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Raising Wages for Direct Support Professionals

One of the most critical issues we are facing at Nishna Productions, Inc. is one that agencies across the state of Iowa are also facing: our most valuable resource – the direct support professional (DSP) – is undervalued and, often, overworked. DSPs provide mental health and disability supports and services. They provide supports to Iowans to live, learn and work in their communities, not institutions. Some of the supports include cooking, cleaning, budgeting, shopping, banking, job development and coaching, transportation, toileting and assisting with hygiene, and community activities. (IACP, Making a Difference Everyday)

Nearly every agency in Iowa that provides services like Nishna Productions has vacant staff positions at the most crucial level – working with the clients in direct care. Agencies have limited options when they are faced with workforce shortages: they can require current staff to work extended shifts; they can hire DSPs with no experience; or, they eliminate services they provide. Any of those options result in the agency being unable to accept addition referrals for services, diminished quality of services, reduced progress of individuals towards their goals, decreased access to individualized community services and exposure to possible harm. Additionally, employee morale and work ethic are impacted when they feel they are not being paid a fair wage or being valued.

It is no wonder then that the current DSP turnover rate has nearly doubled since 2015. State-wide, turnover rates of DSPs is 48% (IACP).

Raising wages is the first step in addressing the DSP workforce crisis. The graph illustrates average starting wages across Iowa for DSPs, as compared to a grocery store, a convenience store and to a fast-food restaurant. An additional comparison is made to the state-run institutions that also care for individuals with disabilities and/or mental health issues. The average rural DSP worker is making $10.94/hr.

What exactly does a DSP do for that $10.94? At NPI, the “Essential Functions” are listed as:

1. Provide quality care.

2. Transport individuals.

3. Provide training in daily living skills (i.e. meal preparation, laundry, cleaning, and personal hygiene).

4. Ensure that housekeeping standards are maintained.

5. Employees must be willing to work with individuals who have behavioral problems. Behavioral problems may include both verbal and physical aggression.

6. Provide a supportive and therapeutic atmosphere.

7. Administer medication and maintain accurate medication documentation, as needed, after being trained.

8. Exercise sound judgment when the situation requires immediate decision-making

9. Work according to assigned work schedule.

10. Complete written and electronic documentation and record keeping according to agency requirements.

11. Must be able to work independently and ensure the welfare and safety of persons served in a residential setting.

12. Comply with state and federal regulations regarding HIPAA (Health Insurance Portability and Accountability Act).

13. Assist individuals receiving services with their activities of daily living, such as, but not limited to; meal preparation, laundry, housekeeping, toileting, and bathing.

This list is by no means complete. Some clients require 24-hour care. Some clients need far more support than others (think feeding, toileting, dressing, etc.). And, for some clients, our staff is the only family they know.

It certainly doesn’t seem like $10.94 an hour comes close to the value these professionals provide to the lives of those for whom they care. Fortunately, at NPI, we were able to increase our starting wage to $14/hr. in 2019. We have made a very focused effort to care for our staff and to show them how much we appreciate all they do, which is why our turnover is about 8%. Other agencies that provide similar services are not so fortunate.

IACP recommends a 10% rate increase in Medicaid reimbursement rates with a 75% pass-through for wages going to DSPs directly supporting individuals receiving those services. When the state approves an increase in the budget, it is then met with Federal money. A $4/hour increase would raise the average DSP wage by $3.00.

Community-based service providers, such as Nishna Productions, offer lifelong supports and services, often 24-hours a day, 7 days a week, 365 days a year. Nearly all the services are funded through Medicaid with very little third party and private payment. These organizations employ more than 30,000 employees in Iowa, supporting over 160,000 Iowans in need of mental health and disability services. IACP members provide services in all 99 Iowa counties and annually contribute over $1.3 billion to Iowa’s economy.

It is imperative that we encourage our legislators to increase Iowa’s Medicaid dollars. This is money that is used to directly care for some of our most vulnerable citizens.

To learn more about how just one individual has been impacted by the low DSP wages and Medicaid reimbursement caps, go to

Please take some time today to contact your legislator and let them know how valuable our DSPs are and how Iowa needs to recognize that through better wages for them.

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