Disability Services Case Competition

In every corner of your community and on your school’s campus, there are people with intellectual or developmental disabilities (I/DD). According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, I/DD refers to “differences that are usually present at birth and that uniquely affect the trajectory of the individual’s physical, intellectual, and/or emotional development.” Examples include cerebral palsy, Down syndrome, fetal alcohol syndrome, Fragile X syndrome and spina bifida.

While social justice advocates are increasing the visibility of those individuals with differing abilities, direct support professionals (DSPs)—the individuals working tirelessly behind the scenes to provide the extra support individuals with I/DD need to live independently, in the community, and a life of their own choosing—too often remain invisible.

Underinvestment in Medicaid Spurs High Turnover, Vacancy Rates

For decades, however, there has been a severe shortage of DSPs due mainly to the fact that states, through their Medicaid programs, dictate the wages their employers can pay. Medicaid programs in all states pay the providers that employ DSPs too little to guarantee a living wage to all DSPs, which has led to a recruitment and retention crisis. On average, provider agencies see a 43% annual turnover rate, meaning that if 100 DSPs work for an agency on January 1, only 57 will remain employed there by December 31 of that same year.

To glean a sense of the difference DSPs make in the lives of people with I/DD, watch a few of the short videos in our seven-part series on what it means to be a DSP.

For years, ANCOR has heard almost daily about the challenges providers face in recruiting and retaining qualified direct support professionals. For example, we often hear about how providers get few or no applications when they publish job postings for open DSP positions. Furthermore, it’s not uncommon to hear about providers losing staff to other employers in their communities. As the story typically goes, a DSP finds the work they do fulfilling, but with rising costs of housing, gas and other bills, they leave their post to work at the local convenience store or big-box store because they can earn two dollars more per hour and don’t have to take their work home with them.

As you might imagine, the COVID-19 pandemic has only made this situation worse. When many industries began experiencing staffing shortages at the onset of the pandemic, employers began offering sign-on bonuses, higher starting hourly wages, pay incentives and more. These measures have worked wonders in terms of improving wages overall, with fast food and retail jobs in some places now paying upwards of $20 per hour.

But for the community providers that employ DSPs, these options didn’t exist. Because providers can pay what their state Medicaid programs’ reimbursement rates will allow, there was only a modest increase in DSP wages in 2020. Whereas starting wages in retail positions may hover around $20 per hour, DSPs earn only about $13.40 per hour at the median—despite the fact that DSPs often perform highly skilled work that is intimate and personal.

As ANCOR CEO Barbara Merrill recently wrote in an op-ed published by The Hill, legislators in Congress have had ample time to take action over this longstanding workforce crisis, but have repeatedly failed to take bold, decisive, bipartisan action in service of millions of people with I/DD and their families. Instead, Congress has continuously missed opportunities for transformational change by repeatedly excluding investments in the Medicaid Home and Community Based Services (HCBS) program.

The Troubling Costs of High Turnover

So why does all this matter? The bottom line is this: when there are too few DSPs, there are too few opportunities for people with I/DD to be supported. If they’re fortunate enough to have a family member with the means to help them, they can live with that family member and be supported by them when they’re not working. And when they lack access to support, the options before them are close to non-existent: the alternative is often being warehoused in a large, state-run institution or a nursing home, even if those settings are far from appropriate for the person needing support.

In other words, the ongoing workforce crisis is contributing to a triple play of troubling impacts:

• For people with disabilities who need services but aren’t currently receiving them, they are often left languishing on states’ waiting lists for services—waiting lists on which families routinely find themselves for years. According to the Kaiser Family Foundation, there were 464,398 people with I/DD on states’ waiting lists for Medicaid-funded Home and Community Based Services in 2020—a number we know meaningfully underestimates the scope of unmet need.
• For people with disabilities who are cleared from states’ waiting lists, there often aren’t providers available to deliver those services. Brand-new research published by ANCOR in October 2022 found that 83% of providers are turning away new “referrals” (i.e., are unable to deliver services to anyone beyond who they’re already supporting) as the result of ongoing problems with DSP recruitment and retention. This makes it unsurprising that 71% of care coordinators reported difficulty connecting people needing disability services with an available provider.
• For people with disabilities who are currently receiving services, the future of those services is in jeopardy. The same survey fielded by ANCOR in the third quarter of 2022 found that 63% of providers have discontinued existing programs and services and 55% percent of providers are considering additional program discontinuations.

