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SUCCESS: Tennessee Advocates Obtain Permanent Increase in DSP Pay Rates


We take break from our regular focus on Value-Based Payments to share with you a success story many of us advocates wish to replicate nationally.  Across the country, not a day passes without a mention of the workforce challenges to recruit and retain workers to care for most vulnerable consumers.  The Tennessee advocates took a long view, worked with consumers, families, peers and legislators to obtain a permanent and substantial increase to be passed on directly to direct care workers.  Bravo and Onward!

Money for DSPs

The Volunteer State’s General Assembly closed its 2021 legislative session in May with a budget that provides $38.9 million for a pay increase for Direct Support Professionals (DSPs), who provide care to Tennesseans with intellectual and developmental disabilities. Along with an additional two-thirds federal match, the budget boosts pay for DSPs from a minimum of $10.50 to $12.50 per hour. That’s another $400 per month on average in the pockets of these essential workers.

Legislators Make the Difference

It’s a remarkable achievement and local media coverage credits dedicated state legislators for pushing it through. The XtraGlobex team is proud to be associated with Tennessee Community Organizations (TNCO), a statewide trade association for service provider organizations that support people with intellectual and developmental disabilities in Tennessee. TNCO worked closely, over many years, with peers from Tennessee Disability Coalition and The ARC of Tennessee in keeping the pressure on Nashville. The active education and advocacy with state legislators were primary drivers to getting the code amendment passed for this recurring sustained public investment in DSP wages and benefits.

TNCO Executive Director Robin Atwood humbly states that there was some luck involved; Tennessee enjoyed unexpectedly high tax revenue, which loosened the purse strings a bit. But in reality, luck had little to do with it. Robin stresses critical, years-long investments in relationship-building that helped stakeholders seize the moment and push the long-needed compensation increases into this latest budget.

Tennessee's MLTSS VBP Effort

In 2014, TennCare launched Quality Improvement in Long Term Services and Supports (QuILTSS) to promote the delivery of high-quality LTSS. Their mission is to build a more competent Direct Service Provider (DSP) workforce to handle the complex challenges of LTSS Care. The MCO UnitedHealthcare (UHC) partners with this program to offer money and support. According to the UHC site, “Two unique features of the QuILTSS program are that it will be offered through local colleges and provide credit toward associates or bachelor degrees in fields such as nursing, health care administration, or other related disciplines; and that the program requires DSPs to demonstrate the expected knowledge, skills and abilities, and intellectual behaviors before earning their credential.”

Tennessee continues to have success with its CHOICES program due to its methodical approach to how it was launched. They listened and built programs based on what their consumers need. In turn, they were able to create a program that improves the quality of care while also saving money.

Advocate’s Roadmap​

In our work with TNCO, we spent time with Robin Atwood who willingly shared the roadmap TCNO has successfully used and will continue to follow as it works toward the next goal of a $15/hour minimum wage for DSPs:

  1. Make sure member providers are continuously engaging with legislators, with the goal of moving them from being listeners to being advocates. While they need hard numbers to work with, “painting a picture” by hosting elected representatives in the field to see the work involved is often more emotionally impactful than spreadsheets. Robin suggests focusing on potential champions: after years of connecting lawmakers to DSPs and their consumers directly, TNCO statehouse support now comes from particularly persuasive orators, one of whom was fortuitously promoted to chair the House Finance Committee.
  2. Enlist and engage with partner organizations to amplify efforts and minimize redundancy. Robin praised the strengths and reach of the advocacy partners that were key to success.
  3. Build on the Consumers’ and Families’ voices. Legislators and the media respond very well to grassroots advocates. Their stories about how the DSP crisis affects them were powerful.
  4. Choose well-respected professional representation for a long-term relationship with legislators. Robin feels the continuity of their representation enhances their influence in the statehouse, where prioritizing the finance committees was more productive than even the health committees in moving the pay increase forward.
  5. Express public appreciation to the action. Obtaining a permanent and significant rate increase is an event noteworthy of private and public acknowledgement. Thank everyone involved while communicating that there is more work to be done.

Advocate’s Roadmap

The success our colleagues experienced in Tennessee is a strong testament to the importance of community collaboration, grassroots advocacy, and most of all, persistence. We are encouraged by TNCO and others to help provide a roadmap for doing this in other states on the way to properly paying those who provide key supports that preserve consumers’ independence in the community.

We acknowledge the contributions of our colleagues Rasa Kay Brittain and Joan W. Martin in preparing this blog.


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