TennCare is partnering with Tennessee Community Organizations (TNCO) and the Institute on Community Integration (ICI) at the University of Minnesota to conduct an annual statewide survey about the direct support workforce in Tennessee. The survey is a key component of a comprehensive workforce strategy in the Quality Improvement in Long-Term Services and Supports (QuILTSS) Initiative.

The 2018 survey (year 1) collected data from calendar year 2018, and the 2019 survey (year 2) collected data from calendar year 2019. The survey results for each year are described in a survey report and depicted in state and regional profiles.

Data gathered from the 2018 survey are informing ongoing discussions and planning with organizations around strategies to find and keep good employees and enhance access to home and community-based services (HCBS) for people with intellectual and developmental disabilities in Tennessee. State and regional results of the 2019 survey will again be shared with TennCare, TNCO, and others to inform efforts for seeking solutions to direct support workforce challenges in Tennessee and to measure progress over time.

Survey Guidance Webinar

The following webinar describes the 2019 annual survey and explains how to complete each section.

Video from the Web version of this publication:

TENNcare Year 2 Survey Webinar: https://www.youtube.com/embed/pNylzaEx2_E

Webinar Q&A

March 9, 2020

What is the definition of a direct support professional (DSP)?

DSPs are employees whose primary responsibilities include providing support, training, supervision, and personal assistance to people with disabilities. They have titles such as direct care worker, family model provider (FMP), house manager with primarily direct care duties, residential aide, job coach, home health aide, personal care assistant, and many other titles. At least 50% of a DSP’s hours are spent in direct support tasks (e.g., personal care, home care, community integration). DSPs may perform some supervisory tasks, but the focus of his/her job is direct support work. Nursing and other professional licensed staff (e.g., LPNs and RNs) are NOT considered DSPs. Unless specifically noted, do not include workers whose position is only on-call (those who do not have any regularly scheduled hours).

What is the definition of a frontline supervisor (FLS)?

Frontline supervisors (FLS) are employees whose primary responsibility (more than 50% of their role) is the supervision of DSPs, including family model providers. While these individuals may perform direct support tasks, their primary job duty is to supervise employees and manage programs. They are not viewed by the organization as DSPs and may include house managers if their duties are not primarily direct support. These individuals may or may not be in licensed or degreed positions (such as a nurse), but the organization views their role as guiding and directing the work of the direct support worker more than 50% of their time.

We hired frontline supervisors (FLS) to provide supervision duties for more than 50% of the time per their job description, but they have been working as DSPs for more than 50% of the time because of staff shortage. Do we consider them a FLS or a DSP?  

We request that a person within an organization be counted as either a DSP or FLS for this survey. They should not be counted as both a DSP and FLS. Organizations will need to determine if they want to consider FLS who may be working as DSPs for more than 50% of their time due to staffing shortage as FLS or DSPs. Part of this decision may be determined based on how wages are paid, benefits are provided, and so fourth, so that other questions in the survey may be answered accordingly. 

Our DSPs are family model providers (FMPs) who receive a 1099 tax form. All of our FMPs are independent contractors who are not on payroll or receive an hourly rate. How do we report their wages on the survey?  

Family model providers are part of our direct support workforce, and we want organizations to report on them as DSPs. If a DSP works regular hours, even if they are contractors, they would be considered either full-time or part-time employees based on the number of hours they worked each week. They would NOT be considered temporary. The differentiation is that they work regular hours while a temporary/on-call/relief employee does not. Please include 1099 and other contract employees if they work regular hours.  

If these employees are not paid hourly, please take their salary and divide by the number of hours they work in a year to come up with an hourly wage. If you are unable to provide this information, you may skip the question. Please provide as much information as possible about all of your DSPs, including family model providers.

Question 13 (of the survey): Do you have a definition of full-time? For example, we have three classes of employees: full-time (40 or more hours), part-time with over 30 hours, and part-time. Would we include "part-time with over 30 hours" with full-time or part-time?  

We recognize that organizations may have different definitions of what is considered full-time.  Because of this, we would ask that you use your definition of full-time.  For the example given, it sounds like full-time is those who work 40 or more hours, which is the 4th response option for Question 13. There is also an option to select “Other” in order to provide your organization’s specific definition of full-time if none of the response options are adequate.  

Question 18: Wages by service type. I have a lot of DSPs across service types and am not sure how to compute an average of their wage. What should I do?  

We would like you to provide wage information specific to the service types.  To compute the average, please add the wages across all DSPS within a specific service type and divide by the total number of DSPs in that service type.  We recognize that many organizations have DSPs that work across service types and that these calculations may be complicated. If you are unable to provide the data in this way or feel it may not be accurate, please leave the items blank.

Question 24: If DSPs start at one salary and increase in two weeks after completing their required training, would this be considered a bonus or just a rate adjustment?  

Question 24 asks specifically about a monetary hiring bonus for newly hired DSPs. A hiring bonus is an extra amount of money provided at time of hire as an incentive to an applicant to accept a job offer or to make up for compensation forfeited at the previous company. Question 20 asks specifically about an hourly wage increase for DSPs once training is completed. In the example given, it sounds like it would be a rate adjustment (question 20) rather than a hiring bonus (question 24).

Question 28: The average number of hours worked per week. How do I calculate this? Do I report the total number of hours or average number of hours per DSP?  

We are looking for the average number of hours worked per week per DSP. You would add up the number of hours worked across all DSPs in a week and divide by the number of DSPs. If you can split it by part-time and full-time DSPs, you would also do this calculation for them separately.  

Questions 47 & 48: Health insurance. What if the organization’s and employee’s health insurance contribution is based on the age of the employee (DSP)?  

If there is not a specific contribution for each type of health insurance coverage, please compute an average contribution cost for each of the health insurance coverage types.