Direct Care Workers and Direct Support Workers in Residential, Sheltered Employment and Extended Day Care Programs for People with Mental Retardation

Direct support workers (DSWs) are an important element in assuring proper care for populations with mental retardation. In recent years, many issues regarding the employment policy of DSWs have arisen. The literature indicates that service providers pay low wages and settle for personnel with minimal training. In addition, they contend with a high turnover.

This study, the first of its kind in Israel, examines central issues relating to the work of DSWs for people with mental retardation in sheltered employment, residential and extended day care programs, including demographic profile and professional background, role structure, employment conditions, job satisfaction, difficulties at work, training, recruitment and turnover.

Data were gathered from a sample of 298 DSWs and 53 directors. Following are selected study findings:

  • The DSWs were mostly women (86%); about half of them were under the age of 34 (43%), had higher education (51%) and were new to their current job (62% had been employed in it for up to five years). DSWs characteristics varied between residential and sheltered employment programs.
  • Only one-third (35%) of the DSWs were certified. In most programs, training was on the job.
  • DSWs perform various tasks: in sheltered employment programs – instruction and assistance with work; in residential and extended day programs – assistance with everyday needs and housekeeping; in all of the programs – personal conversations and social activities, although less time (one-third, on average) is invested in these activities in sheltered employment than in the other two types of programs (one-half).
  • High rates of DSWs reported difficulties at work, mostly related to the participants’ characteristics (57%), such as behavior problems and difficulties in communication. Although DSWs did not report burnout, the average score of physical and emotional burden was 2.3 (on a scale of 1-4). In addition, 20% cited poor physical working conditions. Both directors (89%) and DSWs (20%) stated that the number of participants per DSW was too large.
  • Physical strain is reflected in absenteeism: In the three months preceding the study, 27% were absent three or more days, and 15% were absent five or more days. Among those absent three or more days, the percentage of those experiencing physical exhaustion was higher than among those who were absent less.
  • Data indicates large fluctuations in DSW manpower. In 2001, 31% of the DSWs were recruited, and 23% left. This was most prominent in residential programs (40% were recruited and 32% left). In general, directors reported recruitment difficulties during the two years preceding the study.
  • DSWs perceive the role as having positive characteristics: variety, independence, enjoyment and use of skills (75%-85%). Almost all are very satisfied (61%) or satisfied (35%) with the job, and would choose it again (87%).

The findings raise various issues: the skills needed for performing the job of a DSW, ways to reduce difficulties and fatigue that leads to absenteeism, and ways to keep these personnel in the system while preserving quality.

The study was commissioned by the Division of Services for Mentally Retarded Persons of the Ministry of Social Affairs and the Shalem Foundation, and funded with the assistance of the Shalem Foundation.