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The Direct Care Staff Exodus - Part 1
Table of Contents
The Current Situation
A review of published literature reveals many factors contributing to the high rate of turnover for direct care staff (DCS) including lack of support and appreciation, insufficient training, inadequate pay and the difficulties of the work performed. This is unfortunate, as the number of Americans estimated to need long term care services and supports is expected to more than double, from 12 million in 2010 to 27 million in 2050. Meanwhile, demand for DCS is expected to increase by 48 percent in the next decade. In 2008 the national vacancy range or unfilled positions for DCS was 10-11% (Taylor, 2008)
Why Do Direct Care Staff Leave?
- Lack of Support/Appreciation – Supervisors of DCS are often prior DCS themselves and have not been provided with adequate supervisory training on how to best support, guide, acknowledge and reward their staff. Also, the people DSWs serve are not always able to verbalize or express their appreciation due to physical and/or psychological limitations. Make sure new supervisors have career-ladder support to develop management skills, insist on regular one-on-one meetings to build feedback-friendly relationships, and provide recognition informally whenever you see someone doing something well. A positive word from leadership goes a long way!
- Insufficient Direct Care Staff Training – The training requirements for DCS are fairly minimal, considering the responsibilities they face. Even as the direct care role expands, Texas HHS qualifications for DCS require only that the service provider have a high school diploma OR a state recognized high school equivalency certificate; OR both of the following: a successfully completed written competency-based assessment demonstrating the ability to provide and document care appropriately and written personal references from non-relatives. Since competency assessments are left to individual providers to create and training is expensive as well as time consuming, many minimally-qualified DCS receive expedited training so providers can quickly fill open shifts. This money-saving tactic frequently leads to underperformance and drives turnover rates up. Help ensure the people you trust with the lives of others are adequately prepared for the tasks they have to perform on the job by taking a hard look at your training materials and practices. Prepare DCS for the demands of the job by providing thorough, applicable training topics, ask for feedback after training is complete, and use Focused Software’s Personnel Checklist to ensure it’s all well-documented.
- Inadequate Pay For Direct Care Staff – With falling reimbursement rates from the state it is no wonder inadequate pay has been widely cited as the number one reason for the high rate of turnover amongst DCS. With employee expenses being the highest cost item for most providers staff pay may not be as ample as both employer and employee might wish. Many direct care positions offer at or near the minimum wage without benefits and as a result, just about a quarter of DCS employed in home health care services in the US (in 2006) lived in families with incomes under the federal poverty level.” (Lewin Group, 2008) “About 45 percent of direct-care workers live in households earning below the federal poverty level income, making them eligible for most state and federal public assistance programs. While reimbursement rates often prevent offering pay raises and benefits, try offering other position perks. For example flexible scheduling when possible, build internal support networks through mentor programs, and seek out strategic partnerships that enable you to pass value to your staff (like group purchasing and cellular network discounts).
To keep great DCS talent consider alternatives to pay increases such as flexible scheduling, mentor networks and strategic company partnerships that enable you to pass value to your staff (like group purchasing and cellular network discounts)
- Difficulties of the Work – There are high levels of societal stigma associated with mental illnesses, addictions, intellectual and developmental disabilities, disabilities in general, and aging, so working with such individuals is too often stigmatized as well. This leads many people to believe that the DCS position is a low skill, dead end job for uneducated people who couldn’t get any other kind of work. DCS perform very physically and emotionally demanding work. They’re expected to consistently provide compassionate, intensive personal care but very often, others do not consider the fact that their working conditions are made even more challenging by negative external perceptions. Prepare leaders/supervisors to provide emotional support and encouragement to DCS. Additionally, put in the work necessary to change culture: well-kept lawns at group homes, clean vehicles, company-branded T-shirts and smiling, fulfilled employees will go a long way toward improving image in every community.
Next week we’ll look at the real costs of high staff turnover as well as ways you can improve your DCS retention rate.
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