers in comprehensive, organized, and funded response plans. This needs to be addressed at national and state levels for additional waves of COVID-19 and future pandemics.

Wages for DSPs need to be increased like other healthcare and essential workers during national crises and future pandemics. State-level and national policies should clearly include DSPs. This is needed to keep DSPs in their jobs. Essential worker status and higher pay may give DSPs the childcare and financial support they need to remain in their jobs. Some DSPs left work to care for children or other family members. Many DSPs are single mothers (Hewitt et al., 2019; PHI, 2019). Access to childcare ensures that DSPs can keep coming to work.

Access to career ladders that lead to increased skills and pay.

Seventy percent of DSPs said they were primary wage earners in their household, earning an average of $13.92 per hour. Over half of the participants had household incomes low enough to qualify for federal and state relief programs such as energy assistance, food insecurity programs, and housing assistance. This workforce needs access to career ladders and credentialing programs that result in increased wages and access to affordable benefits. Credentialing programs provide opportunities for DSPs to increase their skills. This results in providing higher-quality supports. It provides a framework for pay increases.

DSPs were asked to report on how the pandemic affected the number of hours they worked, where and when they worked, and how their role may have shifted.

Many DSPs experienced shifts in schedules and work expectations because of the pandemic. Only 55% of DSPs said that there was sufficient staffing in locations where they worked. Also concerning was that only half (51%) of DSPs had access to paid time off if they showed signs of COVID-19.

DSPs need paid time off if they display signs of COVID-19.

Many DSPs cannot afford to take time off. COVID-19 can spread rapidly and severely harm many people. A coordinated response plan to screen workers is needed. People should be able to stay home if they display symptoms to prevent the spread of COVID-19.

DSPs need systems-level pipelines and incentives to enter this workforce.

Vacancy and turnover rates have been high in this industry for decades. Rates are even higher now because of the pandemic. During the pandemic, DSPs lost their jobs due to layoffs or furloughs and others left the field for personal or safety reasons. This will most likely have long-term effects on the workforce. Creating pipelines through educational and workforce development programs will be needed. This can help provide enough workers to fill vacancies in the IDD support sector.

DSPs were asked to report on the kinds of personal protective equipment (PPE) provided by their employer, whether they had adequate training in using PPE, and other safety measures that were taken.

While the majority of DSPs had access to PPE at their work location, some DSPs did not. DSPs who work in more congregate settings were more likely to have access. This is concerning given that the vast majority of services are provided in non-congregate settings (Larson et al., 2020). Only seventy-five percent of DSPs reported that they were provided training on how to safely use PPE.

Increased training on health and safety for DSPs.

Only half of DSPs said that new hires during the COVID-19 pandemic received typical orientation and preservice training that included safety training on the pandemic. Comprehensive safety training needs to be provided at the start of a public health crisis for all DSPs. New hires need comprehensive orientation and onboarding to enter this line of work. They also need knowledge about practices to manage health and safety related to the prevention of COVID-19 and to care for those infected by it.

DSPs were asked to gauge how well the people they supported were following social distancing measures.

The majority of DSPs (58%) said that people with IDD were good or excellent at following social distancing practices, but 42% were reportedly fair or poor at this. These numbers were almost the same as when the survey was first administered in April 2020. Some participants reported that the people they supported had difficulties understanding the changes and restrictions to their lifestyle resulting from the COVID-19 pandemic.

DSPs self-reported demographic information and the primary setting where they worked.

By collecting these data, we were able to look at patterns based on demographics and settings in which DSPs work. One finding was differences in wages paid to DSPs based on race. We also found differences in the number of additional hours that DSPs worked by race as a result of the pandemic. We do not know if there are additional factors or reasons for these differences. Continuing to look at data in this way helps us better understand how to target our advocacy efforts to ensure better wages and supports for DSPs across the United States. More information on these results is available in the report.

Professional recognition and wage equity for direct support.

DSPs have always provided critical, essential supports. The average wage of $13.92 per hour prior to the pandemic – and only $12.36 nationally (National Core Indicators, 2020) – is not reflective of the skilled nature of direct support work. Moreover, this study showed that Black/African American DSPs made significantly lower hourly wages than other races. These disparities must be explored and resolved. All DSPs need to make a livable wage and have access to affordable healthcare benefits. They should not have to work multiple jobs or excess overtime to be able to live above the poverty line.

References

Gleason, J., Ross, W., Fossi, A., Blonsky, H., Tobias, J., & Stephens, M. (2021). The Devastating impact of Covid-19 on individuals with intellectual disabilities in the United States. Catalyst: Innovations in Care Delivery 2(6). https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0051

Hewitt, A., Pettingell, S., Kramme, J., Smith, J., Dean, K., Kleist, B., Sanders, M. & Bershadsky, J. (2021). Direct Support Workforce and COVID-19 National Report: Six-Month Follow-Up. Institute on Community Integration, University of Minnesota. https://publications.ici.umn.edu/community-living/covid19-survey-6-month-followup/main . 

Hewitt, A., Pettingell, S., & Kramme, J. (2019). Minnesota direct support worker survey: Final report. Institute on Community Integration. https://ici-s.umn.edu/files/97yqCJKfgd/direct-support-worker-survey_v5ar

Larson, S. A., Eschenbacher, H. J., Taylor, B., Pettingell, S. L., Sowers, M., & Bourne, M. L. (2020). In-home and residential long-term supports and services for persons with intellectual or developmental disabilities: Status and trends through 2017. University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration. https://ici-s.umn.edu/files/aCHyYaFjMi/risp_2017

National Core Indicators. (2020). 2019 National Core Indicators staff stability survey report, HSRI & NASDDDS. https://www.nationalcoreindicators.org/upload/core-indicators/2019StaffStabilitySurveyReport_FINAL_1_6_21.pdf

PHI. (2019). U.S. Home care workers: Key facts. Author. https://phinational.org/resource/u-s-home-care-workers-key-facts-2019/