Appealing Work that Changes Lives: The Direct Support Profession

“Being a DSP is not a cake-walk.”  “Being a DSP is the most rewarding thing I have ever done.”  “My job is demanding, hard, and it can be stressful.”  Have a conversation with any DSP and it won’t take long for you to hear these kinds of statements.  Of the 10 DSPs interviewed for this article, similar sentiments were shared by all.  Franz Vonderhaar said it this way, “Not everyone is cut out to do this kind of work.”  Franz later mentioned, “it is a privilege to work in this field.”  Lajuan Williams said, “Every new day is a new challenge which can be stressful…and rewarding.”  Phil Rhodes said, “This job is a lot of fun, and it’s a lot of hard work and commitment.”  Brandi Gray remarked, “It’s hard, stressful and a lot of work…but seeing the smiles on the faces, seeing them reach new goals, seeing them dream new dreams, seeing them have a meaningful day…is satisfying because I know that I am making a difference and that makes me feel good.” 

Since both facts, the difficulty of the work on one hand and the rewards of the work on the other, were stated by DSPs with equal frequency, SPEAK hit the streets conducting informal interviews with DSPs to help us discern what kinds of things attract a person to work in a difficult field, and what kinds of things make a person stay.  We remain encouraged, challenged, and reinvigorated by the answers we received. 

1.) When people ask you what you do, what do you tell them?  The people we support have mental retardation and/or developmental disabilities.  Some are easy to support while other require patience, consistency, and dedication.  The specific activities of a DSP includes the following: helping someone with personal care, taking someone into the community, washing hair, doing nails, tying shoes, wiping faces, helping in the restroom, playing games, painting, drawing, creating art, meal planning, cooking, eating, feeding, going for a walk, shopping, reading, hugging, laughing, hanging out, sharing jokes, being a friend, teaching basic living skills, sitting and talking, building confidence, you name it-we do it.  Several DSPs mentioned that in the midst of doing all of these kinds of activities, we are also working on each individual’s unique personal goals and seeking to help them have the most meaningful day possible.

2.)  What event(s) are most memorable in your career thus far? Every DSP we asked shared personal narrative about someone whose life was made better because of the supports received from a DSP.  Tiffany Woods told the story of a lady she supported who progressed so much that she was able to move out of a staffed residence into her own home.  “Seeing the joy that this produced in that associate is something I will never forget.”  Ben McLeod told of an associate who once disliked creating art because she was afraid to get dirty.  He says, “Watching her grow into a person who now loves to paint, and who is creating great artwork is rewarding.”  Ashley Noe said, “I can’t really think of one story that stands out above the rest, but the thing that means the most to me personally is watching all of the individuals I support growing, happy, productive, doing meaningful activities, and excelling not only while they’re with me at the day program, but at home as well.  I love to hear all the stories of how much better their (the clients’) lives are because of my work here.” 

3.)  If you were in charge of hiring new DSPs, how would you go about recruiting new workers?  An overwhelming majority of DSPs responded to this question by saying, “Word of mouth is the best way to find new workers.”  Phil Rhodes said, “Either friends of residents or friends of staff…people off the streets who have no knowledge of this population usually don’t last long.”  Tracy Sanders said, “It takes special people to do this work, so I would begin with natural connections.”  Ashley Noe summed it up well when she said, “The best recruitment tool is word of mouth because only a certain kind of person can do this work, and we (DSPs) know those kinds of people because we are those kinds of people.”   

4.)  What would you tell potential DSPs about the work?  Erica Franklin summed up the “hard” aspects of the job well by saying, “I would tell them the least glamorous parts of the job…that we help in the bathroom, that we clean up body fluids, that we help give baths, etc.  And if a person isn’t willing to do that hard work, they should just move on and look for other work.”  Brandi Gray summed up the “rewarding” side of the work well by saying, “…seeing the smiles when they (clients) ‘get it’ and reach new goals, this makes you feel like you’ve made someone else’s life better.  It’s satisfying helping someone else enjoy their life.”  The collective voice from all 10 DSPs interviewed agree that new applicants should hear both the “best” and the “worst” parts of the job.  In this field, the good parts are really good, and the bad parts are very difficult and demanding.  Another common answer to this question was that a person needs to know that they will have to exercise a lot of patience.  Franz Vonderhaar said, “A DSP must be patient.  I would ask, ‘Are you easily angered or frustrated?’ If so, then do not take a position in this field.”  In summary, if a person is unwilling to take the good with the bad, they should probably look for work in a different field.  If they are easily angered and have low patience, they should consider a different vocation.  

