Workforce woes delay support services for NC residents with disabilities

Thousands of North Carolinians with intellectual and developmental disabilities rely on caregivers, known as direct support professionals, for help with everyday tasks like bathing and eating.

But those workers are in short supply. A recent study by The Arc of North Carolina, a nonprofit that advocates for people with cerebral palsy, Down syndrome and other conditions, found that the state needs at least 20,000 more direct support professionals to meet the current demand.

That estimate is based on the waitlist for N.C. Innovations, a Medicaid program that connects direct support professionals to residents who are unable to live independently without this type of regular assistance. About 16,000 people were waiting for slots to open up in the program, which is at capacity with more than 14,000 participants, in April 2023.

Kelly Crosbie, director of the N.C. Department of Health and Human Services’ developmental disabilities division, addressed the issue during last month’s meeting of the General Assembly’s Joint Legislative Oversight Committee on Medicaid. The direct support field, she told lawmakers, is plagued by high turnover; most workers leave the profession after less than three years.

“Turnover really hurts,” Crosbie said, adding that the workforce churn creates an unpredictable situation for “consumers who need consistency” along with their family members. “It hurts families. They're not able to go to their jobs because they need to take care of their loved one.”

The shortage also affects the behavioral health providers that employ direct support professionals. It can be “very expensive,” Crosbie said, for the providers “to recruit, retain and train new staff.”

Lack of wages, advancement a barrier

Many direct support professionals work part time or travel between several clients over the course of a day. The Arc’s study also found that of the 112,630 direct care workers employed in North Carolina in 2021, more than half were people of color, and nine in 10 of the direct care workers were women. 

One factor fueling the high rate of turnover among these workers is low pay. The average entry-level wage for a direct support professional in North Carolina is less than $15 an hour, according to The Arc. 

“Rate increases aren't keeping up with the cost of living, so workers are able to find, in some cases, easier jobs, quite frankly, that pay better,” Crosbie said. “Sometimes it's easier to work at the Amazon warehouse or to go work at McDonald's or Walmart.”

Those other jobs at least come with the possibility of a promotion. Crosbie said direct support professionals have “very little opportunity for advancement.”

“Pretty much when you enter the field, you continue to do the same services,” Crosbie said. “If you have one year of experience [or] if you have 10 years of experience, there's not a lot of room for career advancement. There aren't stages like a lot of us have the privilege of having when we go through our careers.”

A proposed increase to the minimum wage for direct support professionals could help bring in more caregivers. Davidson, Holland, Whitesell & Company, a management consulting firm in Hickory, has estimated that raising the professionals’ starting pay to $18 an hour would cost the state about $240 million a year for a sufficiently-sized workforce.

Advocates say the investment wouldn’t just benefit caregivers and their clients. Every dollar spent on direct support professionals generates up to $1.63 for the state economy, according to an analysis by The Arc.

“The impact is statewide,” said John Nash, the organization’s executive director. “Every single county has people on the waitlist.”

Hiring enough professionals to care for those people, he added, would “create a lot of jobs” — pumping as much as $1.3 billion into local economies. 

Dry pipeline

But the shortage won’t be solved by better pay alone. The state, Crosbie said, needs a “pipeline to create new direct support professionals.”

“It's not really a career option you hear about in high school,” she said. “There aren't internships for it. We don't have a community college program for it. We don't have apprenticeship programs.”

Crosbie’s division of DHHS has been collaborating with an advisory committee to create a strategic plan to recruit and train caregivers. Her team, she said, is also working with providers and managed care entities to offer “incentives and employment supports” that could help improve retention. 

“We’re very committed to helping individuals with intellectual and developmental disabilities get service,” she told the committee. 

That service is vital for parents like Bill Donohue. 

Donohue is a member of the N.C. Waiver Action Team, a group that advocates for the many families whose loved ones are stuck on the waitlist. His 39-year-old son, who lives with Down syndrome and muscular dystrophy, receives assistance from a direct support professional through the N.C. Innovations program.

“It has made all the difference in his life,” Donohue said of his son’s experience. “He’s been able to go to college. He's been able to function fully in the community. He's a five-sports Special Olympian. He's in a book club. He's in a recreation program. He's got a job working at a coffee shop. 

“None of those things would be possible without a DSP.” 

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.