Thirtieth Anniversary Issue on Progress and Priorities in Direct Support

Martin Pena and Geeter Lowe during a recent visit at Martin's home

Geeter and Angie reminisced about their direct support professional (DSP) experiences over the past 30 years. Core Services is a small provider organization that used the rollout of home and community-based services (HCBS) settings rules to embrace a true person-centered approach to services that significantly improved lives. Over a transformational decade, the organization achieved CQL Person-Centered Excellence with Distinction accreditation as well as credentials as a person-centered, technology-first, and employment-first organization. The organization realized that people do not want a lifetime of good services; people want good lives. As Core Services focused on improving one person’s life at a time, their DSPs’ professional role and job satisfaction also improved. Geeter and Angie reflected on the transformation of care from the start of their careers to the support offered today.

Entering the field of direct support

Geeter and Angie entered the field through different paths that intersected and eventually brought them to the same agency supporting some of the same people 30 years later. Angie started her career in the 1980s as a “developmental technician” at Greene Valley Developmental Center, one of three large state institutions in Tennessee. Throughout a 30-year career, she progressed through different positions at the institution until U.S. Department of Justice lawsuits forced it to close.

Geeter never intended to be a DSP, but he fell into the role at the age of 22. He had worked in various jobs, including at a wrestling company, a shoe shop, and as a bouncer. In 1993, Geeter found himself between jobs. Working with people with intellectual and developmental disabilities (IDD) was the furthest thing from his idea of careers when his sister suggested that he apply to her place of employment, a provider organization for adults with IDD. Geeter was hired as a truck driver/DSP for a sheltered workshop program. He did not know it was the start of a lifelong career.

Direct support in a sheltered workshop, a large group home, and an institution

Geeter’s first memories working in direct support were at a segregated work program that performed industrial sub-contract work. People who attended the program were paid a piece rate for their work. For many individuals, this program was their only socialization opportunity. People commonly earned a paycheck of a few dollars a week. The day was structured for participants—a “this is what we are doing today” approach. Individual choice was usually not an option. If you could perform a particular task or job, you were assigned to it and expected to do it, even if you hated the task. Anything else was considered a “behavior.” If you could not fulfill a useful role, you were assigned to a table where you could do arts and crafts. One or two staff sometimes supported as many as 60 people. The program was viewed as a charity. The people were expected to feel lucky and appreciative that any opportunity was provided.

People often dreamed and talked of an “outside” job. However, with limited agency resources devoted to this goal, this dream was realized by only a few. Although the workshop was located in an industrial park, “outside” jobs were often the tasks no one else wanted to do, such as picking up discarded cigarettes in a parking lot. For everyone else, “community” was a daily walk through the industrial park. Geeter recalls how dating and romantic pursuits among people supported were taboo. They were considered a distraction that should only occur after work hours. However, most people had limited opportunities to do anything outside of the workshop. Geeter remembers his role as a DSP being that of managing behavior, motivating people to perform work tasks they often did not want to do, refereeing disputes, breaking up fights, implementing behavior plans, and trying to keep people calm and safe.

Early in his career, Geeter also worked in an eight-person group home. Eight men shared a communal bedroom and living space. Routines were built to be efficient and cost-effective, not on the life choices of the people who lived there. This included events like four men receiving a shower in the morning and four in the evening. Menus and mealtimes were not negotiable. If you wanted to eat, you presented yourself at mealtime. It was survival of the fittest. Work program clashes often carried over to home, where no one had a choice of with whom they lived.

Geeter and Angie’s early experiences as DSPs occurred during a changing IDD landscape in Tennessee. In 1990, the national work of disability advocacy groups resulted in lawsuits and federal oversight of institutional care. In Tennessee, investigations into unfit conditions at the three large state institutions revealed abuse, inadequate staffing, and insufficient medical care. Tennessee was forced to address unsafe conditions in the state’s developmental centers. Tennessee chose to invest in community-based services.

As this happened, Angie was working at Greene Valley Developmental Center in a men’s cottage that housed more than 40 men. The cottage was set up with eight men sharing two bedrooms and a communal living room. Half of the cottage was assigned as a lock-down unit, housing men who had been involved in legal altercations for aggressive or criminal behavior. The other half of the cottage was a step-down unit, housing men who were physically aggressive toward others. The men had little to no freedom, choice, or privacy. Professionals determined plans of care with no input from the person or DSPs. DSPs were trained to perform care that was efficient and cost-effective. There were scheduled mealtimes, shower times, and bedtimes. Mealtimes were in a large communal area. The DSPs’ most important mealtime role was to prevent people from stealing the others’ food and monitoring for fights.

Transition from institution to community-agency

Geeter and Angie witnessed the transition from institution to community-agency: Geeter from the community agency perspective and Angie from the institutional perspective.

John and Martin were both in Angie’s assigned group of eight men at the developmental center. Both men had aggressive reputations. John entered the developmental center at the age of 12 and reached adulthood in institutional care. Built like an NFL linebacker, John had learned that intimidation and aggression got a few choices. His size and reputation proceeded him. John tended to bully. When he did not get his way, he would strike. Martin was quiet, but aggressive. He did not like to be around others and would let people know this by striking out.

