Addressing the DSP Workforce Crisis

Direct support professionals (DSPs) provide mental health and disability supports and services. They provide support that help Iowans live, learn and work in their communities, not institutions. Some of the supports include cooking, cleaning, budgeting, shopping, banking, job development and coaching, transportation and community activities. 

Click here to view our Workforce Crisis one-pager.

DSP Workforce Crisis


Workforce Impact

-  Unable to accept referrals due to a lack of staff capacity leading to costly alternative placements.
-  Negative consequences to people being served by a workforce shortage:
    -  Diminished quality of service 
    -  Reduced progress to individual goals 
    -  Exposure to possible harm 
    -  Decreased access to individualized community services


Raising Wages is the First Step in Addressing the DSP Workforce Crisis 

Positive results of raising DSP wages 
-  Studies have found employee morale and work ethic improve when employees believe they are paid a fair wage. Higher wages result in better physical and mental health and reduced “decision fatigue,” leading to higher productivity. 
-  Higher wages lead to lower employee turnover. 

Raising wages results in: 
-  Reduced turnover and recruiting costs 
-  Reduced training costs related to turnover 
-  Reduced absenteeism 
-  Increased effective and consistent support 

Which Medicaid programs would be impacted? 
-  Habilitation 
-  Home and Community-Based Services/Intellectual Disabilities (HCBS/ID) 
-  Home and Community-Based Services/Brain Injury (HCBS/BI) 
-  Intermediate Care Facility/Intellectual Disabilities (ICF/ID) 

How do we ensure the funding goes to DSPs? 
IACP is advocating for a 10% rate increase for HCBS services with a 75% pass-through for wages going to DSPs directly supporting individuals receiving these services. 25% would be at employer discretion to cover FICA, benefits, administrative and overhead costs. 

Why separate Iowa’s community-based service providers from other health care providers? 
-  Nearly all of the services provided are funded through Medicaid 
-  Very little third party and private payment 
-  Lifelong Supports and Services 
-  Many services are provided 24 hours a day, 7 days a week, 365 days a year 

National LTSS Workforce Report from PHI (2019)
CQL Article (Feb 2019) The DSP Crisis: Reimbursement Rates, Retention, and Research
President's Committee for People with Intellectual Disabilities 2017 Report to the President
University of Minnesota Institute on Community Integration - IMPACT Volume 31, Number 1 (2018)