Employment and Community First CHOICES Workforce QuILTSS Initiative Survey 2019: Year Two Report


Direct support professionals (DSPs) provide critical supports for people with disabilities so that they can  live, work, and be fully engaged in their community. This workforce continues to be among occupations with the highest growth rate in the United States. Currently, there are over four million direct support workers, and between the years 2016 and 2026 it is anticipated that a little over one million new jobs will be created (Espinoza, 2018).  The demand for workers exceeds the number of new workers wanting to enter this profession.  This results in sustained high vacancy rates and staff shortages.  Organizations also struggle to retain workers once hired, due to competition with other industries for workers, and low entry level wages, and access to affordable benefits.  This direct support workforce shortage is an ongoing crisis across the U.S. and is particularly challenging within Home and Community Based Services (HCBS) for persons with intellectual and developmental disabilities (IDD) (PCPID, 2017).  In Tennessee and across the U.S., State Medicaid agency goals to decrease the number of people in  institutional settings and increase the use of HCBS programs to address waiting lists for services cannot be met without strategic efforts to ensure sufficient and stable DSPs available to provide community services.  Community living for people with disabilities is compromised when effective and timely solutions to the DSP workforce shortage are not available, funded, and evaluated.  Direct support workforce research identifies a critical need for collection, analysis, and use of provider, program, and state/system level comprehensive workforce data to identify and match interventions to recruit and retain DSPs in organizations providing services and supports to people with IDD.  The 2017 Report of the President’s Committee for People with Intellectual Disabilities, which highlighted this issue, made two critical assertions:

“The expansion needed in this workforce is unlikely to take place without significant changes in how [DSPs] are recruited, trained and supported.”

Practices that are likely to positively impact the workforce crisis include, “Teaching business and organization leaders skills to improve their ability to recruit, select and retain [DSPs].

Direct support professionals (DSPs) includes a number of job titles such as DSP, direct care worker, family model provider, residential aide, life skills instructor, job coach, home health aide, personal care assistant, and others. DSPs are employees who spend at least 50% of their time providing primary responsibilities such as: support, training, supervision, home care, personal care, community integration, and others to people with disabilities. DSPs may perform some supervisory tasks, but the focus of their job is direct support work. Nursing and other professional licensed staff (e.g., LPNs and RNs) and on-call staff (those who do not have any regularly scheduled hours) are not considered DSPs.

TennCare administers Tennessee’s Medicaid program to 1.4 million people. As part of a statewide workforce initiative, TennCare sought a method to regularly collect, analyze, and be informed by provider, program, and state/system level comprehensive workforce data for its Managed Long-Term Supports and Services (MLTSS) HCBS programs for people with disabilities.  This effort is connected to the QuILTSS Initiative.  This is the second year of the QuILTSS Initiative survey, which was completed by provider organizations that deliver Employment and Community First CHOICES in Tennessee and employ DSPs.  This report represents the summary of data from 75 provider organizations that completed the survey regarding their workforce in those programs.