2023 Survey and Profiles

The Tennessee LTSS Workforce Quality Improvement Year 6 2023 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 caregivers and 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 years 1-6 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 6-year initiative, participating organizations received a data summary about the direct support workforce in their organization.

This year 6 survey collected data from calendar year 2023. The survey results are described in a survey report and depicted in state and regional profiles. 114 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 dsp-tn@umn.edu.

2023 Survey Report

This report provides an overview of state level data. 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 2023. Most of the report focuses on the results from year 6, and the last section of the report present a summary of the changes from year 1 to year 6. While there were 114 organizations that participated in the survey, not all organizations answered all questions.

View the 2023 Survey Report

2023 State & Regional Profiles

The 2023 Direct Support Workforce state and regional profiles for Tennessee provide an overview of the direct support workforce for the 114 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.

Each participating organization received a personalized profile that summarizes all submitted data specific to their workforce. If you are an organization who participated in the survey but did not receive a data profile summary, please email dsp-tn@umn.edu.

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

State

East

Middle

West

2023 Survey Kickoff

The survey has closed for this year. Links to next year's survey will be emailed in 2025.

Wellpoint, UnitedHealthcare, and BlueCare TN are collaborating for a sixth year with TennCare 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 Tennessee LTSS Quality Improvement Year 6 2023 Survey is a key component of a comprehensive workforce strategy in the state of Tennessee. Data gathered from the first five years of the survey are informing ongoing discussions and planning about wages, benefits, and ways to find and keep good employees and enhance access to home and community-based services (HCBS) for people with intellectual and developmental disabilities, adults 21 years of age and older with a physical disability, and seniors in Tennessee. Participating organizations also receive a customized data summary about the direct support workforce in their organization.

This year 6 survey is collecting data from calendar year 2023. The survey results for each year are described in a survey report and depicted in state and regional profiles. Note that there have been significant changes made to the survey this year.

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.

For more information about the University of Minnesota’s efforts on the QuILTSS Workforce Initiative, please contact dsp-tn@umn.edu.

If you are unsure how to fill out the survey, please watch the webinar below.

Survey Guidance Webinar to Complete the Annual Year 6 Survey

See below for a link to the Survey Guidance Webinar to complete this year's survey. This webinar is designed to support people who are completing the survey. People who complete the survey should have access to personnel data, benefits information, and financial knowledge. There may be multiple people in your organization who provide information for this survey. Team members will be available for any questions you may have about completing the survey.

Frequently Asked Questions (FAQ)

I’ve taken the survey previous years and the survey looks different this year.

We heard your feedback from previous years and made changes to the survey this year. It is significantly shorter and questions have been re-phrased to help you understand them better. Please watch the webinar to see the changes that have been made. If you have any questions about the changes to the survey, please contact dsp-tn@umn.edu.

I’m not sure if I should take the survey. These questions don’t apply to our organization.

If you received the survey link, we would like you to take the survey. For more information about this, please watch the webinar. If you have any questions, please contact dsp-tn@umn.edu.

I did not receive a link to the survey and am not receiving any emails. Who can I contact?

If you did not get a link to the survey, please email dsp-tn@umn.edu with your organization name to request a link. We will respond within 1 business day. You can also access a paper copy of the survey at z.umn.edu/TN-workforce.

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.

How is this data useful or beneficial?

Providers benefit from this data, as your organization will receive your own profile for your own use. Organizations who 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. The sixth year of data collection will be key to continue to inform workforce programs and what they will look like moving forward. Results are used to inform workforce initiatives, such as the DSP Academy, Apprenticeship Program, LINCS, statewide Workforce Task Force groups, provider trainings and opportunities for additional toolkit resources.

How do I know what region we are located in (questions 1 and 2)?