Two additional findings from ANCOR’s 2022 State of America’s Direct Support Workforce Crisis survey reveal the stark realities facing people with I/DD due to of high turnover among DSPs. First, the survey found that 92% of providers are struggling to achieve quality standards, meaning the quality of support—and, in turn, people’s quality of life—is diminished. This is especially problematic for people whose disabilities require support in carrying out the most intimate activities of daily living, such as using the restroom and bathing.

Second, two-thirds (66%) of providers are concerned that the problems described here will worsen when the COVID-19 public health emergency expires. The declaration of a public health emergency has made possible a series of regulatory flexibilities, such as the delivery of virtual supports or the option to use telemedicine for medical appointments, that have made it easier for providers to overcome the challenges associated with the workforce crisis. However, if those regulatory flexibilities are rolled back when the public health emergency is declared to be over, providers will face an even steeper uphill battle.

Although they grapple with a wide array of challenges related to recruitment and retention, community-based disability service providers rise to just about every occasion. Absent the ability to pay living wages to DSPs, providers have gotten creative, seeking other ways to ensure the people they support can continue receiving the support they need and deserve.

Occasionally, these creative solutions simultaneously prove the great lengths to which providers will go to keep people safe, as well as the immense burdens and impossible choices facing professionals when severely understaffed.

For example, we sometimes hear about the most senior executive leaders in an organization—the CEO, the Chief Financial Officer, the Vice President of Human Resources, and others—picking up shifts on the weekends because there aren’t enough DSPs to work in group homes and other residential settings. We have also heard stories of DSPs earning $75,000 or $80,000 in a year, despite their low hourly wages, because they have accrued so much overtime covering shifts in the absence of an adequate workforce. These solutions, though often necessary, are troubling considering a simple fact: tired people make more mistakes than well-rested people.

More often, however, the solutions we see providers pursuing reflect their ingenuity, dedication and commitment. To see some examples of providers’ ingenuity, look no further than the winners of the Moving Mountains Award. A collaboration between ANCOR, the National Alliance for Direct Support Professionals (NADSP) and the Institute on Community Integration at the University of Minnesota (ICI), the Moving Mountains Awards recognize organizations using leading practices in direct support workforce development that result in improved outcomes for people with I/DD.

In 2022, two organizations received the prestigious Moving Mountains Award:

• Based in Johnson City, Core Services of Northwest Tennessee saw a federal regulation known as the HCBS Settings Rule as an opportunity to transform its services to be more person-centered. As Core Services transitioned from delivering 40% of their services in facility-based settings to providing 100% of their services in the community, the organization saw its vacancy rate among DSPs drop from 13% to 6% and its turnover rate drop from 60% to 35%. During this time, DSP wages increased from an average of $11.05 to $15.29, and benefits including a 401(k) savings plan and life insurance were added.
• Kingston, NY-based The Arc Mid-Hudson tackled high turnover and vacancy rates through a relatively new program known as the DSP Success Coach Program. Through this program, three seasoned DSP success coaches provide 1:1, on-the-job training at each new DSP’s worksite during their regularly scheduled work shifts. This removes the burden of DSPs having to commute and adjust their schedules for training and replaces hypothetical, academic learning with real-life, hands-on learning. DSP success coaches model services that are individualized and community based.

The creative solutions such as those pioneered by recipients of the Moving Mountains Awards make us confident that there is a world of untapped solutions out there—ideas big and small that can help provider organizations be more effective in their recruitment and retention of DSPs. And, we’re confident that those solutions come from a variety of creative minds—including your own.

