2025 Survey and Profiles

Wellpoint, UnitedHealthcare, and BlueCare TN are collaborating for an 8th year with TennCare and the Institute on Community Integration (ICI) at the University of Minnesota to conduct the annual Tennessee Long-Term Services and Supports (LTSS) Workforce Quality Improvement 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 Initiative in Tennessee. Data gathered each year from this survey are used to inform ongoing discussions and planning about wages, benefits, ways to find and keep qualified and committed caregivers and/or direct support professionals, and enhance access to home and community-based services for people with intellectual and developmental disabilities, physical disabilities, and older adults in Tennessee.

The year 8 survey will be collecting data from the calendar year 2025. Survey results will be organized into state and regional profiles and outlined in a survey report. Participating organizations will also receive a customized data summary about the direct support workforce at their organization.

This year’s survey will be open June 1st through July 24th, 2026. Invitations to participate in the survey will be sent to organizations mid May.

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 how the University of Minnesota supports this workforce initiative in Tennessee, please contact dsp-tn@umn.edu.

Additional items related to this year’s survey will be made available on this website as they are available in the coming months.

2025 Survey Report

After the year 8 survey closes, a survey report will be developed to provide an overview of state level data in Tennessee. Survey items will also analyzed by region when there is a large enough sample size for analysis. Unless otherwise specified, workforce data will reflect calendar year 2025. The report will focus on the results from this year's survey and any workforce development recommendations that emerged from the survey results.

2025 State & Regional Profiles

The 2025 state and regional profiles for Tennessee will be developed following this year's survey. They will provide an overview of the direct support workforce for the organizations in Tennessee that responded to the survey. Profiles highlight data on service types and sites, staffing, wages and benefits, turnover and vacancy, and other key data points from information collected in the survey.

Each organization who participates in the survey will receive an individualized profile that summarizes all the workforce data they submitted at an organization level. Respondents can chose whether they want to share their organization profiles with managed care organization (MCO) leads in Tennessee for the purposes of technical assistance and training around workforce development initiatives.

Survey Guidance Webinar to Complete the Annual Year 8 Survey

Each year, a survey guidance webinar is created with important information about how to complete the survey. Invitations to attend this webinar will be sent in May and a recording of the webinar will be posted to this website in early June.

Employees with access to personnel data, financial knowledge, and benefits will be best to provide information on the survey. The survey asks questions about your organization related to things like:

• types of services provided
• participation in various workforce initiatives
• number of certain types of workforce employees, like caregivers, direct support professionals, and frontline supervisors
• retention data like employee vacancies and turnover
• wages, bonuses, and other awards
• employee hours and benefits offered and utilized

Team members will be available for any questions you may have about completing the survey.

Frequently Asked Questions

Are we required to submit the survey?

The survey is not required. However, provider participation in the survey is important because the information collected helps guide ongoing discussions and planning related to wages, benefits, recruitment, and retention strategies for the direct care workforce, and improving access to services for individuals with intellectual and developmental disabilities, adults with physical disabilities, and older adults across Tennessee. Recognizing the importance of data driven decision-making, the Tennessee LTSS workforce quality improvement survey is conducted annually, with this being the eighth year Tennessee has conducted this survey. A high response rate from providers ensures that the results accurately reflect the experiences and needs of the direct care workforce across the state.

This survey is a key component of Tennessee’s commitment to supporting a person- centered system in which individuals can define and achieve their goals, live the lives they choose, participate fully in their communities, and have access to valued social roles. Achieving this vision depends on having a diverse, stable, and well-trained workforce capable of delivering high-quality person- centered supports.

The goals of Tennessee's larger workforce initiative and statewide strategy are to support provider organizations in building a more stable and highly skilled workforce overtime and strengthening the direct care workforce through high-quality competency-based training, progressive certifications, professionalization, and expanded career development opportunities. To meet these goals, Tennessee is focusing on ongoing workforce surveys and data collection, competency-based training and wage incentives, the implementation of recruitment and retention strategies for organizations, and evaluation of workforce development efforts overtime.

In addition to gathering data that can be used to inform decisions at the state and regional level in Tennessee, participating organizations receive individualized data profiles that can used to assess, monitor, and support workforce development at the organization level, in partnership with managed care organization (MCO) workforce development staff in Tennessee.

Your partnership and participation in this important initiative are much appreciated.

