Agencies serving disabled struggle to retain workers who form their ‘heart and soul’


JOHNSON CITY, Tenn. (WJHL) – Tina Fields let out a hearty cheer as Paul Britt’s cornhole bag dropped neatly into the target on an overcast Friday afternoon.

Fresh from his two-hour shift at a local convenience store and coming off a quick lunch, Britt — like housemate Max Brandon, was decked out in University of Tennessee orange on a fall-like day.

Without direct support professionals like Fields, the lives of Britt, Brandon and thousands of other intellectual and developmentally disabled people across Tennessee would be much different. DSPs, as they’re called, are cooks, counselors, job coaches, nurses, housekeepers and companions all in one.

“I’m very happy when I walk in,” Fields said of the work she’s done for 17 years. “They’re ready for hugs and kisses, and I feel like I’m making a difference in their lives, so it has become a very rewarding job.”

Tina Fields

Those rewards don’t extend to competitive compensation, though. Most DSPs are paid between $10 and $11 an hour. That includes Fields, who has a bachelor’s degree and has worked on a hospital psych unit and operated a small business with her late husband.

Steve Cox is CEO of Dawn of Hope, the agency that employs Fields and serves Brandon and Britt. He said agencies across Tennessee have advocated for years to gain wage increases for the people he called “the heart and soul and the front line of what every provider like Dawn of Hope does.”

But providers are losing DSPs and having a devil of a time replacing them. Dawn of Hope is down 30 DSPs since COVID-19 hit. The agency has about 110 and needs about 150.

“People just aren’t applying for these kinds of jobs, especially when there are other alternatives out there that provide better wages,” Cox said. “When you can go to Walmart or Target and make between $11 and $15 an hour, or to our good friends AO Smith across the street from our center and make almost $17, you can see it’s hard to find DSPs for $10 an hour to do the work they do.”

That work involves a broad range of skills, requires significant training and is best done by people with a heart for it, Cox said.

Dawn of Hope CEO Steve Cox

“They provide job coaching for people who want to access and find employment, they dispense medications, they chart and document, they provide meal preparation for people with very specialized dietary needs, they provide transportation and they provide very intensive housekeeping,” Cox said.

“And they don’t just do one of those things at a time. They do all of them in the same shift, sometimes within the same hour. I don’t know any other profession that does all of those things, and certainly not for $10 an hour.”

But once they’re hooked, they’re hooked — as long as they can afford to stay.

“We are part of their family and they become part of our family,” Fields said. “I look forward to coming to work.”

That’s despite some real challenges, she said.

“I work in a house that has behaviors and sometimes it’s not easy. It becomes kind of scary sometimes. But I’ve learned to help them along and encourage them. It’s a coaching type job, too, where you’re coaching them to make better decisions.”

From his position, Cox has seen the field become a life-changer for people.

“They don’t look at life the same way they did before they found this field,” he said. “It’s a very special calling. It takes a very special person with a very big heart to do this work.”

Big heart, small paycheck

Even the $10 figure is a relatively recent occurrence.

Cox said he and colleagues at Tennessee Community Organizations (TNCO) — where he is president-elect — appreciate the efforts state legislators make to find money for increases. In general he described “good legislative support for the needs of providers” in Northeast Tennessee.

Several years ago the state raised rates. And when legislators were looking at yet another year of robust state tax revenues in February, TNCO leaders were hopeful that a campaign for another bump would succeed, at least in part.

Max Brandon, left, and Paul Britt with direct support professional Tina Fields outside Brandon and Britt’s home in Piney Flats, Tenn.

“The ultimate goal would be if we could get DSP wages up to $15 an hour at a minimum,” Cox said.

A 2017 report to the Trump administration from the President’s Committee for People with Intellectual Disabilities said “challenges in finding, keeping and training this workforce persist and have reached crisis levels…”

The report noted the pipeline for workers wasn’t keeping pace with demand and cited the following:

  • Average wages of $10.72 an hour — below poverty level for a family of four;
  • Half of DSPs relying on government-funded and means-tested benefits (such as food stamps, Section 8 rent);
  • Most DSPs working two or three jobs;
  • Average turnover rates of 45 percent and vacancy rates of 9 percent.

Those facts leave people like Fields, with grown children who are out of the house, among the only ones who can feasibly stay in DSP jobs.

“It’s not until after your families have grown and you’re taking care of yourself only that you’re able to do something like this,” she said. “That’s terrible to say, but it’s the truth.

“The people who do this job are very valuable. They make a huge difference in these people’s lives and they should be compensated for it.”

Cox said the sad days when a high-quality, well-loved DSP leaves the Dawn of Hope fold are far too common.

“That’s an all too true and sad story that all providers in Tennessee experience is, many good DSPs, great DSPs leave because the needs of their family require more money than what providers are able to pay them,” he said.

“It’s very unfortunate not just for providers and staffing but it’s extremely unfortunate for the people we support, because they get attached to our staff just like our staff get attached to them.”

In Tennessee, funding comes primarily through TennCare. That means the $100 million annually Cox said could achieve that $15 an hour mark would cost about $34 million in state dollars and be matched two-thirds by the feds.

The onset of COVID-19 blew this year’s hope out of the water. It also made work at agencies and for DSPs even harder — serving a medically vulnerable population of people, many of whom crave daily opportunities to be at work or engaged in community activities.

Cox said some changes at the state level are projected to generate an additional $34 million in tax revenue that could be directed to the Department of Intellectual and Developmental Disabilities.

“We’re very hopeful that at least some if not all of that could be used to help fund much-deserved and desperately needed DSP wages,” Cox said. “We would be extremely grateful for anything like that.”

Fields has a message to legislators and taxpayers about her profession.

“They need us as a staff to take care of these people, help these people, because they need somebody here — and we also have to live.”

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