5.)  What has being a DSP taught you about life?  Abby Ramser remarked, “Being a DSP has taught me the value of giving and what I can get out of giving to others.”  Phil Rhodes said, “I’ve learned not to take anything for granted, and I’ve learned to appreciate the small things in life.”  Ashley Noe expressed that she has learned, “not to judge a book by its cover…but instead, to get to know people and discover their unique potential.”  Lajuan Williams has learned “to love people of various diversities and to consider the thoughts of others and be less selfish with my own desires.”  Erica Franklin spoke of “learning to be patient!  Even with my own children, I can see a difference with how I treat them now opposed to how I treated them before working in this field.”  Brandi Gray said, “I now look to my kids with a new gratefulness.  I now see that everyone is human.  We all laugh, we all cry, we all find joy in the small things in life.”  All this to say, being a DSP teaches a person some of life’s most important lessons. 

Thanks to the following DSPs whose insights shaped this article: Phil Rhodes, Erica Franklin, Franz Vonderhaar, Tiffany Woods, Ben McLeod, Ashley Noe, Tracy Sanders, Lajuan Williams, Brandi Gray, and Abby Ramser.  Without your thoughtful contributions, this article could not have been written.  To read full notes for each of these interviews, go to the speak website: www.dspspeak.org

Abby Ramser

When people ask you what you do for a living, what do you tell them?

Social work, then I’ll tell them about the population I support and what I do. Work on social skills and help them live in the community, and personal care.

What is a memorable event in your career up to this point?
The time I intern at Center with Children with Autism, I taught the concept of “ball” and he actually learned and grew to understand the concept I taught.

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

I would go towards desire within people who wants to take care of others. Then tell them about this population and how they are unconditionally loving and fun to work with.

What Kinds of questions would you ask them?

On a scale of 1-10, how patient are you?

Do you have knowledge about this population of people?

Why would you want to work in this field?

What kinds of things would you tell them about the work?

I would tell them about how rewarding it is- unconditional love. Yet, it is a lot of work. How much you can learn from these people. We’re like a big family. We spend 40+ hours a week together and they grow to depend on us.

What has being a DSP taught you about life?

The value of giving and what you can get from giving… what you can learn from any/everyone

Phil Rhodes

When people ask you what you do for a living, what do you tell them?
I work for a group home for adult with disabilities. Do whatever is needed; cooking, feeding, community activities and cleaning.

What is a memorable event in your career up to this point?
3 ½ years- 2 residents don’t usually get involved and seeing ways they have contributed and seen them grow.

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

I would look for friends of residents or other staff. People off the street who have knowledge about folks with disabilities.

What Kinds of questions would you ask them?

What made you want to work here? Look for people with meaning and purpose, and those who can make a difference in other lives.

What kinds of things would you tell them about the work?

Appears “fun” but there is a lot of work and commitment. We help with life skills.

What has being a DSP taught you about life?

Not to take life for granted. I’ve grown appreciative of small things. Perspective!

Ashley Noe

When people ask you what you do for a living, what do you tell them?
I run a art studio/gallery that helps adults with MR. I make them feel a sense of belonging in the community, praise, professional reinforcement, and push them to make stuff and see happiness and growth and life skills.

What is a memorable event in your career up to this point?
Getting these guys in their own art studio. See guys with such talent put in an environment that they excel in. Clients growing happy, productive and that makes me really happy.

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

Word of mouth, cause only a certain group of people can do this work and we know those kind of people because we are those kind of people- patient, caring, and loving.

What Kinds of questions would you ask them?

Are they patient, caring, and loving?

What kinds of things would you tell them about the work?

Don’t separate self from people you support. We’re all equals. No one is above or better than anyone else, and we re-affirm that.

What has being a DSP taught you about life?

Don’t judge a book by it cover. Judge less and get to know people!

Lajuan Williams

When people ask you what you do for a living, what do you tell them?

I tell them I’m an Adult Day Trainer. We train adults with Developmental Disabilities to do everyday life skills like; grocery shopping, money handling, laundry, cleaning, money management, etc.

What is a memorable event in your career up to this point?
I was helping someone with her personal care and she hugged me and told me she loved me. Teaching something that finally clicks and they know it without help now.

 

What Kinds of questions would you ask them?

How well do you accept diversity & willing to work and help all people?

What kinds of things would you tell them about the work?

Everyday is a challenge and it can be stressful & rewarding. There may be something that a person does to make the whole day rewarding.

What has being a DSP taught you about life?

People with DD know when you need a hug. They taught me to love people of various diversities. I learned how to consider thoughts of others and less selfish with my own desires.

Franz Vonderhaar

When people ask you what you do for a living, what do you tell them?

I work for an adult day care serving people with Mental Retardation. I try to make their day meaningful.

What is a memorable event in your career up to this point?

I’ve worked here for 3 years, I worked with 1 client and train him and watched him grow and progress.

