Critical Mode: Disability services industry feels pains of workforce shortage

Erika Leonard: The direct support workforce crisis has been building for years.

Professional Problems

Health services officials say low starting pay for direct-support professionals, currently averaging $9.71 an hour statewide, is the top reason for an employee shortage in the field. Other statistics DSP leaders are hoping to turn around in Missouri:

• 60 percent turnover rate;

• 25 percent job vacancy rate;

• 38 percent of DSPs leave the job within the first year; and

• 52 percent are on public assistance.

Source: Paraprofessional Healthcare Institute Inc.

While there are 800 provider agencies attempting to fill 15,000 staff positions to serve those with intellectual or developmental disabilities in Missouri, Tim Dygon, executive vice president with The Arc of the Ozarks, said there’s not nearly enough interested people to fill openings.

Dygon said one in every four direct support professional jobs in the state are vacant, with the biggest hurdle being low starting pay – currently averaging $9.71 an hour, according to Paraprofessional Healthcare Institute Inc. He said of the 1,300 staff members at The Arc of the Ozarks in Springfield, Monett, Joplin and Kansas City, 1,100 of them are DSPs. The organization last year served over 3,000 clients, including 400 in residential services.

“We could use a big influx of staff immediately,” he said, adding the statewide turnover rate for the position is 60 percent, well above the national average of 45 percent. “We could hire 100 staff tomorrow and put them to work.”

Erika Leonard, executive director for the Jefferson City-based Missouri Association of Rehabilitation Facilities, counts The Arc of the Ozarks as one of the 100 provider agencies it represents. The statewide association helps direct public policy, including educating legislators on the needs of disability providers to ensure its services can continue. She said the DSP workforce shortage crisis has been building for years.

At the capital, Leonard said she lobbies for more state funding to secure, in part, pay increases for the workforce. Wages are based on reimbursement rates set by the state legislature, which she and Dygon said are underfunded. For those considered most medically fragile and receiving services, Leonard said the reimbursement rate is underfunded by $11 an hour.

“Everybody’s fighting for the same dollar,” Leonard said. “It’s really just making them understand your need is more important than others. In our current state of politics, everybody needs a dollar.”

Vital services
With 25,000 Missourians with intellectual and developmental disabilities receiving services through the Department of Mental Health, Leonard said the role of the DSP is vital.

“They’re in charge of somebody’s life,” she said.

Typical job duties involve medical support, skills coaching, crisis intervention, and prevention and behavioral support, Dygon said, adding some also help people with mental health issues.

“A lot is required of DSPs,” he said.

Workday tasks might be driving clients to appointments, guiding them on diet issues or teaching life, health and fitness skills.

“It’s not for everybody,” Leonard added.

For Donna Scott, who began working as a DSP with The Arc of the Ozarks five years ago, the work is challenging but rewarding.

“It’s a challenge for me, and it’s a challenge for them. We work together to get it done,” she said, noting she works at a house with three male clients with disabilities. “I love the guys I’m with. I’ve become attached to them.”

As a supervisor of two other DSPs who also work shifts in the house, Scott said the job “takes a lot of care and compassion.” And that makes it a challenging sell for jobseekers, she said, when starting pay rivals wages at fast food restaurants and convenience stores.

DSP pay range generally falls within $9-$12 per hour, Leonard said.

Dygon said pay is the No. 1 reason for the state’s high turnover rate, but it’s not the sole contributor.

According to PHI, 38 percent of DSPs in Missouri leave the job in their first year of employment. Dygon attributes the high turnover largely to job stresses.

“The work is tough,” he said, adding it requires 40 hours of training before employees start working with clients. “It’s emotionally taxing, emotionally draining.”

Career mobility is also a challenge, he said, as DSP is an entry-level position for which it can be difficult to gain promotions.

“To a certain degree, we’re failing people in Missouri with intellectual and developmental disabilities because of that turnover,” he said. 
 
Funding crisis
Leonard and Dygon both noted pay for DSPs lands above the state’s current minimum wage of $8.60 per hour, up from $7.85 last year, after the November 2018 passage of Proposition B. However, they know more minimum wage hikes are coming, peaking at $12 per hour in 2023, and recognize DSP pay will have to keep pace.

In the interim, both are hopeful more funding can be garnered from the state legislature to help boost pay.

Leonard said Gov. Mike Parson has been supportive of the issue, recommending $12.6 million in increased funding in the Department of Mental Health budget. However, she said House Bill 10, sponsored by Rep. Cody Smith, R-Carthage, proposes to increase funding to DMH’s general revenue to $20 million. The bill currently has been referred to the House of Representatives budget committee. 

Although the Department of Mental Health has recommended $76.5 million to fully fund its reimbursement rate, Leonard and Dygon said they don’t expect the state will find enough in the budget to reach that level. Leonard said that would get starting pay to $12 per hour.

“Going forward with $20 million is not near $80 million, but it’s a much better start than what we’ve had in a long time,” she said, referring to MARF’s unsuccessful lobbying efforts to find support from past Govs. Jay Nixon and Eric Greitens.

“They recognize the issue. I think they’re really trying to help,” Dygon said of the Parson administration. “It’s just a lot of money. It was a crisis that wasn’t addressed for many years that’s just become bigger.”