Breaking the myth of Sisyphus: a parent's guide to understanding and changing face of direct support turnover. (Workforce).

Most parents who have had to rely on any person paid to offer residential, educational, or vocational support for their child with disabilities are probably very much aware that finding and keeping qualified support professionals is a bit like the underworld sentence of the ancient Greek, Sisyphus. The ritual of finding and training new workers becomes as repetitive as rolling the boulder up the hill, where it may teeter for a few days, a month or, if you are very lucky, nearly half a year, before the person resigns and the whole process starts again.

This seemingly "futile and hopeless labor" has human resources staff from support agencies all over the country nearly frantic. And while their lot is bad enough, you and your child know it's even worse when you personally have to rely on this constantly churning workforce to provide the services and supports you need. But unlike Sisyphus, who was condemned for eternity, we can escape this seemingly endless process if we are willing to let go of a few myths of our own and make some necessary changes.

I was recently visiting with a group of 10 middle-aged adults with multiple disabilities who relied on 24-hour support from direct support professionals (DSPs). During that visit, I had the opportunity to hear from four sets of parents about the quality of care they felt their (adult) children were receiving in the agency-run home. Every one of these parents brought up staff turnover as a significant barrier to the quality of care for their children.

What surprised me about this particular set of parents is that they had been participating in an agency-sponsored recruitment and retention workgroup for years. Over time this group, which had most likely started with some energy and spirit, had dwindled into a monthly support group where agency representatives and parents could come together and commiserate over the impossible problem that lay before them. What happened? My guess is that they had fallen prey to one or more of the myths of turnover.

There are a number of real challenges in recruiting and retaining DSPs that will take substantial effort to overcome. Before we can make the necessary changes to improve the situation, however, we have to first let go of the myths that keep many providers and others from effectively tackling these issues. The three most common myths that I believe keep parents and family from getting involved are these:

MYTH # 1: There is nothing that can be done about turnover (aka: it's all about wages).

MYTH # 2: The problem is only temporary.

MYTH # 3: There is no role for parents and families in dealing with recruitment and retention of direct support professionals.

LET'S LOOK AT THESE THREE MYTHS ONE AT A TIME.

MYTH # 1: There is nothing that can be done about turnover (aka: it's all about wages).

Wage and benefit issues are real. The majority of DSPs currently do not make a livable wage and many go without even basic benefits such as access to adequate healthcare and paid leave time. In recent years, we have put a lot of effort into thinking about quality of life issues for people with disabilities but we must also take a hard look at the quality of life of the people who support them. We simply cannot provide the necessary supports for each person with a disability on the backs of workers who are scrambling to make ends meet.

Creative effort to improve this situation, including pushing state and federal funding sources to take these issues into account, must be part of dealing with the current workforce problems. However, agencies, families, and others that fall back to the wage issue as the only solution to retention are only seeing one aspect of the problem. Until we can obtain better resources, we have to spend more wisely. For instance, the cost of hiring and training new employees, which has been estimated at anywhere from 10 to 40 percent of an employee's annual salary, is a huge potential savings that can be funneled back into wages and benefits of long-term employees.

Ultimately, direct support is a profession, and very few of us choose our professions based on wages alone. Most people who are drawn to direct support obviously came to the table for more than wage. They stay with this work for a variety of reasons: finding it to be a rewarding, meaningful, and challenging career choice. When we look at recruitment and retention strategies that have been used in all types of industries (from high-tech to hotel maid service), there are a number of things outside of wages that help to keep people content and motivated.

There are five fundamental areas that can affect the retention of workers: recruitment; hiring; training and development; recognition and reward; and general management practices. Here is a quick summary of these five areas.

RECRUITMENT STRATEGIES: These are strategies that help bring people to the door. The traditional strategy has been to place an ad in the local newspaper, but in most places this has ended up being very expensive and highly ineffective. The key to recruitment isn't just about finding anybody; it's about finding the right people. Direct support work doesn't get a lot of press and when it does, it is often bad. Recruiting in the new millennium needs to include a significant amount of outreach, to educate potential workers on the possibilities and benefits of working in the field. Recruitment includes helping to inspire people to want to do this work, but it also includes providing information about the less positive aspects of the work so that people who are not suited to the field can opt out early in the process.

HIRING STRATEGIES: These are the strategies that help the employer select the right workers from among candidates that meet basic eligibility. Too often, in our zeal to fill vacant positions the screening aspects of hiring are being overlooked. Some agencies have as high as 15 percent of their turnover due to firing. This means that too many unsuitable workers are being hired and may also point to lack of adequate support and training for new employees.

TRAINING AND DEVELOPMENT OPPORTUNITIES: Good training and development opportunities are what turn employees with good potential into excellent employees. Current orientation, training, and development practices do not adequately prepare DSPs for their duties, which in turn leads to unnecessary stress and poor performance. In addition, according to responses on employee surveys, much of worker dissatisfaction, and ultimately turnover, is a result of poor relationships with coworkers and supervisors. The industry has not emphasized training in stress and anger management, teamwork, and professionalism, all of which are central to reducing turnover and improving the quality of services.

REWARDS AND RECOGNITION: Despite the fact that quality of services ultimately rests in the hands of the DSPs, quite often good workers are not acknowledged for the work they do. Agencies and family members will do well to reward and recognize excellent DSPs both formally and informally, on a frequent basis in order to increase job satisfaction and retain the best workers.