How do I find out if a survey was sent to us and if so, who it was sent to?

In order to find out if a survey was sent to your organization and identify who it was sent to, you can email the University of Minnesota Workforce Survey Team at dsp-tn@umn.edu. The unique survey link is sent to one main survey contact at each organization in our sample. We can provide you with your unique survey link again if you need it, and we are happy to update the main survey contact for your organization at any time.

Should you complete the survey if you didn't have in members or staff during the calendar year that the survey is collecting data for?

No, you should not complete the survey this year if you did not have any staff to report on during the period of time that the survey is collecting data on. If that is the case, reach out to us at dsp-tn@umn.edu and let us know. We will make a note of that in our records, add you to our sample for next year, and make sure to follow up with you as the next year’s survey gets underway.

We are a provider that operates in multiple states. For the section on Revenue, should I answer these questions based on data from all states we operate in, or should I limit my responses to Tennessee only?

Since this is the Tennessee survey, we're specifically looking for information relevant to Tennessee.

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

If you have any questions about whether or not you qualify to complete the survey, please contact dsp-tn@umn.edu and we can help you determine if you are eligible.

I did not receive a link to the survey and am not receiving any emails. I believe I should be taking the survey. 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.

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, and the information you have entered will remain. Once you submit the survey, you cannot return to the survey and make any edits. Do not click submit until your survey is fully complete.

How is this workforce data useful or beneficial?

Statewide, this data collection process serves as part of a larger initiative to collect and monitor key workforce data and use it to make data driven decisions that support efforts to strengthen and stabilize the direct support workforce (direct support professionals and caregivers) who provide long term services and supports to either people with intellectual and developmental disabilities or older adults and/or adults with physical disabilities.

For example, the results of this survey 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.

At the organization level, providers will receive an individualized data profile that outlines many key workforce metrics at their organization. Organizations who have taken the survey in the past have found this data useful to inform the implementation of individual workforce strategies at the organization level. Individualized organizational profiles also allow organizations to compare their data to state, regional, and national workforce data to see where you stand and where they might prioritize improvements. Each year of data collection will continue to inform workforce programs and other initiatives in the state of Tennessee.

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

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 their prime focus of their role is 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 people 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 the prime focus of their role is 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 Supervisor (FLS): A FLS is an employee whose primary responsibility (more than 50% of their role) is the supervision of Caregivers/DSPs (as defined above). While FLSs 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. 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 Caregivers/DSPs more than 50% of their time. FLSs may include house managers if their duties are not primarily direct support. FLSs’ responsibilities usually include conducting performance reviews of Caregivers/DSPs.

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?

Each person within your organization should only be counted once, as either a Caregiver/DSP or FLS for this survey. They should not be counted as both a Caregiver/DSP and FLS.

As stated in the FLS definition above, a FLS is an employee whose primary responsibility (more than 50% of their role) is the supervision of Caregivers/DSPs. While FLSs may perform direct support tasks, their primary job duty is to supervise employees and manage programs. These individuals may or may not be in licensed or degreed positions (such as a nurse). Ultimately, the organization views their role as guiding and directing the work of Caregivers/DSPs more than 50% of their time. FLSs may include house managers if their duties are not primarily direct support. It can be helpful to note that a FLSs’ responsibilities usually include conducting performance reviews of Caregivers/DSPs.

Please note that we base this definition off of their job description. In reality, we know that frontline supervisors often spend more than 50% of their time in direct care filling shifts, but they are not viewed by the organization as Caregivers/DSPs. Knowing this and the definition above, organizations will need to determine if they want to consider FLSs who may be providing direct support for more than 50% of their time due to staffing shortage as FLSs or Caregivers/DSPs, but should only count them once, as either a FLS or Caregiver/DSP. 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.

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

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. Hourly wage increases are often tied to things like longevity, performance, cost of living increases, market-competitive adjustments, continuing education or competency based training, or employee retention. In the example given, it sounds like this salary increase would be a rate adjustment rather than a hiring bonus.

How do I calculate the average number of hours worked per week? 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, including overtime hours, per Caregiver/DSP. To compute an average, add up the weekly hours worked by Caregivers/DSPs and divide by the number of Caregivers/DSPs who worked those hours. If you can split it by part-time and full-time Caregivers/DSPs, you would also do this calculation for them separately.

Last Edited: June 2026