g Component 3 Introduction

In April of 2001, a report by the Long Term Services Division of the New Mexico Department of Health commented that:

Nationwide, direct support staff turnover in the long term care industry has approached crisis status. Factors working against this career path include low pay, high stress, poor working conditions and few opportunities for career advancement. Ultimately, individuals with disabilities are the most seriously affected by this problem….At a minimum, individuals and their families are having to get to know, trust and train new staff constantly. At worst, the health and safety of individuals can be at risk when tasks are performed by new staff who don’t know them and their particular needs.

Direct support staffing Analysis

Long Term Services Division

New Mexico Department of Health

April 6, 2001

New Mexico shares this problem with the rest of the nation.[1] National studies have found varying rates of turnover for direct support staff. One review of recent studies found a range of between 45% and 70%[2], while another found turnover rates of between 25% and 500%, depending on the field and the region.[3] A 2001 analysis in New Mexico of one hundred and twenty one provider agencies under contract to the Long Term Services Division found annual separation rates of between 28.6% and 58% (Long Term Services Division, 2001).

There is a substantial body of research on the national level that documents reasons for these significant turnover rates.[4] According to a synthesis of research findings published by the State of Wyoming[5], the “….lack of support from management and co-workers was the most often-cited reason for burnout and employee turnover” of direct support staff. The second most significant predictor of turnover was inadequate wages and benefits, followed by a lack of training and inadequate working conditions including stress, role ambiguity and a lack of support.[6] A second review of the literature reported that the three top reasons that direct support staff leave their jobs are: co-worker problems, poor pay, and supervisor problems.[7]

g Methodology

As part of the Infrastructure Study funded by the New Mexico Developmental Disabilities Planning Council, the Community Support Alliance at the University of New Mexico’s Center for Development and Disability sent a survey on recruitment and retention issues to one thousand direct support staff across the state.[8] Based on a review of the national research literature and guided by the Infrastructure Study Steering Committee representing key stakeholders,[9] the survey asked direct support staff for their opinions on three main issues:

Factors relating to recruitment to the jobs they now hold, including how they heard about their current jobs, factors that were important to them in selecting the job they hold, and their perceptions about the quantity and accuracy of information about their jobs given to them by provider agencies before they began work;

Their assessment of the state-mandated training program that all direct support staff in New Mexico are required by state regulation to complete in the first year of employment as direct support staff; and

Issues relating to factors that were important to them in deciding whether to remain in their jobs or seek employment elsewhere. In deciding on what factors to use in survey questions about retention, project staff used a 2001 survey distributed by the Long Term Services Division of the New Mexico Department of Health to executive directors of provider agencies asking what strategies they employed to retain staff. Asking direct support staff how important these strategies were to them would allow a direct comparison of what strategies agency heads indicated they were using with the perceived importance of these strategies to direct support staff.

Surveys were distributed to direct support staff on a proportional basis in each of the five LTSD regions to ensure that each region was adequately represented in the sample. Twenty-six surveys were returned as undeliverable or due to errors in identifying direct support staff. Two hundred and ninety one surveys were returned, for a net response rate of 30%. While lower than project staff had hoped, this survey represents the perceptions of the largest number of direct support staff in New Mexico to date relative to recruitment and retention.

At the same time that the survey was being reviewed, distributed and analyzed, project staff also completed three related tasks:

Interviews with twenty six key stakeholders in New Mexico, including system advocates, provider agency directors, parents of DD waiver recipients, and case management directors;[10]

Focus groups with seventeen consumers who are recipients of services provided by direct support staff;[11] and

A national review of “best practice” literature and key documents relative to recruitment and retention of direct support staff.[12]

Together, these sources of information about recruitment and retention of direct support staff in New Mexico represent a rich and comprehensive view “what matters” in the recruitment and retention of qualified, well-trained direct support staff.

g Findings

Profile Of Respondents

In general, numbers of direct support staff who responded to the survey were roughly proportionate to numbers of direct support staff in each region. The Southeast region was somewhat over-represented in the sample, while the Southwest and Northwest regions were slightly under-represented (Figure 1). Nearly three-quarters of respondents had High School or GEDs as their highest educational degree (Figure 2), while the overwhelming majority (97%) work for one agency full or part-time (Figure 3).

Finally, respondents have worked as direct support staff for an average of just over seven years.

The Challenge Of Recruiting “Premier Staff”

Introduction

Key stakeholders interviewed viewed the process of recruiting what one termed “premier”[13] direct support staff as a significant problem. However, there was a disconnect between the perceptions of agency staff interviewed and direct support staff who responded to the survey on the role that competition from other job opportunities plays in recruitment of direct support staff. A number of key stakeholders interviewed for this project commented on the difficulties they faced in recruiting direct support staff because of competition from other job opportunities. Typical comments included[14]

“Vacancies are high because an $8 per hour salary cannot compete with retail salaries or the hospital that pays $10”

“The economy here is so strong [it’s] tough for hiring because there are other jobs.”

“Anyone with knowledge of education can get more money doing other types of work. As long as there is competition in the area for workers, there will always be problems [recruiting staff].”

Direct support staff who responded to the survey, however, saw job opportunities in their communities with a somewhat different eye. When asked, “If you were to decide to look for another job in your community, how many other job opportunities are there?”, just over eighty percent (83%) said that there were “no”, “not many” or “some” job opportunities” (Figure 4).
Component 2

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