Below are the counties that are in each of the Regions of Tennessee:

• East Counties: Anderson, Bledsoe, Blount, Bradley, Campbell, Carter, Claiborne, Cocke, Cumberland, Grainger, Greene, Hamblen, Hamilton, Hancock, Hawkins, Jefferson, Johnson, Knox, Loudon, McMinn, Marion, Meigs, Monroe, Morgan, Polk, Rhea, Roane, Scott, Sevier, Sullivan, Unicoi, Union, Washington
• Middle Counties: Bedford, Cannon, Cheatham, Clay, Coffee, Davidson, DeKalb, Dickson, Fentress, Franklin, Giles, Grundy, Hickman, Houston, Humphreys, Jackson, Lawrence, Lewis, Lincoln, Macon, Marshall, Maury, Montgomery, Moore, Overton, Perry, Pickett, Putnam, Robertson, Rutherford, Sequatchie, Smith, Stewart, Sumner, Trousdale, Van Buren, Warren, Wayne, White, Williamson, Wilson
• West Counties: Benton, Carroll, Chester, Crockett, Decatur, Dyer, Fayette, Gibson, Hardeman, Hardin, Haywood, Henderson, Henry, Lake, Lauderdale, Madison, McNairy, Obion, Shelby, Tipton, Weakley

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

The definition has changed this year. Please pay attention to the change.

Direct Support Professional (DSP): A DSP is a paid worker whose primary responsibilities include providing support, guidance, personal assistance, or help with skills development during any activity or at any location (e.g., at work, at home, leisure activities, recreational activities) to adults with intellectual and developmental disabilities (IDD). They may have titles such as Direct Support Workers (DSWs), Personal Care Assistants (PCAs), Employment Specialists (job coaches), Home Health Aides (HHAs), Community Integration Specialists, and many other titles.

Direct support work is their primary job responsibility and at least 50% of their hours are spent in direct support tasks doing direct support work. DSPs may perform some supervisory tasks, but only if more than 50% of their hours are spent doing direct support tasks.

Caregiver: A Caregiver is a paid worker whose primary responsibilities include helping clients to maintain independence, providing personal assistance with Activities of Daily Living (ADLs) [dressing, grooming, toileting, personal hygiene, eating, and basic clinical tasks (helping with prescribed exercises, administering medication, monitoring vital signs, etc.)], assisting with housekeeping, grocery shopping and cooking, accompanying clients to doctor appointments or other errands, companionship, providing support in community engagement, day centers or other day activities, and respite support to older adults and/or individuals with physical disabilities. Certified Nursing Assistants (CNAs) should be included IF the nursing care they provide is basic (monitoring vital signs, cleaning wounds, helping with prescribed exercises, applying or changing bandages, or administering medications).

Caregiving work is their primary job responsibility and at least 50% of their hours are spent doing direct care and support tasks. Caregivers may perform some supervisory tasks, but only if more than 50% of their hours are spent doing direct care tasks.

Do NOT include:

• Workers who are On-call or PRN, hired through a contract or 1099 arrangement, or a temporary personnel agency, unless otherwise specified
• Clinically licensed staff (registered nurses, licensed practical nurses (LPNs), psychologists, social workers, therapists, etc.), behavior specialists, behavior clinicians, or behavior technicians (BCBA)
• Caregivers that work exclusively in nursing homes
• Those who only provide transportation, home modifications, and/or meal delivery services
• Administrative or supervisory staff, unless they spend 50% or more of their time doing direct support work

Regarding host/foster/family home arrangements: Please respond only about Caregivers/DSPs who are employed and work in addition to the primary shared living/foster care provider.

Regarding Fiscal Intermediaries or Employers of Record for Caregivers/DSPs working for people who are self-directing their own services: If your agency functions solely as a fiscal intermediary or employer of record, please do not respond to this survey.

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 FLSs who may be working as Caregivers/DSPs for more than 50% of their time due to staffing shortage as FLSs 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.

Questions 24 and 25: 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 25 asks specifically about a monetary hiring bonus for newly hired Caregivers/DSPs. A hiring bonus is an extra amount of money provided at the 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 24 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 24) rather than a hiring bonus (question 25).

Question 26: 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, including overtime hours, 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.