This survey is a continuation of TennCare’s Quality Improvement in Long-Term Services and Supports (QuILTSS) Initiative project that included a collaboration between TennCare, Tennessee Community Organizations (TNCO) and the Institute on Community Integration (ICI) to address workforce challenges for direct support professionals (DSPs) in Tennessee. This annual survey has been a key component of a comprehensive workforce strategy in the Quality Improvement in Long-Term Services and Supports (QuILTSS) Initiative. As part of this comprehensive effort, data gathered from the first three years of the survey are informing ongoing discussions and planning about wages, benefits, and ways to recruit and retain good employees and enhance access to home and community-based services (HCBS) for people with intellectual and developmental disabilities in Tennessee. During the 3-year initiative, participating organizations received a data summary about the direct support workforce in their organization. Participating organizations also had the opportunity to take advantage of training and technical assistance from ICI workforce consultants and TN workforce coaches to identify and address at least one key challenge that their organization faces to improve their direct support workforce turnover and retention rates.

This year 4 survey is collecting data from calendar year 2021. The survey results for each year are described in a survey report and depicted in state and regional profiles. 131 organizations in Tennessee responded to the survey that asked questions about their caregivers/direct support professionals (DSPs) and frontline supervisors (FLSs).

For more information about the University of Minnesota’s efforts on the QuILTSS Workforce Initiative, please contact

2021 Survey Report

This report provides an overview of state level data. State and regional profiles are available in Appendix A. Survey items were analyzed by region when there was a large enough sample size for analysis. Unless otherwise specified, responses to survey questions reflect calendar year 2021. Most of the report focuses on the results from year 4. The last sections of the report present a summary of the changes from year 1 to year 3, an overview of training and consultation activities, and the impact of COVID-19 on organizations. While there were 131 organizations that participated in the survey, not all organizations answered all questions.

View the 2021 Survey Report

The 2021 Direct Support Workforce state and regional profiles for Tennessee provide an overview of the direct support workforce for the 131 organizations in Tennessee that responded to the survey. This overview includes data on staffing, wages, direct support professional turnover and vacancy, and other key data points from information collected in the survey.

Use the buttons below to view the Tennessee state and regional profiles.


View the Tennessee state profile.

East Region

View the Tennessee east region profile.

Middle Region

View the Tennessee middle region profile.

West Region

View the Tennessee west region profile.

2021 Survey Kickoff

Note: The 2021 Workforce Survey has closed. Please contact if you have any questions.

The Institute on Community Integration at the University of Minnesota, in partnership with Amerigroup, BlueCare Tennessee, UnitedHealthcare, and TennCare, conducted the annual statewide survey about the caregiver and direct support workforce in Tennessee. The survey is a key component of a comprehensive workforce strategy in the QuILTSS Initiative. Data gathered from the previous years’ surveys are informing ongoing discussions and efforts to improve the recruitment, selection, and retention of high-quality employees to enhance home and community-based services for seniors and people with disabilities in Tennessee.

The 2021 survey (year 4) is collecting data from calendar year 2021. The 2018 survey (year 1) collected data from calendar year 2018, the 2019 survey (year 2) collected data from calendar year 2019, and the 2020 (year 3) survey collected data from calendar year 2020. The survey results for each year are described in a survey report and depicted in state and regional profiles.

Your involvement and willingness to participate in this survey is voluntary. Partaking in this survey will provide you with important data to target your improvement efforts and to measure your agency’s progress over time. Your agency’s contributions also help to inform future workforce initiatives that may include development of additional workforce tools and supportive training opportunities to address the workforce crisis.

Survey Guidance Webinar

We hosted a webinar on June 8, 2022 to provide an overview of the 2021 survey and clarify how to complete items in the survey. The webinar was recorded for people who are unable to attend and for attendees to review the information as they complete the survey. The recording, along with the questions asked during the webinar, is listed below.

Video from the Web version of this publication:

QuILTSS Workforce Initiative Year 4 2021 Survey Webinar:

Frequently Asked Questions

If you did not get a link to the survey, please email with your organization name to request a link. We will respond within 24 hours. You can also access a paper copy of the survey at

Does the online version of the survey save? Can I come back and make edits?

You can leave and re-enter your survey as often as you would like, using your personal link. Once you submit, you cannot make edits to the survey. Do not click submit until your survey is fully complete.

Will the slide deck be distributed for use?

You can view the webinar in the video above on YouTube. This page is also where you will be able to find the report and the state and regional profiles later this year. Your organization will receive your personalized profile, but this will not be publicly available.

I just took another survey called the National Core Indicators Staff Stability Survey (NCI-SS). Why do I need to take both?

You may have been asked to complete the National Core Indicators Staff Stability Survey (NCI-SS) sometime between February and June. QulLTSS is in the field from June through July.  With the QulLTSS Survey, each organization that submits data will get a summary of your key data points to use throughout the year as you look for workforce strategies to implement to improve workforce recruitment and retention. The QuILTSS survey also provides organizations with regional-level and state-level data to compare their own workforce data to. You do not receive organizational-level data from NCI-SS. Note that while some organizations will need to fill out two surveys, many of the items on the NCI-SS survey overlap with those on the QulLTSS survey. 

How is this data useful or beneficial?

The survey results will be reviewed annually by MCOs and other key stakeholders in Tennessee to help inform future workforce work throughout the state. Providers benefit from this data, as your organization will receive your own profile for your own use. Organizations that have taken the survey in the past have found their data to be useful to inform their individual workforce strategies. Your organization will be able to compare your data profile to state, regional, and national data to see where you stand and where you can improve. If you complete this annually, you will begin to see if workforce strategies you’re trying at your organization to improve recruitment and retention are working, or if you need to try different strategies. 

Results from past years’ surveys have been used to inform statewide workforce activities, including ECF CHOICES FMAP wage change. Results are used to inform workforce initiatives, such as the Apprenticeship Program, statewide Workforce Task Force groups, provider trainings, and opportunities for additional toolkit resources. The fourth year of data collection will be key to continue to inform workforce programs and what they will look like moving forward. For more information about how the data is useful to you and how it is used in Tennessee, please contact your MCO workforce coach or and we will connect you.

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

Employees whose primary responsibilities include providing support, training, supervision, and personal assistance to people with disabilities and seniors. They have titles such as direct care worker, family model provider (FMP), house managers 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 their job is direct support work. Nursing and other professional licensed staff (e.g., LPNs and RNs) are NOT considered DSPs. Unless noted specifically, 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 Caregivers/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 Caregivers/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 Caregivers/DSPs for more than 50% of the time because of staff shortage. Do we consider them a FLS or a Caregiver/DSP?  

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

Our Caregivers/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 Caregivers/DSPs. If your organization only uses contract employees (where you issue a 1099), you may not qualify for this survey. Please contact and we will help you determine if you qualify.

Questions 11 and 13: 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 11. 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 17: Wages by service type. I have a lot of Caregivers/DSPs across service types and am not sure how to compute an average 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 Caregivers/DSPs within a specific service type and divide by the total number of Caregivers/DSPs in that service type.  We recognize that many organizations have Caregivers/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.

Questions 19 and 23: If Caregivers/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 23 asks specifically about a monetary hiring bonus for newly hired Caregivers/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 19 asks specifically about an hourly wage increase for Caregivers/DSPs once training is completed. In the example given, it sounds like it would be a rate adjustment (question 19) rather than a hiring bonus (question 23).

Question 27: 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 Caregiver/DSP?

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

Questions 43-47: Health insurance. What if the organization’s and employee’s health insurance contribution is based on the age of the employee (Caregiver/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.