A new survey highlighted the challenges facing America’s direct support workforce, revealing a care system in crisis due to ongoing recruitment and retention issues.

Direct support professionals (DSPs) play a crucial role in assisting individuals with intellectual and developmental disabilities. They help these individuals develop the skills needed to live and thrive in both home and community settings. Their services can vary widely, from aiding with personal daily activities to fostering meaningful relationships and supporting career planning.

For the fifth consecutive year, ANCOR has conducted a survey to assess the workforce crisis’s impact on service providers and the individuals they support. Approximately 500 providers from 47 states and the District of Columbia participated in the 2024 survey.

The State of America’s Direct Workforce Crisis 2024 survey found that 90% of providers faced moderate to severe staffing issues in the past year, leading to 69% turning away new referrals.

These challenges have negatively impacted the access to services for individuals needing care. About 49% of respondents reported discontinuing programs or services, while 64% indicated they planned to delay the launch of new programs. Even more concerning, 34% are contemplating further program cuts if recruitment and retention issues persist.

Additionally, 57% of those surveyed stated that they provide services in areas with few or no other providers. This lack of a sufficient network of community providers puts states at risk of violating federal access standards and jeopardizes the safety and well-being of individuals relying on these services.

The report emphasizes that “this decades-long workforce crisis has affected community-based services due to long-term underinvestment in Medicaid, which has hindered community-based providers from offering wages that are competitive with those in hourly wage industries.”

The resulting direct support professional (DSP) workforce crisis has significantly impacted community providers’ ability to deliver essential programs and support individuals with disabilities in their homes and communities.

Furthermore, significant federal regulations have altered the authorization, delivery and monitoring of community-based services for people with intellectual or developmental disabilities. While these policies are necessary to strengthen the care system, the workforce crisis creates considerable challenges in implementing new federal policies, particularly those that increase service delivery costs without corresponding funding, as the report indicates.

For instance, 87% of respondents subject to Medicaid electronic visit verification (EVV) requirements reported receiving no additional funding to cover the extra compliance costs. This situation often placed a financial burden on community providers, as compliance resulted in significant additional expenses for service delivery without the financial resources required to support it.

While many community providers were required to purchase new software and hardware, few states adjusted reimbursement rates to reflect these costs. Consequently, many providers had to forgo wage increases to afford equipment and hire additional staff to manage the administrative tasks linked to EVV-related billing and reconciliation.

Without sufficient funding from the outset, these added expenses and challenges further hinder the stabilization of the direct support workforce, according to the report.

“The findings of this year’s survey reveal the fragility of the disability service delivery system and the need for additional progress to be made,” Lydia Dawson, vice president of government relations at ANCOR told Home Health Care News. “To prevent further setbacks and ensure a stronger system moving forward, we must preserve and expand funding for home- and community-based services. We must also ensure that states are compelled to regularly review and adjust their payment rates as a critical step toward closing the gap between the cost of delivering services and the rates at which providers are reimbursed for those services.”