ANCOR and the ANCOR Foundation seek creative, proven, and scalable solutions to the direct support workforce crisis from students like you because we know that you are the next generation of human service leaders. Although workable solutions to the staffing crisis in the field of disability services are long overdue, the solutions we embrace must have staying power. They must be lasting. And they must be envisioned by the next generation of leaders who will ultimately be responsible for carrying them out.

That brings us to the Disability Services Case Competition. We have invested in this Case Competition because we know that sometimes, stepping outside the proverbial box is essential. Moreover, we refuse to leave any stone unturned in our quest to stem the tide of growing turnover and vacancy rates once and for all.

That’s why we’re turning to you. We see an opportunity to identify and engage the next generation of leaders—people like you who believe in civil rights, social justice and liberation. This is your opportunity to make your mark to positively affect social justice for decades to come.

Three phases comprise the Disability Services Case Competition:

1. A preliminary presentation submission.
2. A virtual presentation delivered by semifinalists.
3. A live presentation delivered by finalists at the 2023 ANCOR Annual Conference in Chicago.

Teams will analyze the current workforce crisis in the disability services industry and offer a solution geared toward attracting Gen Z candidates to a career in the field of disability services. The solution should be presented in the form of a narrated PowerPoint presentation (i.e., a slide presentation that includes voiceover from the three students that comprise the team). Competitors invited to the final round of the competition will also be asked to present their solution in the form of a short video, not to exceed two minutes in length, that demonstrates how their solution will come to life.

Hiring managers, decision-makers, influencers, and C-Suite executives will evaluate the solutions devised by each three-person team based on:

• The creativity exhibited by the proposed solution.
• The feasibility of implementing the proposed solution.
• The level of awareness of the contours of the workforce crisis exhibited by the proposed solution.
• The quality of the presentation of the proposal.
• The top 10 teams will advance to the semifinals, which will be a virtual presentation to ANCOR staff members, it’s Professional & Organizational Development Committee and the ANCOR Foundation Board of Directors. The top three teams will reach the finals.

The three teams selected to advance to the final round of the competition will be invited to present their proposed solution to participants at the 2023 ANCOR Annual Conference, the largest national gathering of the provider community. The 2023 ANCOR Annual Conference will take place April 24-26 in Chicago. Learn more about the ANCOR Annual Conference experience.

After a mainstage presentation, the finalist teams will be ranked first, second and third by the audience, with prize money to be distributed as follows:

• 1st place: $12,000 ($4,000 per team member)
• 2nd place: $6,000 ($2,000 per team member)
• 3rd place: $2,100 ($700 per team member)

In addition to the opportunity to improve access to the community for people with I/DD and the chance to win scholarship money, there is an array of other benefits to participating in the Disability Services Case Competition, including:

• An impressive addition to your resume.
• The opportunity to work with and receive feedback from national leaders in the human services field.
• Networking and learning opportunities at the 2023 ANCOR Annual Conference (if selected as a finalist).

Entering the Competition

Teams must be composed of three students enrolled in either Grade 9, Grade 10, Grade 11, or Grade 12 at a high school that has membership in the National Speech and Debate Association. All students must attend the same school.

Each case competition entry will present a solution to this year’s case, published on the ANCOR Foundation website. Teams must register and submit their entries using the link on the Case Competition website.

Each entry must:

• Complete the online submission form. No handwritten forms will be accepted. Each team will be asked to identify their school, college/university department, first and last names, pronouns, email addresses, mobile phone numbers, and team captain.
• Upload a resume for each team member to be shared with our membership.
• Submit a PowerPoint Presentation that contains your case analysis.
• Adhere to the competition’s Ethical Standards.

• January 1, 2023: Competition Kickoff (Case Competition Guide is made available on ANCOR Foundation website)
• January 13, 2023: Deadline to Submit Questions to Competition Organizers (we will make every effort to address questions submitted after this date, but cannot guarantee a response)
• February 6, 2022: Case Solutions Due
• February 13, 2023: Semifinalists (Top 10) Announced
• February 20-24, 2023: Virtual Semifinalist Presentations
• March 17, 2023: Finalists Announced
• April 25, 2023: Finalists Presentations on the Mainstage at ANCOR’s 2023 Annual Conference in Chicago