60% of IDD Providers Thinking About Shutting Down Services

The industry outlook for community-based intellectual and developmental disability (IDD) providers worsened in 2023.

Poll data from the nonprofit advocacy organization American Network of Community Options and Resources (ANCOR) shows that 60% of professionals polled at 581 organizations that operate in 45 states and the District of Columbia said that their organizations were likely to shut down programs, barring a shift in the high rates of turnover and shortages plaguing the sector.

“Notably, this is one of the few measures where the outcome in 2023 was actually worse than the outcome in 2022 — 9% worse, to be precise — which reinforces the fragility of gains that have been made in other areas,” the organization’s survey report states.


The report focuses on the shortage of direct support professionals (DSPs), a division of professions within the classification of direct care workers that with with IDD patients. DSPs’ duties may include caregiving. But they often go far beyond that, enabling their patients to live more dignified lives.

It’s hard to get a grasp on the size of the DSP workforce. The U.S. Bureau of Labor Statistics doesn’t track this occupation; multiple occupations may do DSP work. A close equivalent are home health and personal care aides. There were about 3.72 million in this field in 2022, according to BLS.

Other data shows that the shortage is not likely to improve in the near term based on demand dynamics.


Citing another report, ANCOR states that the demand for home-based care services is expected to increase by 35% in the next decade and add 1 million jobs for direct care workers to fill, including DSPs. All of which leaves a relatively small workforce for the IDD sector.

Here are other key stats from the survey report:

— 95% report “moderate or severe” staffing shortage in the previous year

— 77% turned away new referrals for lack of staff

— 72% struggled to establish quality standards due to staff challenges

— 54% work in areas with “few or no” similar service providers

For organizations that offer only IDD case management services, 75% reported they had difficulties connecting people with services because of a lack of local availability.

The report places unambiguous blame on the cause of the shortage: “underinvestment in Medicaid.” This puts DSP providers at a disadvantage compared to other industries with similar wage rates and structures, like retail and fast food. But unlike these industries, DSP providers and similar organizations are often forced to take payments set by public bodies rather than based on market dynamics.

“Providers want to pay more, but lack the funding needed to do so, leaving the median direct support professional with an hourly wage around $14.50,” the report states. “In turn, providers at the national level are left to grapple with turnover rates hovering around 44% and vacancy rates in excess of 20%.”

The report proposes three initiatives to aid the workforce situation and bills in Congress that could enact these ideas.

Increasing federal funding for state Medicaid programs to pay for home- and community-based services would better enable providers to compete for workers. The report highlights the HCBS Relief Act (S. 3118/H.R. 6296) and the Better Care Better Jobs Act (S. 100/H.R. 547).

Since the federal government doesn’t track DSPs, the report suggests establishing a standard occupational classification (SOC) for DSPs. SOCs are the language that the federal government uses to conceptualize and understand the American workforce.

It also calls for the passage of the Supporting Our Direct Care Workforce and Family Caregivers Act (S. 1298) and the Direct CARE Opportunity Act (H.R. 4720) to create a career pipeline for DSPs and better professionalize a still-developing occupation.

Companies featured in this article: