The CMS Community Rule and the
Raising Expectations of Direct
Support Professionals
October 27, 2014
Joseph M. Macbeth
Executive Director
National Alliance for Direct Support Professionals
New Federal Requirements
441.301(c) (4) – Optimizes, but
does not regiment, individual
initiative, autonomy, and
independence in making life
choices, including but not limited
to: daily activities, physical
environment, and with whom to
interact.
Proposed State Transition Plan
Deliverables:
“Identify, develop, and distribute
training tools and policy updates
that are needed for compliance”
Providers Must Ensure that Services are
furnished:
(i)
Under a written person-centered
service plan (also called plan of care)
that is based on a person-centered
approach
•Reflect risk factors and measures in place
to minimize them, including individualized
back-up plans and strategies when
needed.
•The individual will lead the personcentered planning process where possible
•Includes people chosen by the individual.
•Individual directs the process to the
maximum extent possible,
•Reflects cultural considerations of the
individual
National Alliance for Direct
Support Professionals (NADSP)
Actions To Complete For
Compliance
Direct Support Professionals
& the new CMS Regulations
• People have the freedom and support to control their
own schedules and activities, and have access to food
at any time.
• People are able to have visitors of their choosing at
any time.
• People have the freedom to furnish and decorate their
sleeping or living units
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professionals Must Ensure That:
Historically….
Now and in the Future….
• Primarily Seen as Caretaker
• Ambassador, Mentor &
Facilitator
• Focus on Custodial Care
• Culturally Competent
• Providing Companionship
• Close Interactions with
Families - often in Family
Settings
• Providing Coverage
• Primarily Focused on Health &
Safety Issues
• Entry-Level Job
• Supporting Informed
Decisions: Assessing RISK and
Facilitating Choice
• Possession of Complex Skills
National Alliance for Direct
Support Professionals (NADSP)
The Emerging Role of Direct Support
Professionals
Historically….
Now and in the Future….
• Follow the Plan
• Creating plans with People
they support
• Filling shifts
• Building meaningful
friendships & relationships
• Rely on readily available
supervision
• Inclusion – not recreation
• Community Outings
• System-Centered
Identification
• Advocating WITH – not FOR
people with disabilities
• Person-Centered
Identification
National Alliance for Direct
Support Professionals (NADSP)
Raising the Expectations of the Direct
Support Workforce
National Alliance for Direct
Support Professionals (NADSP)
Building & Maintaining Friendships
National Alliance for Direct
Support Professionals (NADSP)
Speaking of Inclusion & Disabilities
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professionals
Career Builder, 2014
Recent Trends in Direct Support
•
% change in employment (2012 – 2022): 48.8%
•
Number employed (2012): 1,190,600
•
Number employed (2022): 1,771,400
•
Median annual income: $19,190 ($9.23/hour)
•
Nationwide median of $34,750
•
The BLS expects that over 580,000 new jobs for Personal Care Aides will be
created in the decade through 2022
US Department of Labor, Bureau of Labor Statistics, 2014
National Alliance for Direct
Support Professionals (NADSP)
The Second Fastest Growing Occupation:
Personal Care Aides
Recent Trends in Direct Support
•
% change in employment (2012 – 2022): 48.5%
•
Number employed (2012): 875,100
•
Number employed (2022): 1,299,300
•
Median annual income: $20,820 ($10.01/hour)
•
Nationwide median of $34,750
•
The BLS expects that over 424,000 new jobs for Home Health Aides will be
created in the decade through 2022
US Department of Labor, Bureau of Labor Statistics, 2014
National Alliance for Direct
Support Professionals (NADSP)
The Third Fastest Growing Occupation:
Home Health Aides
• Cost per hire
• Long-term Supports and Services(2005):
$3,278 (UMN)
• Long-term Supports and Services(2011):
$6,000 (PHI)
Good Turnover? Bad Hiring…
National Alliance for Direct
Support Professionals (NADSP)
The Financial Cost of Turnover
“Decreasing turnover is about
sustaining quality”
The Other Costs of Turnover
• Services are fractured
Impact on Direct Support
Professional Workforce
• Forced overtime
• Personal growth is disrupted
• Activities and events are
canceled
• Increased medication errors and
other incidents
• Trusting relationships are broken
• Increased job stress
• Unsafe situations are created
impacting health & safety
• Reduced productivity
• Revolving door of strangers
performing the most intimate
interactions of daily life
• Deteriorating job satisfaction
• Burn Out
• Ultimately….More Turnover
National Alliance for Direct
Support Professionals (NADSP)
Impact on People with
Disabilities
“Preparing” Direct Support Professionals:
How Have We Done?
Teach me and I might remember.
Involve me and I will learn”.
- Chinese Proverb
National Alliance for Direct
Support Professionals (NADSP)
“Tell me and I will forget.
National Alliance for Direct
Support Professionals (NADSP)
Invest in Direct Support Professionals
“It is defined at the point of interaction
between the staff member and the individual
with a developmental disability.”