GENERAL MANAGEMENT PRACTICES: Management practices include all the strategies previously mentioned, but pulls them together into a cohesive structure. Management structures in the new millennium will need to be less hierarchical and will need to draw on the ideas and concerns of all employees to be maximally effective. The inclusion of participatory management practices, self-directed work teams and other methods of providing DSPs with direct influence over decisions that affect the quality of services will be important. Similarly, a strong mission and vision that each employee understands and believes in will help create an environment where each employee is clear on the intention of the agency and empowered to make on-the-fly decisions that are necessary in highly dispersed and individual service settings where supervisors and other managers may not be available to help with all decision-making.

As you can see, there are many factors that agencies need to consider when evaluating which strategies are the highest priority for their specific turnover problems, but many agencies have found success in reducing their turnover through the implementation of strategies in these areas, even when they cannot obtain better funding to improve wages.

MYTH # 2: The problem is only temporary.

Many agencies are dragging their feet on making the changes necessary to curb turnover, based on the belief that since turnover has always been a big struggle for support agencies, things will eventually change back in their favor. It is true that the recent crisis is more an effect of changes in demographics (i.e., fewer workers available in traditional pools with a simultaneous increase in competing services to elderly people) and economics (i.e., low unemployment, reduction in the real buying power of wages, and higher wages in competing industries such as fast food, retail, etc.) than any change in turnover rates in our industry.

Unfortunately, current projections on demographics and the economy do not support the theory that these factors will be getting any more favorable in the near future, and in fact, it is likely that the changes have not yet ended. However, regardless of whether the pendulum swings one way or another with the economy and demographics, the industry has seen another fundamental change that will make historical turnover rates unacceptable: the move to consumer-directed, individual supports.

The trend toward highly dispersed service settings (ideally, people's own homes, communities, and places of employment) will require a different type of direct support professional. The new DSP will have to have a deep understanding of person-centered and directed supports, community inclusion, and working with diverse teams. He will have to be able to implement effective, creative supports in a variety of settings, with minimal supervision. Continuity of support, attention to health and safety, and the achievement of meaningful life goals will have to be built on long-term working relationships between people with disabilities, their families, friends, and advocates, and the professionals who support them.

MYTH # 3: There is no role for parents and families in dealing with recruitment and retention of direct support professionals.

It is time for everyone to pull together if we want to tackle this situation. Not only do parents have a role in working with agencies who hire DSPs. More often, people with disabilities and their families are becoming direct purchasers of services and will need to implement their own plans for effectively recruiting and retaining DSPs.

Fortunately, parents have the history to take on this role. If we are going to make substantial changes in the workforce crisis, it will take a political and social movement similar to the one that brought about the move to community-based supports. Parents became active then through formal and informal advocacy groups, to push the system to keep their children in the community. The workforce issue is the next stage in that battle.

Now that you know that many of the barriers to resolving the workforce crisis are myths, what can be done? Parents and others who care about this situation have a number of avenues to pursue in seeking solutions to the workforce problem.

The first step is to educate yourself. This edition of EXCEPTIONAL PARENT should give a good jumping-off point for understanding the issues around recruitment and retention of DSPs. As you learn, share your knowledge with providers, your elected officials, other families, and anyone who can have an influence on the situation. Use your contacts and skills to get these issues to the forefront of the local and national agendas in supports to people with disabilities.

* Push providers to attend to these issues. When looking for services for your child, ask providers hard questions about what they are doing to deal with workforce issues and the effect it has on the quality of supports. This will send the message that as consumers of services, you and your child have an expectation that dealing progressively with workforce issues needs to be part of the package. Whenever possible, choose providers that at least seem to have a willingness to work on these issues and understand the relationship between workforce development and quality of services.

* Leverage your resources. Often family members contribute to the agencies that support their loved ones as a way of rewarding and recognizing long-term, dedicated DSPs. Contributions of things like tickets to local sporting events or gift certificates to local restaurants that the agency can distribute can go a long way toward making DSPs feel appreciated. Do you bring holiday baskets for the people who receive services? What about bringing holiday baskets for the DSPs?

* Become part of the recruitment team. Agencies are strapped and are often so caught up in the day-to-day struggle that they don't have all the resources necessary to be as proactive as they would like. Would you and a group of other parents and people receiving supports be willing to develop relationships with the local high schools, community centers, and other points of contact to help educate prospective employees about the role of the DSP, and to build a ready supply of new workers? Ask the agency that supports your child where it needs assistance and see if you can help.

Lack of qualified DSPs is probably the biggest threat to community supports today. There is no way we will be able to continue to sustain growth in community services if the linchpin of those services, the direct support professional, is unavailable or unable to do the job. Fortunately, there are many options for improving the situation once we let go of the myths that hold us back. Parents and family members have a number of critical roles to fill in helping to change this situation. If we all apply ourselves, it is possible that Sisyphus will have to do without us on his next trip up the hill.

Susan N. O'Nell has worked as a direct support professional in community services for 10 years. She currently works as one of the researchers at the University of Minnesota's Institute on Community Integration who are dedicated to understanding and improving workforce issues in human service settings. She is also employed as a quality analyst by The Council on Quality and Leadership in Supports for People with Disabilities on the National Quality Review project.