Family Expectations of Direct Support Professionals (DSPs)

What expectations do family members have of the people who directly support their loved one?  How valuable are DSPs to families?  To answer these questions, SPEAK interviewed eight families who are hosts for Pre-Service Orientation.

What skills and knowledge are required of a DSP?
-DSPs need to know the people they’re assisting.  They need to have skills in meeting the particular needs of the persons with whom they work.  This could include knowing how to use equipment for lifting a client; skills in interpreting facial expressions; skills in feeding someone who can not feed him/herself; or understanding of dietary and nutritional issues that affect a participants overall health.  DSPs need to be able to give assistance without overstepping their role and causing the participant to become unnecessarily dependant.  This requires patience, understanding, empathy, and the ability to be flexible.

-Good communication skills are vital.  DSPs must be able to communicate.  They must, at times, be able to communicate to medical professionals about the kinds of behaviors they witness.  They need to be able to communicate with co-workers and supervisors about activities and behaviors that took place.  They also must be able to communicate with the participant, and, at times, teach them new skills.  Some participants may not be able to speak.

-DSPs must be good watchers and observers, and they need to have good intuition.  They need to be able to predict a dangerous situation, and avoid it.  They need to be able to read situations, and avoid unnecessary conflict between participants and/or between participants and other staff.  They should be able to calmly deescalate situation that can cause with participants who have behavior issues.  Good DSPs should keep an eye out for how families do things, and then incorporate the family’s style into the way they give care to the participant.  DSPs also need to have stamina and endurance.  We find so many who burn out.  We need workers who will be able to do tomorrow what they did yesterday.

-DSPs need to have skills in empathy.  They must be able to relate to the problems faced by those they serve.  They must be able to encourage and motivate a participant.  They must be able to draw out of a participant and encourage them to reach their fullest potential.  They must be able to meet needs that go unspoken.  All this is in addition to the important essentials of a strong enough back to pick up, lift, or reposition a participant.

What attitudes and personal qualities are essential for a DSP?
-The attitudes and personal qualities of DSP’s are more important than their skills and knowledge because people who have good internal qualities can learn the skills needed to do the work. If they don’t have a loving, tender heart; if they don’t really want to do the work, then all the skills in the world won’t help them to be good DSPs. DSPs need to want to do their jobs. There are support workers who have a lot of knowledge, but they lack these personal qualities and it strongly impacts the way their skills are received.  Participants always know when people giving them support do it with a glad heart, or if they simply do it out of duty.

-DSPs need to have a willingness to learn from the participant.  They should value every individual and respect that each person, whether he or she has a disability, has a unique story worth telling.  DSPs need to be able to see and rightly discern internal and external qualities within each person. 

-DSPs need to be compassionate.  They also need to be able to have empathy without looking down because of their disabilities.

-DSPs need to have internal happiness.  They need to be optimistic and hopeful.  They need a smile on their face, even if their world is falling apart.  Participants will catch their mood.

What constitutes poor care?
-Some DSPs seem so hurried.  They always do the bare minimum of what’s required.  Some are very task-oriented, as opposed to person-oriented, and they really don’t get involved in the lives of the people they caring for.  One simple word—if the person doesn’t care, then the work is “poor.”

-We’ve witnessed some DSPs who just seem to be putting in time.  When we see them at work, they seem bored, distracted and unengaged, and it feels to us like they’re just drawing a check.  For us, this not only is disappointing, but we sometimes worry because we trust these people to care for our loved one.  We also know how this affects our adult child who can read a person like a book.  These DSPs usually don’t stay around very long.  I don’t think there’s much in this field for people who aren’t caring

-DSPs give poor care when they walk into a situation with a pre-set agenda or an inaccurate assessment of a situation.  When their perceptions are wrong or distorted, then their actions also are wrong and distorted.  DSPs give poor care when they cease to be relational.  They need to be open-minded.  They must be able to think outside the box; seek to understand the complexity of a person’s disabilities; and desire to care for the person, even if the participant does have challenging behaviors.