John F. Kennedy, Jr. (1995)
Chair, President’s Committee on Mental Retardation
Developmental Disabilities
Where are those at the point of interaction of service delivery
typically found on organizational charts?
National Alliance for Direct
Support Professionals (NADSP)
Where is Quality Defined?
Future Organizational Chart
Executive
& Admin
Staff
Direct
Support
Professionals
Clinical,
Middle
Management
& Other
Support Staff
Clinical,
Middle
Management
& Other
Support Staff
Direct
Support
Professionals
Executive
& Admin
Staff
National Alliance for Direct
Support Professionals (NADSP)
Typical Organizational Chart
Quality
Intersection
(Training Based on Research)
Ineffective
Practice
Values
(NADSP Code of Ethics)
Unethical
Practice
Quality
Support
Uninformed
of Best
Practice
Skills
(OPWDD Core
Competencies)
National Alliance for Direct
Support Professionals (NADSP)
Knowledge
The Five Elements of a Profession
Body
of
Knowledge
Code
of
Ethics
Universal
Skill
Standards
90,000 in NYS
License,
Certificate or
Credential
Affiliation with
Professional
Organization
Approximately 4 Million Cross-Sector
PHI, 2012
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professionals
“Not Ready for Apartment Living”
A DSP with Good Intentions
and the absence of a Code of Ethics
National Alliance for Direct
Support Professionals (NADSP)
A Day In the Life of a DSP…
Media and Public Policy in
New York State…
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professionals
and the Media
And finally, the big one…
“At state-run homes,
abuse and impunity”
The New York Times, New York
March 12, 2011
National Alliance for Direct Support
Professionals (NADSP)
Which led to…..
“Legislative Leaders Announce Agreement on Legislation to
(New York Times, June 18, 2012)
Legislation Establishes Justice Center for the Protection
of People with Special Needs to Prevent, Investigate and
Prosecute Abuse and Neglect of Vulnerable New Yorkers
National Alliance for Direct
Support Professionals (NADSP)
Protect People with Special Needs and Disabilities”
Closing the Barn Door after the
horse has bolted.
Legislation that focuses on
Prosecution is NOT considering
Prevention & Building Excellence
National Alliance for Direct
Support Professionals (NADSP)
Which is sort of like…
“Direct Support jobs are compensated poorly, with
many workers living at or near the poverty level or
forced to work multiple jobs to make ends meet. One
might summarize the job description of the direct
support worker as requiring the wisdom of Solomon, the
patience of Job and the caring of Florence Nightingale…
While much is said about the value of these direct
support jobs, the traditional hallmarks of value are often
missing – qualifying credentials, adequate pay, career
ladders, attention to working conditions, adequate
training, managerial and supervisory support and so
on…”
The Measure of a Society: Protection of Vulnerable Persons in
Residential Facilities Against Abuse & Neglect . Clarence J. Sundram,
National Alliance for Direct Support
2012
Professionals
National Alliance for Direct
Support Professionals (NADSP)
But it also led to this….
“Take Me Out to the Ball
Game”
A Nice Afternoon
National Alliance for Direct
Support Professionals (NADSP)
A Day In the Life of a DSP…
C -Citizen
H -Harm/Risk
O -Opportunities
I -Informed Decision
C -Community
E -Experience
National Alliance for Direct
Support Professionals (NADSP)
CHOICE
National Alliance for Direct
Support Professionals (NADSP)
CHOICE
EXPERIENCE
We all learn by
experience-usually, its bad
experience…
People we support need
opportunities to
EXPERIENCE different
options in order to
establish a preference.
Those options may and
will include some degree
of risk!
National Alliance for Direct
Support Professionals (NADSP)
Something we get just
after we needed it…
Five Steps to the Decision
Making Process
2-Gather information and
resources
3-List Options/Choices &
Evaluate
4-Consider Outcomes
(Risk/Reward)
5-Make a decision & plan
of action-Reflect on the
decision
National Alliance for Direct
Support Professionals (NADSP)
1-Define the
problem/situation
Working on writing his
autobiography
Getting tattoos
Jumping out of
airplanes
Living his life, on his
terms
“The System opens the door to community; direct support
professionals help people go through that door.
National Alliance for Direct
Support Professionals (NADSP)
ED: Nearly 25 Years Later
DSPs will be critical in
supporting people in
learning to make
Informed Decisions
DSPs must learn about
Person-Centered
Planning, Risk Planning,
Code of Ethics, Social
Capital, the Informed
Decision Making
Process and more……
National Alliance for Direct
Support Professionals (NADSP)
Direct Support Professional’s Role in
Informed Decision Making
National Alliance for Direct
Support Professionals (NADSP)
OPWDD Regional Centers for
Workforce Development (RCWT)
OPWDD Regional Centers for
Workforce Development (RCWT)
“The core competencies are not a training program; they
represent the day-to-day valuable work that DSPs perform
when serving individuals with developmental disabilities.
