Status and trends in the direct support workforce in self-directed supports.

Bogenschutz et al. (2010) sent surveys to people with intellectual or developmental disabilities who hired their own support staff. They asked how happy clients were and what wages, benefits, and training the workers got.

The team also questioned agency bosses to see if self-directed budgets really paid better than traditional services.

Clients loved choosing their own staff. They felt in control and said services matched their needs.

But the workers paid through self-directed dollars still lacked health insurance, paid days off, or solid training. Higher hourly wages did not fix the benefit gap.

Laws et al. (2024) now call the DSP shortage a 'deepening crisis.' The 2010 warning about weak benefits looks mild compared with today's worse turnover and racial pay gaps.

Adams et al. (2021) let staff speak for themselves. DSPs repeated the same six needs Matthew first flagged: fair pay, real training, smaller workloads, and respect. The 2010 numbers and the 2021 voices line up perfectly.

Howard et al. (2023) ran a similar survey during COVID-19. They found DSPs still earn less and feel less supported than frontline supervisors. The pattern extends the 2010 result into the pandemic era.

Hutchins et al. (2020) wrap all these studies into one big message: fix pay, training, and career paths or lose quality services. Their synthesis treats Matthew et al. as the first clear evidence that self-direction alone does not solve workforce problems.

If you write waiver budgets or train DSPs, do not assume higher hourly pay is enough. Add line items for health benefits, paid time off, and structured onboarding. Build brief training modules you can deliver in two-hour chunks. Track turnover monthly and adjust packages before staff walk. Self-direction gives clients power, but only steady support workers turn that power into real progress.