Report to the President 2017

America’s Direct Support Workforce Crisis:

Effects on People with Intellectual Disabilities,

Families, Communities and the U.S. Economy
Report to the President 2017: America’s Direct Support Workforce Crisis 2

DISCLAIMER

This Report to the President 2017, America’s 

Direct Support Workforce Crisis: Effects on 

People with Intellectual Disabilities, Families, 

Communities and the U.S. Economy, does not 

necessarily reflect the views of the United States 

Department of Health and Human Services 

(HHS) or the agencies represented by the ex 

officio members of the President’s Committee 

for People with Intellectual Disabilities (PCPID).

Information and data contained in this Report 

were contributed by authorities in the fields of 

intellectual and developmental disabilities, 

disability research, workforce development, 

public policy and otherrelated fields. The 

personal opinions that such contributors may 

hold or choose to express outside of this Report 

do not necessarily reflect the views of the PCPID, 

HHS or other federal agencies.

This Report does not suggest that the HHSPCPID endorses any organization, product or 

service described in this document.
President’s Committee for People with Intellectual Disabilities 3

ABOUT THE PRESIDENT’S COMMITTEE FOR PEOPLE WITH

INTELLECTUAL DISABILITIES

The President’s Committee for People with Intellectual Disabilities was started in 1961 by President 

Kennedy. It advises the President and the Secretary of Health and Human Services (HHS) on 

matters related to individuals with intellectual disability. Its goal is to help people with disabilities 

to be valued in their communities.

PEOPLE WITH INTELLECTUAL AND RELATED DEVELOPMENTAL

DISABILITIES

People with intellectual and developmental 

disabilities (ID/DD) are friends, neighbors, coworkers, voters, and taxpayers. They live in and 

add much to their communities. They have a 

wide range of limitations, and many need 

ongoing support from others. There are about 5

million Americans with ID/DD, and about 1.4 

million receive services from state agencies.

The support needed by persons with ID/ DD is 

usually provided by family caregivers and paid 

workers. Most of the paid, hands- on support is 

done by Direct Support Professionals (DSPs). 

For most people with ID/DD to participate in all 

aspects of community life, there must be a 

well- trained workforce.

THE DIRECT SUPPORT PROFESSIONAL WORKFORCE

Direct Support Professionals, or DSPs, support 

people with intellectual and developmental 

disabilities. They help them to live their lives 

and to enjoy the same benefits as people 

without disabilities. DSPs work in a range of 

settings, including a person’s own home or 

family home, large and small care facilities, 

group homes, training programs, and 

community job sites.

Most DSPs (70%) work full-time; 30% work 

part-time. DSPs are part of a larger group of 

human services workers who provide support 

to people with serious needs. Some of the 

people they help are frail older people and 

people with physical and other kinds of 

disabilities. More than 4.5 million people do 

the work of direct support.
Report to the President 2017: America’s Direct Support Workforce Crisis 4

In the past, DSPs usually worked in large 

settings that served many people together. In 

those places, trained professionals such as 

nurses, therapists, psychologists, and social

workers also worked on-site. As individuals with 

ID/DD moved into community settings, DSPs 

were expected to work more independently 

with less support from trained professionals. 

The role of the DSP demanded increased skills 

and knowledge.

DSPs must be trained to gain the knowledge, skills, 

and attitudes required for their work. 

Unfortunately, there are no federal regulations and 

little funding for good training programs. In 

contrast, Certified Nursing Assistants (CNAs) and 

Home Health Aides (HHAs) must receive 75 hours 

of training before they start their jobs, training that 

is provided by most community and technical 

colleges. The duties of DSPs are much like those of 

CNAs and HHAs, but DSPs go much further, aiding 

people with ID/DD in learning new skills, making 

wise decisions, and becoming active members of 

their communities. Despite these clear differences, 

CNAs and HHAs often receive higher wages, and 

their jobs are seen as valued careers.

Figure 1. DSP Scope of Practice

Like teachers, DSPs create ways to teach

people new skills. Like nurses, they pass 

medications, provide treatments, 

document care, and speak with medical

professionals. Like social workers, they get 

people connected to their communities.

Like counselors, they listen, reflect, and offer 

suggestions. DSPs provide whatever support it 

takes so people can thrive in their 

communities.

AMERICA’S DIRECT SUPPORT WORKFORCE CRISIS

Over the past 30 years, there has been high 

turnover in the direct support workforce.

Almost half of DSPs leave their jobs within the 

first year, and most within the first six months. 