How do you (families) want DSPs to interact with you?
-We like to know the DSPs working with our family member.  The better we know them, the better we feel about leaving our adult child in his/her care.  If there is a problem, we want to be informed.  We are parents, and we want to be treated as such.

-Our family member now is a grown-up, with a very full life.  We certainly want to know if there’s a problem or if the DSP needs our help with anything, but we don’t necessarily need to hear from him or her more than once a month.

-We consider the people who give care to our adult child a part of our family.  We trust these workers to care for the most precious person in our life.  We expect them to be very honest, and to care for us (not just our adult child), as family.  One of the things that family does is bestow value, and so, we want the DSPs to value us, our beliefs, and our wishes regarding the ways that care is given to our adult child.

-We deeply appreciate open lines of communication between ourselves and the people working with our family member.  We work hard at maintaining good relationships with the people caring for our loved one.  We want to be a resource to DSPs who can help with discipline and/or positive reinforcement.  We want to celebrate accomplishments and help combat negative behaviors.

How important is it that the same DSP care for your loved one each day?
-Not too important—our child comes from a big family and is thus flexible.  Our family member adapts well to change.
-There’s more turnover than we like.  That’s just the nature of this field.  It would be best to have one person as long as possible, but we know that people move on and we’ve learned over the years to adjust to new people.  It’s just a part of what we face having a loved one with a disability.
-Our adult child is non-verbal, and every time a staff member leaves, we start from scratch.  It takes a long time to learn what certain facial expressions mean, and what to do when our adult child makes a certain noise.  Because of the level of dependence, it takes a long time for our child to adjust each time there’s a turnover in staff.  We have grown to dread those phone calls that inform us that “another staff has turned in a resignation.”
-Consistency is very important.  My loved one needs a stabilizing force that continuously builds level after level of trust.  When that changes, my loved one doesn’t know what to expect.  His whole system gets undone, and it produces fear when that person is taken away.                                                    

Are DSPs professionals?
-Yes!  They have a very important job.  My children are my biggest investments, and I trust DSPs to take good care of one of them, who happens now to be an adult.
-In their own right, they are professionals.  It takes a certain type of person to do this kind of work.  Now I should say, there are some in this field who are not very professional.  If they’re not caring, if they just need a job, then they’re not real professionals.  If they do the work the way it ought to be done, then they certainly are professionals in my book.
-Absolutely!  If not at the beginning of their career, then certainly at the end.  Not that they have to have a lot of professional skills coming in, but they learn professional skills through the people they work with and the people they serve.
-Yes, definitely.  They are the closest person (second in line to family) to my loved one, which is a good feeling.  I trust DSPs to look after my loved one’s best interest. For all the skills and responsibilities that DSPs have, they ought to be treated as professionals.

How much is DSP care worth?
-The pay should be comparable with other professionals, like teachers.  I would think between $15-$25/hour with full benefits.
-$15/hour is not enough.  They ought to be making at least $20/hour plus benefits.
-Priceless.  How can you put a value on it?  The little bit of relief DSPs give to us is invaluable!  At minimum, $15/hour.
-A good DSP is worth a LOT!  Currently, I know they’re not paid what they’re worth.  A good DSP is certainly worth no less than $10/hour plus benefits.
-Not less than $10/hour.  I would think about $15 per hour would be fair.  DSPs earn their money.  It isn’t given to them.  A million dollars. It’s so nice to be able to trust these people.
-A good DSP is worth his/her weight in gold.  I would think $45,000.00/year plus benefits would be fair.

Conclusion:  Family members place very high expectations on DSPs.  They expect DSPs to have certain skills/knowledge, and believe that DSPs need to possess certain attitudes and personal qualities that allow them to do their work well.  Given these high expectations, families also believe that the compensation packages received by DSPs ought to be much higher than the local average.