John and Martin transitioned early from the developmental center to the community agency where Geeter was employed. Geeter describes John’s transition as a “big deal.” With his aggressive tendency, there were safety concerns about John living in the community. Geeter remembers being invited to the transition meeting, perhaps for the role of bouncer. There was a room full of people including officials from the developmental center and agency. During the meeting, Geeter remembers the group talking in code about John’s behaviors. They were trying not to upset John during the meeting. That meeting affected John’s support for the next 20 years.

John Humphrey and Angie Cobble

Martin entered care in his late teens. The child of a migrant farm worker family, Martin was institutionalized after he became aggressive and too hard for his family to handle. At transition time, Geeter was sent to the developmental center to pick up Martin in the agency van. At the institution, people had few personal belongings. Geeter remembers how Martin was brought out with just a suitcase and box. Martin at first was noticeably quiet and reserved. Three days after the move, quiet time was over. Martin wanted personal space and communicated that through aggression. Geeter remembers how Martin got angry and threw a screwdriver at someone. The agency response was to isolate Martin. They built a cage around his workstation with baseball netting.

With both transitions, Geeter recalls there was little to no information communicated to DSPs specific to the people being supported. Even less was communicated to John and Martin about what was happening to them. Mealtime instructions, bathing preferences, interests, and the unique personality of that person had to be learned day-to-day. John and Martin were aggressive to others as they struggled to adapt to their new lives.

Changes in direct support

When I asked Geeter and Angie about pivotal changes in services and support they remember over the years, they had similar responses.

Angie recalls the lawsuits and involvement of the Department of Justice with the developmental centers. Although she describes it as a “horrible experience” to be employed through, she knows the process was necessary to force change and promote peoples’ rights.

With the lawsuits came Independent Support Coordinators (ISCs). At Geeter’s agency, the Case Managers, who were independent of the agency, questioned the standards of care. For example, Geeter remembers an ISC rejecting Martin’s caged workstation. ISCs also, for the first time, advocated for inviting DSPs to annual planning meetings.

Susan Arwood

In the late 1990s, Angie participated in personal outcome measures training. With newfound knowledge and awareness, Angie realized how wrong they had been doing things. It forced her and others to recognize differences between a service model and a support model. Planning meetings now focus on people’s outcomes and goals, not those of the organization.

Geeter also remembers the transition from group homes to smaller supported living arrangements. A person-centered focus emphasizes community-based day activities. They moved away from segregated day programs and sheltered workshops. In the early days of community-based day activities, Geeter remembers driving people around in a van all day. When housemate matching became a focus, Geeter remembers pairing more assertive people with more passive people who would go along with the desired routines of their more dominant housemates. Regardless, the priorities were changing toward a focus on individual choice. People also had opportunities to look for employment.

Without question, Geeter and Angie both believe the most transformational period in care was the last decade. With the rollout of the Home and Community Based Setting Rules, organizations like Core Services of Northeast Tennessee looked for more opportunities to support individual lives. This was when the professional DSP role truly evolved.

John and Martin are supported where they want to live and work

Now in 2026, John enjoys his own apartment with no housemates. John has technology supports and can now choose when he wants DSP support. He chooses not to have staff in his home during the night. Aggressive behaviors are a thing of the past. They disappeared when unwanted housemates went away. For years, John was not allowed to have female staff. Mistruths about aggression toward women followed John from the 1990s transition from developmental center to community agency. He now prefers female staff. John has a cat and goes on vacation. He alone chooses his meals, showers, and bedtimes.

Martin lives with two very compatible housemates and chooses how he spends his day. He is kind and laid-back. He loves his preferred routine. It would be hard to reconcile the Martin of today with the caged man in the sheltered workshop.

Geeter continues to work with both John and Martin. He describes how they both are living their best lives.

In Geeter’s experience, the role of DSP has changed as drastically as John and Martin’s lives over the years. In 1990, Geeter, barely making minimum wage, was a caretaker, sometimes warden or overseer. DSPs were not invited to annual planning meetings. Like people supported, DSPs did not have a voice in planning services or supports. Today, Geeter holds professional certification in Enabling Technology, and he is earning professional DSP certification through the NADSP E-Badge Academy. He earns a living wage and serves on the Core Council, a governing board of DSPs at Core Services who meet independently to review and approve agency policy. Geeter is a skilled and trusted supporter. He supports men like Martin and John to live out their idea of their best life, stepping in to help with life’s decisions only when it is requested or necessary.

Reflecting on direct support 30 years ago, Angie says the role of the DSP was just to keep people safe and healthy. It was all service driven. Every day was very structured and followed a specific schedule. She recalls how DSPs showered people at a certain time, assisted with meals (everyone ate together), and distributed snacks at specific times. Many people had bathroom schedules that DSPs had to follow. There was a laundry room where everyone’s laundry was done together. Everyone went to bed and were awakened at the same time. There were specific timeframes to get all this done to move forward with the day. People rarely left campus unless they worked in an enclave. An enclave was a group of people supported who went to a job location to work while being supervised by a DSP. It was the same day after day. Things rarely changed. DSPs were mainly caretakers. Today, the job is vastly different. While DSPs still provide care and keep people as healthy and safe as possible, health and safety are now defined by the person. The old structure is gone. The work is driven by the person. Instead of worrying about getting everything done according to a schedule, DSPs now work with people supported to be independent in every aspect of their lives, helping them experience new things such as travel, dating, having a job, etc. DSPs are now mentors, teachers, and advocates. Being a DSP is not a regular 9-5 job. It’s so much more. DSPs are now in the front row, supporting people to realize their potential, reach personal goals, and thrive.