The current moment is highly charged with political potential energy. It’s a new year, there’s a new president, and, on a more local level, we in Indiana are working on a new state budget. So I felt like this might be a good time to discuss a political issue not often brought up, particularly as it ties into some of my moral/pedagogical beliefs. That issue is direct support professional wages.
DSPs are “front-line” supports for people with disabilities. They provide personal care and transportation, they help prepare meals, do laundry, help people with disabilities take showers, put on cloths, clean their homes. They administer medication, track bowel movements, implement behavior plans, provide access to the community … and, they make less than an entry level employee at Walmart.
The statewide average wage for a DSP is $11.36 an hour. At Walmart the average wage for full time employees was $13.38 (according to the Indiana Association of Rehabilitation Facilities, INARF).
It should come as no surprise then that in 2020 the turnover rate for DSPs was 51%. And the problem is snowballing because the higher the turnover rate the more understaffed facilities are, and the more understaffed facilities are, the more stressful the job is, hence the higher the turnover rate. There is currently an average vacancy rate of 23% for DSP positions in Indiana 1.
Providers cannot simply increase DSP wages. DSP wages are determined by Medicaid reimbursement rates, Medicaid being the sole source of funding for DSP services. Service providers can only offer employees higher wages if the rate at which Medicaid reimburses them also goes up.
But there is also what I see as a larger issue. The problem is not just total funding for Medicaid, but the way Medicaid funding is distributed. What I mean is that whereas Behavior Management (BMAN) is reimbursed at $18.20 per .25 hours, or $72.80 an hour, DSP services are reimbursed at something closer to $8.90 an hour — depending on the exact service and situation.
What it seems to me this does is invert Maslow’s hierarchy of needs. It doesn’t matter how good of a behavior plan you come up with, if someone’s basic needs are not met, there are going to be behavior problems. I admit that the situation is complicated and I am far from understanding all the ins and outs of it. But to me the situation smacks of the neoliberal mentality: to speak of freedom and self-actualization while basic physiological and psychological needs are unmet.
In my opinion there is a classist and counterproductive devision of labor and reimbursement. The gap in salary between typically high-school educated DSPs and college educated therapists is ultimately damaging to the people they are supposed to serve. It is not that the college educated therapists don’t deserve the money they make, it is that they can’t actually do their jobs if clients’ more basic needs are not met. I fear that the “higher order” services are merely being provided as a smokescreen to mask the poor daily living standards of most people with disabilities.
I am still new to this field, however, and willing to admit my conclusions might be hasty. For more info/sources see:
- https://www.inarf.org/statehouse_news.html
- https://www.forbes.com/sites/denisebrodey/2019/01/10/the-job-most-americans-dont-know-about-but-is-crucial-to-the-success-of-people-with-disabilities/?sh=2f0aa3a86105
- https://www.c-q-l.org/wp-content/uploads/2020/02/CQL-2019-Friedman-The-DSP-crisis-Reimbursement-rates-retention-and-research-HCBS.pdf
- http://provider.indianamedicaid.com/ihcp/Bulletins/BT201766_PF.pdf
- https://www.inarf.org/news/residential-habilitation-and-support-daily-rate-service-definition
recycled paper clips 