Results from DSP Job Satisfaction Survey

Before SPEAK began operation of its programs, DSPs from all of our partnering agencies were offered a DSP Job Satisfaction Survey.  SPEAK received back 139 of the questionnaires and we then sent them to external evaluators (a group from the University of Kentucky) that compiled the data and arrived at several conclusions.  See results on page 2:

Items 9-36 were rated on a descending 6-point scale where “1”= Strongly Agree and “6”= Strongly Disagree.  Items 37a and 37b were rated on an ascending 10-point scale where “1”= No job satisfaction and “10”= Greatest possible job satisfaction.  Average ratings for each item are listed in the table below for all SPEAK partnering agencies. 

 It is important to note that not all of the items are parallel in their desired responses; if employees were completely satisfied with their jobs, one would expect them to answer “strongly agree” to some questions while “strongly disagree” to others.  Therefore, looking for the lowest average response, closer to “strongly agree,” does not always mean the employees are more satisfied.  Keeping this point in mind, the overall average responses suggest that employees are relatively satisfied with their jobs.

Conclusions from Survey Results:

· First, both the overall job satisfaction and perceived co-workers’ satisfaction are in the “7” out of “10” range.  These numbers suggest that while there is room for improvement, employees are satisfied with their jobs and believe others are as well.

· The survey results also suggest some key strengths and weaknesses in the job satisfaction ratings.  Items that showed personal meaning and fulfillment with the job were rated highest (e.g., my work activities are personally meaningful to me” and “I make a difference in the lives of other people”).  Items that were related to financial reward from the job were rated the lowest (e.g., “I am satisfied with my income” and “I make pretty good money compared to others in this field”).  Thus, employees appear to be satisfied with the intrinsic value of their jobs, but are not satisfied with their pay.

· A third, and somewhat more surprising finding related to work stress.  While SPEAK addresses the need of personal supports for DSPs, these data suggest that many DSPs are not feeling overwhelmed by their jobs (e.g., “I feel overwhelmed by my responsibilities at work,” “this job demands too much (physically, emotionally, mentally),” and “this job adds significant pressure and anxiety to my life”).  It is important to note, however, that each of these items has a relatively large standard deviation, meaning while the majority of respondents rated these items positively, there were several others who were not as satisfied.

Thanks to all who took this DSP Job Satisfaction Questionnaire!  We are hopeful and confident that the supports offered through SPEAK will continue to increase your overall job satisfaction.

DSP Retention Rates Across Kentucky
DSP Retention Rates Across Kentucky

In 2000 reports show that 504,793 (12.5%) of Kentucky's 4,041,769 citizens were aged 65 or older, an 8.1% increase since 1990. The US Census estimates that by 2030 Kentucky's 65+ population will increase by 79%. By that year the traditional care-giving workforce (women aged 25 to 44) will decrease by 10.2%.

Kentucky has one of the highest rates of disability (23.7%) in the nation; the national average is 19.3% for the population of people five and older.

A 2003 report conducted by The Bureau of Labor Statistics states that 30,260 nursing assistants, home health aides, and personal care/home care aides worked in Kentucky earning an average of $8.94 an hour. These numbers do not include many direct-care workers who are self-employed.

According to a survey by the American Healthcare Association (AHCA) in 2002, the statewide vacancy rate for Kentucky Certified Nursing Assistants (CNAs) was 10% and the turnover rate was 107.6%. It is anticipated that the state's already high rates of direct-care worker vacancies and turnover will worse as the population continues to age, and the “care gap” between those needing care and those available to care for them continues to widen.  (This article was reprinted with the permission of the National Clearinghouse on the Direct Care Workforce (www.directcareclearinghouse.org), a Program of the Paraprofessional Healthcare Institute.

SPEAK, along with other federally funded demonstrations projects, represents one way the Center for Medicare and Medicaid Services is addressing this looming crisis.  We, too, need to stay informed and advocate for better compensation and other supports to develop this critically needed work force.