We Have to Use Every Creative Idea We Have

posted by Chris Sparks on Tuesday, July 3, 2018

"I have big news about your nephew," my mother shared recently in our daily phone chat. "They have a place for him in a group home," she continued. In this case, "they" is a very good organization run by a friend of mine. The "group home" is a typical house he would share with three other guys in a regular neighborhood in southeast Iowa.

My nephew is a fun-loving person who is obsessed with his smart phone, loves to ride his wave runner, is a reliable employee, and also has an intellectual disability, an anxiety disorder, and obsessive compulsive disorder. After talking to him, I learned he is approaching this change with a "still under consideration" mindset. Everyone else is very excited. I, too, am excited, for this next chapter of his life to begin, for the friendships I know he’ll form, and for him to enjoy additional independence. But, my excitement is also mixed with a sense of apprehension.

My uneasiness is driven by an understanding that in our community services for people with intellectual and/or developmental disabilities (IDD) we are never any better than our Direct Support Professionals (DSPs). And, we are in the midst of a developing direct support workforce crisis — one that creates a serious problem for us and the people we serve. Turnover, recruitment, and retention have been bad for a long time, and in many places things are getting worse.

Direct Support Professionals do the real work in organizations that provide community services. They help people acquire needed skills to live successfully, get jobs, develop social networks, and explore interests that turn into activities that lead to true participation and inclusion. DSPs are often the cultural guides that help people with IDD navigate their communities and find their places in them.

Those are the obvious impacts of DSPs; there are many far more subtle. DSPs are a key confidante and advocate for those with whom they work; they develop trusting relationships, they nurture and support, and the most talented of them are able to work from a basis of kindness and compassion that multiplies their effectiveness. It’s a fine line we are asking DSPs to walk, yet I see staff do so successfully every day in our organization.

Like any responsible organization we have spent years working to improve our DSP recruitment and retention. We have substantially increased wages several times, and our benefit package is among the best in the industry. We have invested in training for our DSPs to make sure they have the skills to do their jobs. Believing front-line supervisors are key to this equation we have invested in their training and worked to equip them to provide great supervision and support to DSPs. Yet, our turnover ticks up.

Making all our efforts more challenging is the fact that as a predominantly Medicaid-funded service we have limited access to rate increases that would allow us make substantial changes in pay and benefits. The result continues to be DSPs holding vital and challenging jobs for which they are just not paid enough. Changing regulatory requirements now put pressure on organizations to produce Medicaid-compliant documentation; this causes DSPs to take precious time away from those they support to meet documentation expectations. In staff surveys, DSPs articulately tell us what frustrates them about their jobs —  bureaucratic requirements, poor communication, not feeling like valued members of the service team, low pay. What keeps them in their jobs? Their commitment to the people they support. Loved ones of people we serve are blunt about the changing regulatory environment: "All they seem to do is sit behind their computers" is an often-heard concern.

We see the impacts of high turnover and recruitment challenges everywhere we look. Moms and dads of people we have supported for decades continue to worry about staff changes, fearing the next one will negatively impact their loved one. A missed medication, not understanding the nuances of communication, or simply not investing in their loved one — there is so much that can go wrong. Existing DSPs work far too many hours, and frontline supervisors and other managers fill in for open shifts. While not a bad thing occasionally, there are clear increases in stress and overall negative impacts on employee morale when this becomes a routine part of the staffing solution. And, with few other options, it has become a routine part of staffing in many organizations. Overworking existing DSPs and other supervisors as they fill in for vacant positions provides a paradoxical solution; the work is covered in the short run, but it leads to rapid burnout and exhaustion and often results in increased turnover.

So what do we do about all of this? This is a complex problem and we need to treat it as such. The work of DSPs is both challenging and demanding and it must pay a living wage. To that end our advocacy for adequate funding simply has to continue, even in this fiscally challenging environment. It is critical we leverage all support offered by technology so people with disabilities can live with more privacy while still having access to help when needed, and allowing us to deploy staff only when absolutely necessary. We have to use every creative idea we have to capture capable and interested people — and hang onto them — such as career ladders or lattices, early outreach to high school students, and meaningful internships.

Very nearly 35 years ago I got my start in the field of disability services as a houseparent. My wife and I worked together and it was a wonderful job, one that continues to shape our perspective and career choices. I believe DSPs provide critical services. But, everything hangs in the balance for my nephew and other people with IDD needing supports. For people with disabilities to live in and become a true member of their communities, we have to have an adequate supply of well-trained DSPs. Let’s work together to prospect for solutions to this thorny problem. History will judge us on how well we navigate this moment.