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Minnesotans in every region of the state are struggling to recruit and retain direct support professionals (DSPs). DSPs are workers who provide critical support to older adults, people with disabilities and people with mental health care needs. Although their services are essential to the health and well-being of many Minnesotans, numerous positions remain unfilled and shortages are predicted to get worse over the next 10 years.
The workforce crisis prevents access to services, can be a factor in abuse, neglect and injury incidents, and contributes to people living in facilities. For example, between 2020 and 2022, more than 50 Minnesotans reported each year they moved into nursing homes because they could not find a caregiver to provide in-home services. Many elderly family members are caring for their adult children and worry about what will happen when they are no longer able to provide support.
While DHS is not able to control many of the contributing factors to this staffing crisis, the department strives to provide resources, information and collaboration with others to address the shortage.
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DSPs are commonly called support staff, direct care workers, personal care assistants, etc. The titles for these workers vary by the more than 10,000 provider organizations in home and community-based services for which they work. DSPs work in a variety of settings, including family homes, individual homes, small community group homes, vocational and day programs, care facilities, as well as other locations.
These professionals provide various services to support children and adults with disabilities or illness. While the exact duties vary with each position, a DSP typically is skilled at using many effective support strategies. Some DSPs assist with personal cares and activities of daily living, such as feeding, bathing, dressing, grooming, toileting and ambulation (walking from place to place independently) while others assist people at jobs, prepare meals, provide transportation, complete light housekeeping and administer medications and treatments. DSPs might also prevent and respond to challenging behaviors, collect data, carry out therapy recommendations, support people in using assistive technology and many other tasks.
DSPs help people to increase their independence and be more included in community life. Their work requires creativity, flexibility, dedication, problem-solving skills and compassion.
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In April 2017, the Olmstead Subcabinet told DHS and DEED to form a multiagency workgroup to develop recommendations for expanding, diversifying and improving Minnesota’s direct care and support workforce.
The group's official name is the Direct Care Workforce Stakeholder Group, previously known as the Direct Care Workforce Shortage Cross Agency Steering Team. The workgroup identified seven priorities (listed below), and works with partners and providers to attract more workers into this field.
Workgroup representatives
While individual representatives change periodically, the following organizations and stakeholders are regular members and helped to develop the seven priorities listed below:
- People who rely on direct support professionals for care
- Family members of people who rely on services
- People who work as direct support professionals
- Disability leaders and advocates
- Employers and service providers
- Governor’s Workforce Development Board
- Minnesota State University
- University of Minnesota
- Minnesota Department of Employment and Economic Development (DEED)
- Minnesota Department of Human Services (DHS)
- Minnesota Department of Health (MDH)
The seven priorities
We have listed the priorities in order of importance, with Priority 1 containing strategies the workgroup found most important. We drew these strategies from research, personal experiences and expertise both within Minnesota and nationally.
While DHS and DEED support these priorities, state agencies do not have the authority to implement all of them. For example, increasing the reimbursement rates for provider agencies so they can increase wages and benefits is reliant on the state budget and legislative action. Some priorities will require partner groups, such as other government agencies, service providers, educational facilities, businesses, etc., to move forward.
Priority 1: Increase worker wages and/or benefits
Strategies:
- Provide a livable wage to enhance job satisfaction and retention, and address statutory limits on reimbursement rates that make it difficult for service providers to pay direct support professionals a livable wage.
- Assess the potential of creating an employee pool group consisting of direct support professionals throughout the state to achieve the best possible health coverage at the most affordable price.
Priority 2: Expand the worker pool to ensure that people with disabilities have the workforce they need to live, learn, work and enjoy life in the most integrated setting
Strategies:
- Expand the worker pool to non-traditional candidates.
- Explore options to address transportation barriers for direct support professionals and the people who depend on their services.
- Provide resources to help organizations use recruitment and retention strategies known to increase the quality of candidates hired.
- Develop a service corps through partnerships with colleges, universities, and/or private partners.
- Develop apprenticeship opportunities.
Priority 3: Improve the workforce by enhancing training for direct support professionals
Strategies:
- Assess the value of developing a training and scholarship program consistent with DEED’s career pathway model.
- Promote use of existing training and development options.
Priority 4: Increase job satisfaction (including quality of the job)
Strategies:
- Ensure access to effective supervision.
Priority 5: Raise public awareness by promoting direct care and support careers
Strategies:
- Leverage Minnesota's career, training and business services to develop a statewide recruitment and promotional plan to attract job-seekers to direct care and support careers.
- Create a recruitment and retention guide, promotional materials and public service announcements on direct care and support careers, targeted to potential workers.
- Develop an educational awareness plan on direct care and support careers targeted to high school students.
Priority 6: Promote service innovation
Strategies:
- Identify and promote the use of technology solutions.
- Examine possible policy or regulatory barriers to the employment of potential workers or the accessibility of services by the people who need them.
Priority 7: Enhance data collection
Strategies:
- Regularly gather and report direct care and support workforce data across long-term services and supports in Minnesota.
- Identify ongoing data needs for monitoring workforce issues.
- Gather and report annual direct care and support workforce data across service types and groups of people who receive long-term services and supports.
- Monitor improvements or worsening of the workforce issues based on baseline data.
- Provide funding to allow monitoring of the relationship between critical incidents, return to institutionalization and emergency room visits based on reductions or increases in vacancy and turnover rates.
- Articulate an ideal monitoring system and data needs, determine existing data sources and gaps.
More information
Find more information about the priorities, such as research history and key activity and outcome details, in:
Historical information
In 2016, DHS held a one-day summit to collaborate with community partners on workforce shortage issues. Details of that summit can be found in the Direct Care/Support Workforce Summit Summary Report and Next Steps (PDF). From that summit, DHS published a directory of leaders in 2017 to help connect people and organizations with other people willing to lead workforce shortage projects (leaders were identified through an online interest survey conducted in late 2016). This work helped inform some of the priorities identified by the Direct Care Workforce Stakeholder Group.
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Data from the Minnesota Department of Human Services
Data from the Minnesota Department of Employment and Economic Development
Data from the Minnesota Department of Health
Data from the federal government
People who provide care
Women, people of color and immigrants are disproportionally represented in the direct care workforce compared to overall populations:
- 7 percent of Minnesota’s population identifies as black or African American. However, black workers constitute 22.7 percent of personal care aides and 20.5 percent of nursing, psychiatric and home health aides in Minnesota (DEED: Minnesota's Black Labor Force).
- While people of color make up 40 percent of the total U.S. labor force, they constitute 63 percent of all home care workers, 60 percent of residential care aides and 58 percent of all nursing assistants in nursing homes. (PHI Direct Care Workers in the United States 2022).
- While immigrants make up 16 percent of the total labor force, they constitute 31 percent of the home care workforce, 22 percent of the residential care aide workforce and 22 percent of the nursing assistant workforce (PHI Direct Care Workers in the United States 2022).
- Women hold 76% of all health care jobs (Census.gov: Your Health Care Is in Women’s Hands). 87.5% of home health aides and 81.5% of personal care aides are women (U.S. Department of Labor: Employment and Earnings by Occupation). 90.4% of nurses in Minnesota are female (Minnesota Board of Nursing: Workforce Data Report March 2022).