This is caused in part by lowwages, poor 

benefits, and lack of training. The average wage for 

a DSP is $10.72 per hour, which is below the 

poverty level for a family of four. Half of DSPs rely 

on government benefits, and most need to work 

two or three jobs.
President’s Committee for People with Intellectual Disabilities 5

People with ID/DD rely on DSPs for the daily 

support they need to live in their communities. 

Their families rely on the DSP

workforce to provide sound, quality support so 

they can work and have respite from the dayto-day stressors of caregiving. Finding, training, 

and keeping this workforce has reached crisis 

levels.

The trend has been that more people need 

supports and services, but fewer people are 

working as DSPs. At the same time, there is less 

funding for ID/DD services.

When the economy is doing poorly and people 

need jobs, agencies can find people to work as 

DSPs. But when unemployment rates are low, it 

is harder to find people to provide direct 

support. Right now, more than 9% of DSP 

positions are unfilled. This creates extra work 

and stress for DSPs who remain on the job and 

results in lower- quality care. DSPs who are tired 

from working long hours or more than one job 

are more likely to make mistakes and to face 

more stressful situations. When DSPs do not 

know the people they support, they may not 

recognize signs and symptoms of illness.

When it is hard to find staff to support 

people in community homes and at job 

sites, people with ID/DD often have few

choices besides group homes or sheltered

Figure 2. DSP Turnover Rate

work settings. To make sure that people with 

ID/DD can use all that communities have to 

offer, they must have skilled support provided 

by a stable, well-prepared direct support

workforce.

Another challenge for the DSP workforce is 

that direct support is not seen as a valued, 

professional career, and there is little 

opportunity for career advancement.

The direct support workforce and the service 

system that supports it are in crisis. The results 

will be tragic for people with ID/DD and their 

families unless important changes are made at 

once.

Source: National Core Indicators, 2017.
Report to the President 2017: America’s Direct Support Workforce Crisis 6

RECOMMENDATIONS

The direct support workforce crisis can be addressed in the following ways:

Recognizing direct support as a valued career. Programs 

that recognize direct support as a professional career will be 

useful in raising awareness of job openings and of the 

importance of people with ID/DD living valued lives in their 

communities.

Helping business and organizational leaders learn the 

skills to improve their ability to find and keep DSPs.

A number of tools have helped agencies find and keep DSPs. These 

tools include flyers and advertisements to find people interested in 

direct support work; structured interview questions that help

agencies find the best workers; and realistic job preview videos 

that allow people to see what the work will be like before they 

begin their jobs.

Using self-directed services that allow individuals and 

families to hire their own DSPs.

Self-directed services promote people’s independence and 

control over their own lives. While this model works for many 

individuals and families, it is not yet widely used within the 

ID/DD service system. Currently, 41 states offer some type of 

self-direction as a support option. Individuals and families who 

self-direct may pay a higher hourly rate for their DSPs. Some 

studies have shown lower rates of DSP turnover under such

options.
President’s Committee for People with Intellectual Disabilities 7

Using worker cooperative and independent provider 

models.

Several states have begun using an independent provider (IP) 

model for direct support staff. Independent providers, or 

independent contractors, are self- employed and provide 

services directly to people with ID/DD. The IP model gives 

people with ID/DD and their families greater choice over who 

provides services to them. This model also usually costs less.

Provide credentialing for Direct Support Professionals. 

One way to add to the value of the DSP position is to provide 

DPSs credentials. The process reviews the education, training, 

experience, and competency of each DSP. CNAs and HHAs must 

have credentials. The National Association for Direct Support 

Professionals (NADSP) offers a national credentialing program 

for DSPs, and other agencies offer state-level credentialing 

programs.

Credentialed employees stay on the job longer and provide 

higher-quality of services to the people they support.

Credentialing should lead to increased wages for DSPs and make 

direct service a valued career path. Credentialing and training 

programs specific to the role of DSPs are needed in the 

community college system in the U.S.

Using technology-enhanced supports.

New technologies are being used to provide support topeople with 

ID/DD who need low levels of on-site direct support. Such supports 

are sometimes used in addition to, or in the absence of, DSPs. They 

are used in individual homes, family homes, and group living 

situations to monitor the safety and support the independence of 

people with ID/DD. Technology is also used to help people find what 

they need in their communities, and to support their daily schedules.

This direct support workforce crisis has been coming for decades. There is no issue 

more pressing for people with ID/DD than this serious crisis. Correcting the problems 

will require bold leadership and immediate action.