Random Workplace Observations: About the Critical Shortage of Direct Care Work

By Joseph M. Macbeth

The National Alliance for Direct Support Professionals is an advocacy organization that was founded in 1996 by the late John F. Kennedy Jr. and is the only national advocacy organization whose sole purpose is dedicated to advancing the direct support profession.

Mr. Kennedy wrote in a report to the President that “Quality is defined at the point of interaction between the staff member and the individual with a disability.” For more than 25 years, our mission has been to enhance the quality of support provided to people with disabilities through the provision of products, services, and certifications that elevate the status of direct support workers, improve their practice standards, promote systems reform and, most importantly, advance their knowledge, skills, and values.

So what exactly does Quality at the point of interaction mean to those outside of the disability circles? Well, every industry, whether it be manufacturing, technology, finance, sales, healthcare, or supporting people with disabilities have a benchmark for Quality. In our work, we measure Quality in terms of what we call “valued outcomes” – helping people with disabilities achieve things that are important to them – big things like finding and keeping a job, helping people develop meaningful and relationships, helping people live in their own homes, helping people stay connected and included in their communities – or helping people stay out of institutional settings. Outcomes can also be small things like preparing a meal, dressing oneself or balancing a checkbook.

As we’ve seen over the past two and a half years, these outcomes can be a matter of life and death – like keeping people healthy and safe during a worldwide pandemic and free of a virus that is three times more likely to cause death for people with disabilities and advanced age due to pre-existing conditions.

You might say that direct support professionals are the Jack and Jills of all trades – they do it all. Oh, and by the way, these outcomes that define Quality are never accidental, nor do they just magically happen. When you analyze these outcomes, when you deconstruct them, you will most often find a direct support professional, or more likely a team of direct support professionals, who are highly intentional in their practice and can objectively demonstrate the correlation between their knowledge, skills and ethics with outcomes. Quality rests squarely on the shoulders of the direct support workforce.

For decades, there has been a perception across this country that direct support is unskilled work, entry-level work, or a job that just anyone can do. I can assure you that after 40 years of working with direct support professionals in many service sectors, including IDD, aging, behavioral health, at-risk youth – nothing can be further from the truth. The work of a direct support professional is challenging, complex and continually changing, and no day at work is ever the same. It requires high levels of acuity, responsibility, judgment, and character. I would argue that the false perception around this work is why we find ourselves at the cliff’s edge where a critical shortage of qualified workers is leading to service programs closing, people and families being unserved, and highly vulnerable people at significant risk of abuse, neglect and exploitation.

We can’t blame the pandemic; in fact, in my strong opinion, COVID-19 has merely lifted a veil and has exposed our service systems weakest link – the direct care workforce. Make no mistake, this is no longer a crisis – a crisis is defined as sudden, unexpected and temporary. We knew this day was coming more than 25 years ago and, as a system, we failed to address it. Yet, we continue to collect and share data about the poverty-level wages, inadequate training, the absence of career ladders, and a lack of professional identity and a lack of professional respect.

The critical shortage of our direct support workforce is well documented, and if there is a silver lining to this dreadful pandemic, it might be that the highest levels of government are now beginning to take notice of just how “essential” direct care workers are and are infusing much needed financial resources to address the shortage. Let’s not squander this opportunity. Let’s do it right. Let’s make careful, deliberate investments into the workforce that can address this systemic failure for long term success.

If you survey direct care workers and ask them, “What is the most important thing we can do to support you?”, their overwhelming answer is, “Give us a living wage” – a wage where I don’t have to work two or three jobs to support my family. There are many reports on direct care wages. And we know that low wages feed high turnover, and we see a revolving door of strangers supporting vulnerable people, often times with the most intimate of care. Year after year we see half of this workforce leave and that costs your state millions of taxpayer dollars.

To be sure, solving this complex issue will require comprehensive solutions – there is no one solution, no silver bullet. Here’s a few ideas:

•  Introduce legislation that provides a living wage to recruit new workers and, at the same time, addresses wage compression issues so tenured direct care workers are recognized for their time and not left behind in order to attract new workers.

•  To reduce turnover, create rate setting methodologies with value-based payments that incentivize career ladders that lead to voluntary credentialing for tenured direct care workers. We must keep high performing direct care workers in the jobs in which they excel and enjoy.

•  Encourage your members of Congress and United States Senators to sponsor H.R. 4779 and Senate Resolution 1437 - Recognizing the Role of Direct Support Professionals Act which would require the Office of Management and Budget to establish a separate category within the Standard Occupational Classification system for direct support professionals so we can begin to collect more accurate data.

•  Lastly, I co-authored the report to the President in 2017 for the President’s Committee for People with Intellectual Disabilities. In this report, we identified 9 recommendations to address the workforce shortage. I am saddened and frustrated that none of the report’s findings have been implemented. We know what needs to be done. It’s up to policy makers and elected officials to have the will to

do it.

About the Author

Joseph M. Macbeth is the Chief Executive Officer and President of the National Alliance for Direct Support Professionals (NADSP) and has worked in the field of intellectual and developmental disabilities for 40 years - beginning as a Direct Support Professional. Macbeth is recognized as an international leader in the advocacy & movement to recognize direct support as a profession and for the past decade, has been a highly sought-after speaker and contributor on the workforce challenges that affected the intellectual and developmental disability service system.