Staff Turnover in IDD Care: What the Data Shows
Direct support professionals (DSPs) are essential to the lives of individuals with intellectual and developmental disabilities. They support personal care, medications, health monitoring, daily living, employment, relationships, community participation, and individual choice.
Despite the importance of this work, IDD providers continue to struggle with recruiting and retaining qualified employees. High turnover is not simply a human-resources issue. It affects service quality, safety, organizational capacity, and the consistency of support individuals receive.
What the National Data Shows
The National Core Indicators–Intellectual and Developmental Disabilities State of the Workforce Survey collects information about DSP wages, vacancies, benefits, turnover, and retention.
The 2023 national report found:
- DSP turnover rates ranged from 23.6% to 48.6% across participating states.
- The weighted average turnover rate was 39.7%.
- More than one-third of DSPs had worked for their agency for one year or less.
- Many employees who left had been employed for less than one year.
For an agency employing 100 DSPs, a turnover rate near the national average could mean approximately 40 departures in one year.
Reported 2024 figures showed modest improvement, with average turnover near 37%. However, losing more than one-third of the workforce annually remains highly disruptive. Staffing shortages have also caused some agencies to stop accepting or turn away referrals.
Why DSPs Leave
Turnover rarely has a single cause. Common factors include:
- Low or uncompetitive wages
- Limited benefits
- Unpredictable schedules and mandatory overtime
- Inadequate orientation
- Weak or disrespectful supervision
- Physical and emotional demands
- Insufficient staffing
- Limited opportunities for advancement
- Lack of recognition and support
DSPs may administer medications, respond to emergencies, provide personal care, implement behavioral strategies, transport individuals, complete detailed documentation, and recognize changes in health. When compensation and organizational support do not reflect these responsibilities, employees may seek work elsewhere.
Immediate supervisors also strongly influence retention. Employees are less likely to remain when managers communicate disrespectfully, apply rules inconsistently, ignore concerns, change schedules without notice, or fail to recognize good performance.
How Turnover Affects Individuals
Effective support often depends on familiarity, trust, and knowledge of the individual. Experienced DSPs may recognize:
- Subtle signs of pain or illness
- Changes in seizure activity
- Unique communication methods
- Triggers for anxiety
- Effective calming strategies
- Personal-care preferences
- Important routines and relationships
- Small changes from the person’s usual functioning
When experienced employees leave, this knowledge may be lost. Individuals may experience unfamiliar staff, disrupted routines, canceled activities, reduced community participation, delayed goal progress, inconsistent support, and increased anxiety.
Repeated staffing changes can be especially difficult for people who rely on predictability or need time to become comfortable with new caregivers.
Turnover Also Affects Providers
Each departure creates costs related to advertising, interviewing, background checks, orientation, training, overtime, temporary coverage, and supervisor time.
Turnover can also create a damaging cycle:
- 1An employee leaves.
- 2Remaining staff work additional hours.
- 3Fatigue and dissatisfaction increase.
- 4More employees leave.
- 5Services become more difficult to maintain.
Breaking this cycle requires more than continuously hiring new employees.
Retention Requires a Complete Strategy
Bonuses may attract applicants, but they cannot overcome persistent problems with wages, scheduling, supervision, or workplace culture.
A stronger retention strategy should include:
- Competitive and transparent compensation
- Realistic job previews
- Competency-based orientation
- Individual-specific training
- Mentoring and supervised practice
- Weekly check-ins during the first 90 days
- Predictable scheduling
- Fair treatment and meaningful recognition
- Supervisor-development programs
- Clear career pathways
- Regular stay interviews
Early turnover deserves special attention. Employees who leave within the first 30, 60, or 90 days may reveal problems with recruiting, job expectations, onboarding, scheduling, staff assignments, or supervisory support.
Turn Workforce Data Into Action
Providers should track turnover by location, supervisor, shift, service, employment status, and length of employment. Other helpful measures include vacancy rates, overtime, call-outs, training completion, employee satisfaction, exit-interview themes, referral refusals, and services interrupted because of staffing shortages.
When data reveal a pattern, leadership should:
- 1Identify where and when turnover occurs.
- 2Investigate the possible causes.
- 3Select a focused intervention.
- 4Assign responsibility for implementation.
- 5Measure whether retention improves.
- 6Revise the strategy based on results.
Recruiting more employees into an unchanged system may only produce more turnover.
The Bottom Line
DSP turnover affects much more than staffing schedules. It affects relationships, health monitoring, safety, community participation, individual goals, service availability, and quality of life.
Providers may not be able to solve every workforce challenge, especially when reimbursement limits compensation. However, they can strengthen retention through better onboarding, supervision, scheduling, recognition, career development, and employee involvement.
The most important question is not simply, “How many employees left?” It is, “Why are they leaving—and what are we prepared to change?”
National averages should be treated as benchmarks rather than exact predictions. Providers should compare their results with current state, service-specific, and organizational data.