Coupled with the recently adopted National Alliance of Direct
Support Professionals’ Code of Ethics, the standardized DSP
competencies will help set standards for quality supports and
services; provide guidance for DSPs; promote professionalism;
standardize DSP skills; improve service provision; and save
training costs”.
Commissioner Courtney Burke
National Alliance for Direct
Support Professionals (NADSP)
OPWDD Core Competencies
OPWDD Regional Centers for
Workforce Development (RCWT)
“The Code of Ethics developed through the National Alliance for
Direct Support Professionals (NADSP) guides DSPs through the
ethical dilemmas they face daily and encourages the highest
professional ideals. Direct support staff, agency leaders,
policymakers, and people receiving services are urged to read the
code and to consider ways that these ethical statements can be
incorporated into daily practice. This code is not the handbook of
the profession, but rather a roadmap to assist in staying the
course of securing freedom, justice, and equality for all”.
National Alliance for Direct Support Professionals
National Alliance for Direct
Support Professionals (NADSP)
Code of Ethics for Direct Support Professionals
NY State OPWDD Direct Support
Core Competencies
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
Supporting a person’s unique
capacities, personality and
potential
Getting to know the person
through assessment and discovery
Promoting advocacy with the
individual
Facilitating personal growth and
development
Facilitation of supports and
services
Building and maintaining
relationships
Creating meaningful
communication
Developing professional
relationships
Exhibiting professional behavior
Showing respect for diversity ad
inclusion
Creating meaningful
L. Education, training and self-development
activities
M. Organizational participation
N. Exhibiting ethical behavior on the job
O. Promoting positive behavior and supports
P. Supporting Health and Wellness
Q. Preventing, recognizing and reporting
abuse
R. Supporting crisis prevention, intervention
and resolution
S. Supporting safety
T. Ensuring safety of individuals during
environmental emergencies
U. Supporting people to live in a home of
their own choice
V. Supporting ACTIVE participation in the
community
W. Supporting employment, educational and
career goal attainment
National Alliance for Direct
Support Professionals (NADSP)
A.
The NADSP Code of Ethics
Adopted by New
York in 2012
Adopted by New
Hampshire in
2014
Universally
Accepted
National Alliance for Direct
Support Professionals( NADSP)
Developed by
NADSP in 2001
Every day Direct Support Professionals
help make decisions with the people
they support.
Decisions based on what one thinks is
ok, good or right will lead to a slippery
slope into possible unethical practice.
National Alliance for Direct
Support Professionals (NADSP)
WHY must we consider Ethics in the
role of Direct Support Professionals?
National Alliance for Direct
Support Professionals (NADSP)
Code of Ethics Word Cloud
OPWDD Regional Centers for
Workforce Development (RCWT)
• “The Why and The How” Seminars: A Series of Two Day
Sessions in each RCWT
• Building Workforce Champions and Skill Mentors in Regions
and Provider Organization
• Baseline and Periodic Surveys to Measure Organizational BuyIn and Implementation
• Website and Resource Sharing Network
• Technical Assistance
• Engaging Other Stakeholders (Families and People with
Disabilities)
National Alliance for Direct
Support Professionals (NADSP)
Rolling Out the Code of Ethics and Core Competencies
OPWDD Regional Centers for
Workforce Development (RCWT)
Region 2 (North) Contact – Suzanne Lavigne, Citizen Advocates:
suzannelavigne@citizenadvocates.net
Region 2 (South), 3, 4 & 5 Contact – Kirsten Sanchirico,
NYSACRA: kirstens@nysacra.org
OPWDD Contact: Regis Obijiski, Deputy Director of Workforce
Transformation: regis.m.obijiski@opwdd.ny.gov
National Alliance for Direct
Support Professionals (NADSP)
Region 1 Contact - Katie O’Donnell, Finger Lakes Collaborative:
kodonnell@arcmonroe.org
OPWDD Regional Centers for
Workforce Development (RCWT)
Please Join Part Two of this Webinar
Implementing a Comprehensive Direct Support Development Initiative:
Monarch of North Carolina's – 2014 Moving Mountains Award
Peggy Terhune, PhD, CEO and President, Monarch of North Carolina
Dr. Terhune will share Monarch's comprehensive initiatives in direct support
professional workforce development. Monarch, a statewide provider of cross-sector
services in North Carolina that has been accredited by The Council on Quality and
Leadership - CQL for many years is the 2014 Moving Mountains Award Winner. Topics
will include Monarch's recruitment & retention strategies, staff development & career
ladder opportunities, recognition strategies and organizational culture - all of which
lead to quality outcomes for people receiving services by the organization. This webinar
will discuss how other organizations can begin to transform the expectations and
responsibilities of its direct support workforce.
National Alliance for Direct
Support Professionals (NADSP)
November 13th @ 3:00
Customized Trainings, One-Day Workshops and
Culture of Direct Support Competency Technical
Assistance
Join us on Facebook!
YES, We’re on YouTube
Follow us on Twitter @NADSPINC
jmacbeth@nadsp.org
National Alliance for Direct
Support Professionals (NADSP)
Join Our Membership at www.nadsp.org!