People who are physically or mentally challenged often live in group homes, small residential facilities in the general community that ideally have six or fewer occupants who are watched over by trained caregivers 24 hours per day. Turnover of group homes staff members is quite high for a variety of reasons, including burnout and low pay.


The early 20th-century eugenics movement saw people with disabilities as genetically flawed and supported incarcerating them in large, crowded state institutions. Nazi Germany systematically killed institutionalized physically and mentally disabled people. In the United States, a national movement advocating the closure of large state institutions began in the 1960s. Many physically and mentally challenged people moved into group homes, some run by state governments and others by private organizations.

Group Homes

An estimated 4.3 million Americans with intellectual, developmental or physical disabilities live in group homes, their own homes or with family members, according to the federal Health and Human Services Department. Their disabilities include autism, Down syndrome, mental illness and many other medical conditions. Disabled persons living in group homes and some of those living in their own homes are cared for by staff called direct support professionals or DSPs. They are also referred to as home health and personal care aides. DSPs working in group homes and providing in-home care have high turnover rates. A 2006 U.S. Department of Health and Human Services report, "The Supply of Direct Support Professionals Serving Individuals with Intellectual Disabilities and Other Developmental Disabilities," estimated that the national turnover rate for DSPs working in group homes and in-home care was 53.6 percent between 1998 and 2003.

Causes of Turnover

A 2001 study, "Issues in the Direct Support Workforce," produced by the American Network of Community Options and Resources, analyzes the reasons why turnover among DSPs working in group homes is so high. Prior to the 1960s, DSPs were typically government employees working for large state institutions. While some state institutions were brutal, mismanaged and overcrowded, DSPs had structured jobs and were often trained and supervised by medical personnel in carrying out a variety of planned programs. The shift to small group houses that are frequently run by private organizations has left many DSPs lacking needed training and supervision in an era when the medical complexity of care needed by intellectually and physically disabled persons has increased. In addition, DSP jobs are seen by most Americans as poorly paid, low status, lacking promotion opportunities and offering few employee benefits, leading to high turnover and chronic understaffing. DSPs are paid a median yearly salary of $20,170.

Turnover Results

The average DSP is a woman between the ages of 18 to 39. A third of all DSPs have college degrees, and many are minorities or recent immigrants to the United States. Faced with physically and emotionally demanding responsibilities, overwork due to staff shortages, inadequate training, low pay, few opportunities for advancement and sometimes receiving no employee benefits such as health insurance and vacation time, many leave the profession for other jobs. Job vacancies for DSPs are projected to grow by 70 percent between 2010 and 2020, due to the aging of the baby boomers. A Montgomery County, Maryland, study of DSPs found that agencies that paid their DSPs $10 per hour or higher showed dramatically lower turnover and vacancy rates. Securing added funding for DSP salaries is a complex problem as much of the care for persons with disabilities is controlled by state and federal budgets.