 

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

Try to establish this as a service field. Pre Service Orientation is needed! Not all are cut out for this kind of work.

What Kinds of questions would you ask them?
What is their knowledge of MR & experience of MR? and do a background check.

 

What kinds of things would you tell them about the work?

Need patience. Do you get frustrated and angry easily? If so, don’t take this position. How comfortable are you with personal care.

What has being a DSP taught you about life?

I’ve had the privilege of doing ministry work away from here.

Ben McLeod

When people ask you what you do for a living, what do you tell them?

I work at a studio with people with Mental Retardation. I help develop art skills, and support art and life skills.

What is a memorable event in your career up to this point?
At six months, I can think of stories for everyone. A participant getting excited about painting when she used to be worried about getting dirty, now she loves to paint.

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

Communicating, interact, and see progress. Tell them about how rewarding this job is. Being apart of this is rewarding.

What Kinds of questions would you ask them?
I would ask about past experiences with MR. How they feel about people with disabilities.

What kinds of things would you tell them about the work?

That this job is important, fun, but you also have responsibilities.

What has being a DSP taught you about life?

Just being patient and becoming creative, flexible, and helping other reach goals.

Tiffany Woods

 

When people ask you what you do for a living, what do you tell them?

I work with people with Mental Retardation and Developmental Disabilities. Giving them life skills and support.

 

What is a memorable event in your career up to this point?

My 4 year in this field, seeing people progress and moving from staffed residence to their own place.

 

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

Make sure the people would treat participant right.

What Kinds of questions would you ask them?
I would ask about experiences.

What kinds of things would you tell them about the work?

Things don’t always go as planned. Patience is required.

What has being a DSP taught you about life?

To be appreciative, and more accepting and patient.

Tracy Sanders

 

When people ask you what you do for a living, what do you tell them?

I work with adults with DD and help them with personal needs.

What is a memorable event in your career up to this point?
I’ve worked in this field for 10 years. I come across people who have made me want to come to work everyday.

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

It takes special people to do this type of work. I would look for natural connections.

What kinds of things would you tell them about the work?

This job is very rewarding. You have good days and bad days.

What has being a DSP taught you about life?

Make the most of your life. I’m here to make the best day I can for others. Never take anything for granted.

Erica Franklin

When people ask you what you do for a living, what do you tell them?

I assist adult with MR/DD with basic living skills. I teach them how to use the washer and dryer, build confidence, cooking, cleaning, take them to the community, and shopping.

 

What is a memorable event in your career up to this point?

Six years in this field, my moment is how the whole community helped me grieve through a severe lost of my child.

 

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

I would look for natural connections. Word of mouth and friend of employees.

What Kinds of questions would you ask them?

Why do they want to do this? Look for characteristics like; outgoing, helpful, and welcoming.

What kinds of things would you tell them about the work?

This work requires personal care, bathing, cleaning up, etc. It’s not easy being a DSP.

What has being a DSP taught you about life?

Patience! This job has helped me with my own children. Their mistakes remind me of mistakes my children made.

Brandi Gray

When people ask you what you do for a living, what do you tell them?

I work at The Mattingly Center. I help adults with severe to moderate DD. I make sure they have a meaningful day. Take them out to the community, personal care, and work on personal goals they have.

What is a memorable event in your career up to this point?

So much we do here. When I get up, it’s fun to come into work. I enjoy the staff and the people I support. I’m thankful for all I have. It hits your heart, and makes you thankful for all you have.

 

If you were in charge of hiring new DSPs, how would you go about recruiting new workers?

I don’t think everyone can do this type of work. I guess this is why it’s hard to find people to work in this field.

What Kinds of questions would you ask them?

How are your organizational skills? Because we need to plan activities and follow through. I would also ask them how comfortable they would feel with personal care.

What kinds of things would you tell them about the work?

It’s a lot of work. I can be stressful, but seeing smiles when they reach their goals makes you feel like you’ve made someone else’s life better. It’s satisfying helping someone else reach their personal goals.

What has being a DSP taught you about life?

Not to take things for granted. I look and see that everyone is human. We all laugh and find joy in little things in life.

 Paying for Quality Care

        From the perspective of someone receiving personal care services (PCS), the most basic quality issue is straightforward: Can I find a qualified worker to provide the services I need? While many factors influence the adequacy and stability of the workforce available for delivering PCS, growing evidence shows that the wages and benefits paid to personal care workers play a fundamental role in determining the quality and quantity of workers.  In light of the critical interconnections between the quality of jobs and the quality of care, this report examines state and local initiatives to improve wages and benefits for direct-care workers delivering Medicaid PCS. Seven strategies for improving direct-care wages and benefits are identified and effective practices for states are highlighted.

