Public and private agencies that serve people with developmental disabilities say they are embracing various initiatives — from recruitment campaigns to longevity pay and an emphasis on the emotional rewards — to attract the workers the system so desperately needs.
"Opportunities like ours are an opportunity to change lives, as well as your own," said Matt Hobbs of Boundless, a Columbus-based nonprofit agency. "You are the facilitator of a smile. You are the happiness in someone's day. And with a lot of people, that really does strike a chord."
Boundless is participating in DSPOhio, a new statewide effort to link employers and job seekers interested in becoming DSPs, or "direct support professionals."
The DSPOhio.org website has job descriptions, videos and county-by-county listings of participating companies and nonprofit organizations that are looking for employees.
"We've got to go on the offense; we've got to introduce our system," said Mark Davis, president of the Ohio Provider Resource Association. "Outside this system, how many people even know what a DSP is?"
The association launched DSPOhio with support from the state and several county boards of developmental disabilities. John Martin, director of the Ohio Department of Developmental Disabilities, said the idea was fairly grassroots. "It was born of, 'How do we make people more aware of this profession?' " said Martin, who once worked as a direct-support provider.
Though the pay remains low, especially in relation to the responsibility, wages have increased some in the past few years and more agencies are offering benefits. They still need to do a better job selling themselves, said the provider association's Jeff Davis.
"One of the ways in which a provider described the job was, 'housekeeping, bathing, cooking,' " he said. "Would you want that? The job is fundamentally about supporting an individual to help them be all that they can be."
That's true, said Gary Tonks, executive director of The ARC of Ohio, a statewide membership association that represents more than 300,000 people with intellectual and developmental disabilities and their family members.
But he sees no reason not to be up front about the all the tasks that need to be done to fulfill the rights of people with disabilities to be safe, healthy and live with dignity. "I talk about pee and poop, about changing menstrual pads," Tonks said. "Do that and you get a real good sense of the quality of the (potential) staff."
Personality is paramount. "The quality of the agency is only as good as the person they send you that day," Tonks said.
The ARC recently began employing direct-support providers and last year served more than 50 families. "We didn't want to, but people were begging us," Tonks said.
Those who work through the ARC often are friends or acquaintances, fellow church members or neighbors, willing to help out someone they know but not interested in applying to work at a typical disability-services agency. At first, Tonks expected many of them to start at the ARC, obtain training and then become independent providers, or contractors who can bill Medicaid directly for their services.
Most have opted to stay. The ARC pays about $11 an hour and doesn't ask for non-compete clauses. The arrangement, Tonks said, has helped several families keep consistent providers.
"I've been doing this for 40 years, and turnover has always been high," he said. "But now we have more people with disabilities than ever, and more competition for jobs."
The demand is such that alternatives to traditional provider-consumer relationship will need to grow, Tonks said. Shared living is popular in some states — it used to be called adult foster care — and technology is expected to play a greater role with remote monitoring and oversight.
"One of the big pushes, and for good reason, is to try to look at other ways of delivering services when appropriate," said Jed Morison, superintendent of the Franklin County Board of Developmental Disabilities.
In Fairfield County, the local disabilities board is developing an "excellence network" to work with agencies on a common vision and set of values, Superintendent John Pekar said. He sees it as a way to strengthen cooperation in the new era of outsourcing and privatization — services once the domain of county disabilities boards are shifting to private companies and nonprofits.
County boards cannot subsidize those provider agencies, but there are other ways to help "in return for someone guaranteeing that they will work their butts off to provide high-quality services," Pekar said.
Some advocates also think the provider landscape could be improved if county boards had more authority over the quality of services — a means to step in when agencies operate below acceptable standards. "The interesting thing is, I think most people expect us to have that authority," Pekar said.
The hardest thing to address in a big way, of course, is pay.
"Unless something radical is done on the pay side, I'm not sure we're going to have enough people to work in this field," Pekar said. "We're dancing as fast as we can here. But at the end of the day, our excellence network is not going to be the answer unless we can pair it with higher rates."