Frontline Initiative Documentation

A Daring Decision:
The Dutch Direct Support Professional


Ralph W. Vunderink is a senior lecturer in philosophy at Aquinas College, Grand Rapids, Michigan, and is a retired caregiver of Spectrum Community Services.

It is common knowledge that Direct Support Professionals (DSPs) in the United States lack an indispensable ingredient. Whether one works for a large company or for a smaller organization, the same scenario unfolds before one’s eyes. Should one assist in a small home, in a setting supporting people with challenging behaviors, or in a program supporting people with mental health issues, one often witnesses the painful turnover of DSPs. Having been actively involved in the lives of people with disabilities for over twelve years, I can testify to the same sobering conclusion. Individuals being supported resent having staff come and after being trained, decide to leave. Rather, they like stability. They love to relate to the DSPs they have come to trust. They hate when bonding relations with caregivers are severed.

An Attractive Alternative

An inviting model of support is found in the Netherlands, the tiny country of my birth. Over a century ago (1891), a group of dedicated people formed an “Association for the education and care of idiots and backward children.” Its members were moved by the plight of Dutch children with disabilities, many of whom were then bound to furniture or locked up in outhouses or attics. Together they started a small institution on an estate belonging to the Knights of St. John — first for boys and, as it grew, also for girls.


Before individuals can become direct caregivers in the Netherlands, they must be properly educated. During three years of training, they take courses in medication and hygiene, in human relations, and, above all, in comprehensive care giving; only those with seven years of education may administer medications. Prior to receiving their diploma, they pass an internship, which enables program directors to determine whether or not candidates are suitable for their vocation and applicants to assess if they really like their future employment.

The more education one acquires (one can even branch out into psychiatry), the more readily prospective caregivers can expect good financial rewards. Once trainees have obtained their diploma, they are deemed authorized and thus competent in all areas of this profession, including how to administer tube-feedings. In other words, the Dutch model permits greater initiative on the part of the caregivers and demands less supervision by administrators since the responsibility lies as much with the workers as with those placed in charge. Staff members are, further, encouraged to adopt the values of the people they support, and to help make where they live not just a house, but a home. Rarely are residents exposed to disruptive changes in staff.


Among the young entering this field of employment in the Netherlands are more women than men. According to one trend, women tend to get married after awhile, raise a family, and then return to this vocation on a part-time basis. While there is a growing shortage of competent workers — more in the cities (where wages in other professions are more alluring) than as yet in the provinces (where a slower pace of life appeals to some) — there exists a large pool of experienced mothers willing to help out as needed while their husbands take care of the children in the evening. Each home, I was told, tries to accommodate the part-timers in their choice of hours —either early in the morning or in the evening. This solution has very few cases of last minute “sickness” and “no show no call” incidents.


Before the Dutch changed their national currency from the guilder to the Euro, the nearly common European coin, employment for caregivers in the Netherlands was winsome. After this unsettling change, their life, and that of many other Dutch citizens, has become more expensive, while the wages have remained more or less the same. A single caregiver still enjoys a comfortable life, a married couple less so, and a family with one child needs to look for a part-time job to make monthly ends meet. Many caregivers, however, consider their work a way of life rather than merely a paid job.


The Dutch government pays a big part of the financial costs for the support of people with disabilities (though it does not dictate how each organization administers that support). Since the Dutch have a national health insurance policy, which covers all Dutch citizens including individuals with disabilities, all medical expenses are paid by, as the Dutch lovingly call their government, “Father.” Each adult with disabilities pays only a small amount to cover some of their costs. Fund raising is limited to special projects, such as taking a person on an extended outing.


As I am writing this article, I wonder how long it will take the Unites States to require comprehensive training and state certification of DSPs. I also wonder when our nation will recognize that the profession of care is worthy of fitting pay and deserves the same public respect as do other professions in America.