Findings
1. In most states, wages for agency workers delivering Medicaid PCS are not set by the state but rather are determined by employers. However, a number of states do set wages for consumer-directed PCS workers.
2. The ability to provide access to affordable health insurance for direct-care workers is an issue of growing concern around the country.
3. States, localities, and advocates have engaged in seven types of strategies to improve direct-care wages and benefits:
*wage pass-through legislation;
*rate enhancements linked to provider performance goals or targets;
*reform of methods for rebasing and updating reimbursement rates for home and community-based services (HCBS) so that they are based on actual costs and/or competitive market rates;
*litigation against state Medicaid agencies;
*collective bargaining by direct-care workers;
*living wage ordinances and minimum wage improvements; and
*health insurance initiatives targeted at direct-care workers.     

Conclusions
This review of state and local efforts to improve compensation for direct-care workers suggests several important issues and implications for advocates, policymakers, researchers, and providers.

1. Lack of Federal Oversight and Guidance. Federal oversight of and guidance to state Medicaid rate-determination methods and procedures have been minimal but should be strengthened to help improve workforce adequacy and the quality of services received by consumers.

Useful guidance could include:
*Standards for assessing the adequacy and reasonableness of rates.
*Guidelines concerning the minimum frequency with which rates should be revised.
*Options regarding the economic and financial information to be considered when establishing and/or revising base rates as well as updating them.
*Options for creating rate enhancements.

2. Existing Direction to States. Court decisions as well as federal statutes and regulations arguably provide the following direction to state Medicaid agencies:
*Payments for services must be consistent with efficiency, economy, and quality of care.
*The state Medicaid agency.s payments must be sufficient to enlist enough providers so that services under the plan are available to recipients at least to the extent that those services are available to the general population.

 3. Ad Hoc Reimbursement Rate-Setting Methods. Most states set reimbursement rates for Medicaid PCS in a relatively ad hoc manner:
*No systematic process is in place to regularly update or rebase rates taking into account relevant economic and financial information, including provider costs.
*Most states do not know what the provider agencies they contract with pay their workers.

4. Problematic Rate Setting. Most current approaches to PCS rate setting and wage determination are problematic for several reasons:
*Rates tend to be state budget-driven.
*Providers are subject to considerable uncertainty regarding their year-to-year funding.
*There is a danger that rate increases will not reach workers.
*Lack of an integrated approach to rate setting across Medicaid HCBS can lead to unrelated and inconsistent rate setting across departments and programs.

5. No Single State Solution. Exemplary approaches to improving wage rates and benefits for personal care workers usually are unique to particular state contexts.

In sum, ensuring good quality care hinges on the ability of policymakers to address the adequacy of the wages and benefits paid to direct-care workers. Most states appear to be at the earliest stages of designing comprehensive and systematic approaches to setting payment rates for PCS workers.

Article reprinted with permission.

Ask Beth

Dear Beth,
I understand that SPEAK has joined NADSP.  Why?  Could you help me understand the value of membership in this organization for DSPs here in Louisville?

Thanks for your help!
A Growing DSP!

Dear Growing DSP,

Before I answer your question I want to educate those who do not know what The National Alliance for Direct Support Professionals (NADSP) is. NADSP is a professional  association for DSP's that promotes the development of a highly competent human services workforce. NADSP vision is to encourage the acceptance of a new vision, where direct support is seen as a profession as well as encouraging the individual they serve to lead a self-directed life and contribute to his/her community; and encourages attitudes and behaviors that enhance inclusion in his/her community.

NADSP goals are to: improve the status and image of DSPs; increase opportunities for education, training and lifelong learning for DSP’s; promote partnerships among people served, DSPs and families; support national voluntary credentialing for DSP’s; support policy change at organizational, local, state, and national levels.

NADSP offers to those who join:
*Membership;

*Web site;

*Credentialing program;

*Code of Ethics;

*Frontline (a quarterly newsletter of the NADSP)

*Moving Mountains Awards (an annual recognition of DSP’s affiliates)

However, in a nutshell, NADSP not only promotes a highly competent workforce and works hard to improve the status and image of the DSP but works to build partnerships to change social policy and organizational change that will and is gradually changing the wages that DSP’s earn.

SPEAK is exploring the possibility of joining as a NADSP chapter but to do so there has to be at least 10 DSP’s that belong to NADSP from SPEAK. So, in is my opinion, I hope you will decide that there is rationale enough to join NADSP. DSP’s deserve to be seen as professionals and paid as ones!

Do you have a question that you would like to
“Ask Beth?”
Email your questions to:
brichardson@councilonmr.org
Or send them to:
Beth Richardson
101 Witherspoon St
Louisville KY 40202