Disability workers are much more than caretakers or caregivers seeing to individuals’ basic needs; Disability workers support individuals to achieve a high quality of life by helping them to participate in community life, build and maintain relationships, learn to do things for themselves, set and achieve personal goals and much more. But what happens to individuals’ quality of life when there is high staff turnover? A recent study by Carli Friedman of The Council on Quality and Leadership (CQL) helps answer this question.
Friedman looked at the results of interviews with 1,341 individuals with disabilities using the CQL’s Personal Outcome Measures which defines quality of life through 21 indicators in five outcome areas:
- Human security – individuals are safe, free from abuse/neglect, have the best possible health, are treated fairly, are respected, exercise their rights, and have stability and security
- Community – individuals interact with community members, live their lives in integrated environments, participate in community life, and are able to get around their environments
- Relationships – individuals have friends, have close personal relationships (including romantic), are connected to their natural support networks, decide when to share personal information, and have different social roles
- Choice – individuals choose where and with whom to live, what services they want, and where to work
- Goals – individuals choose their personal goals, and achieve their personal goals
Individuals were asked if they had experienced staff turnover in the past two years. Nearly 56% of the respondents had experienced at least one staff change. Friedman then compared outcomes for those who had experienced staff turnover with outcomes of those who had not.
Impact on outcomes achieved
In comparison with those who experienced staff turnover, individuals with stable staff were
- 6.3 times more likely to feel secure and stable in their life
- 3.7 times more likely to live in integrated environments
- 2.4 times more likely to feel respected
- 2.1 times more likely to choose where and with whom they live
- 2.1 times more likely to be connected to natural support networks
- 2 times more likely to feel they are treated fairly
- 2 times more likely to interact with other community members
- 2 times more likely to participate in community life
- 2 times more likely to have friends
- 1.8 times more likely to be able to get around and use their environments
- 1.7 times more likely to have control over their personal information
- 1.7 times more likely to have a variety of social roles
- 1.6 times more likely to feel safe
- 1.6 times more likely to exercise their rights
- 1.5 times more likely to have the best possible health
- 1.5 times more likely to have close personal or intimate relationships
This study also looked at characteristics of individuals and service settings to see whether some individuals were at more risk of staff leaving than others. Individuals with behaviour issues or complex needs were 2.7 times more likely to experience staff turnover than those without complex needs.
Impact on staffing
Whenever staff leave, organizations have to recruit and train new support workers to take their place. This takes time. Meanwhile, existing staff scramble to cover as much of the former staff’s workload as possible. The result is increased overtime costs, overworked and stressed disability workers and a greater service focus on basic needs with less time spent on community inclusion, building skills for independence and choice for the individuals being supported.
The greatest single impact on turnover in disability services is wages. Near-minimum wage compensation for highly skilled, demanding work puts a critical strain on the disability services sector. Friedman cites reports that “when San Francisco County increased their [front line disability worker] wages, annual turnover decreased by almost half” (p. 235).
Alberta experienced a similar decrease in turnover when funding for worker compensation last increased in 2014. With no wage increases in 4 years except related to minimum wage, turnover is reaching levels where individuals with developmental disabilities can once again expect to see staff leave and personal outcomes at risk. How long will it be before the government addresses the negative impact that a lack of funding for front-line wages have on turnover and the direct relation to the quality of life for individuals they support?
Friedman, C. (2018). Direct support professionals and quality of life of people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 56(4), 234-250. https://goo.gl/JKUDsc. Webinar Link: https://youtu.be/Fl6RYNOHnZc?t=31