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Rural Disability and Rehabilitation
Research Progress Report #25

Montana Providers of Services to Adults with Developmental Disabilities: Urban/Rural Characteristics, and Direct Service Staff Turnover Rates and Replacement Costs

Research and Training Center on Disability in Rural Communities
The University of Montana Rural Institute

August, 2004

Background: RTC: Rural researchers have documented the cost to Montana developmental disability service providers of replacing, hiring and training direct service staff (Research Progress Report #17, 2002). Our research also found a correlation between direct service staff turnover and increased incidence/costs of consumer injuries (Research Progress Report #3, 1999). These findings suggest that reducing turnover may improve consumers' well-being and save money. As part of a multi-stage effort to improve health outcomes for adult Montanans who live in supported environments and have intellectual and developmental disabilities, this report documents the next step in assessing the economics of direct service staff turnover.

Methods: In June, 2002, RTC: Rural researchers sent a Cost of Turnover to Service
Corporations and Organizations Survey to 33 Montana community and institutional
service providers. We asked Executive Directors and/or Human Resource Directors to complete the survey, which had been pilot-tested and developed with provider input (Research Progress Report #17, 2002). Thirteen community service providers and one state intermediate care facility (ICF-MR) returned surveys (42% response rate). This report looks at urban and rural data on providers' specific organizational and structural characteristics, including workforce size, budgets, and consumers served. It also examines urban and rural direct service staff turnover rates, job benefits, reasons for job exits, and replacement costs of staff recruitment and training.

Although Montana is predominantly rural, the urban-rural geographic distribution of the fourteen providers is representative of the entire state. Five providers were in urban counties with populations of 55,000 or more and large labor market areas. These counties are regional trade and service centers serving market areas of multiple surrounding counties. Nine providers were in rural counties with smaller populations and a geographic orientation toward the urban trade centers. Summary descriptions for urban and rural providers are included.

Results:

Initial findings include:

1. Urban service providers serve more consumers and employ more staff on average than rural providers.

2. Urban service providers have significantly larger budgets on average than rural providers.

3. Urban service providers have slightly more consumers in supported living situations and fewer in group home environments. For rural providers, this trend in residential placement is reversed.

4. Rural service providers serve significantly higher numbers of consumers with severe disabilities than do urban providers.

5. Turnover rates of direct service staff varied across service providers depending on the proportions of full-time, part-time, and relief pool employees.

6. Turnover rates were lowest among full-time staff, and highest among relief staff.

7. Average hiring costs associated with turnover rates were $1,085 for urban providers and $811 for rural providers.

8. Training costs per direct service hire averaged slightly above $600 for both urban and rural employers.

Provider Characteristics: An organization's direct service staff turnover is affected by: 1. Its size; 2. The wages it pays; 3. The benefits it provides; 4. The quality of management it offers; and 5. The types of consumers it serves. Table 1 shows urban and rural data for some of these factors, including direct service staff size, annual budget, consumer disability levels, and consumer living arrangements (group home or supported living). The table provides average and median values, plus a low-high range. "Urban" and "rural" designations are determined by a provider's county location.

Description of Table 1. Urban and Rural Provider Characteristics

The average urban service provider employed 95 direct service staff compared to the average rural provider's 50 direct service staff. Urban provider direct service staff ranged from five to 195 full-time, part-time, and relief/substitute staff. Rural provider direct service staff ranged from 14 to 97 employees.

The average urban service provider's annual operating budget was more than $3 million (range of $1.7-$5.3 million). The average rural provider's annual budget was $900,000 (range of $400,000 to $2.1 million).

Providers rated disability levels of the consumers they served on a scale of 1 = mild, 2 = moderate, and 3 = severe. Rural providers typically served consumers with more severe disability. The average rural provider rated 62 percent of the consumers served as having severe disability. The average urban provider rated 19 percent of the consumers served as having severe disability (range of 2 to 36%). The average urban provider served 44 consumers in group living arrangements and 56 consumers in supported living settings. The average rural provider served 15 consumers in group living arrangements and six in supported living arrangements.

Turnover Rates: The survey collected turnover data for full-time, part-time, and substitute/relief direct service staff. During initial field-testing of the survey, respondents identified relief staff as an important population to be measured across providers.

Turnover rates varied for full-time, part-time, and substitute/relief direct service staff
(Table 2). Across all providers, part-time and relief staff turnover was generally higher than full-time staff turnover. This finding suggests that direct service is structured into a hierarchy of primary and secondary jobs. Primary jobs are permanent and full-time, with greater stability and opportunities for advancement. Secondary jobs pay lower wages, have less-desirable working conditions, are more unstable, and offer fewer opportunities for advancement. Experienced workers with skills and education may immediately qualify for primary jobs, while those with fewer skills and less experience qualify only for secondary jobs. Some job seekers specifically want temporary and/or part-time work, while for others these secondary jobs are an opportunity to demonstrate good work habits and accumulate experience before qualifying for primary jobs.

Description of Table 2. Urban/Rural Turnover Rates for 3-Month Period: Full-time, Part-time and Relief Direct Service Staff

Slightly more than half (55%) of the urban provider direct service staff worked full-time; 30 percent worked part-time, and 15 percent were relief staff. Three-quarters (75%) of rural direct service staff worked full-time; 15 percent worked part-time, and 10 percent were relief staff. Rural providers appeared to maintain relatively larger full-time workforces (with low turnover), and smaller proportions of relief staff (with high turnover).

For the three months preceding the survey, both urban and rural full-time staff turnover rates were lower than part-time and relief staff turnover rates. For urban providers, the average full-time staff turnover rate was 17 percent and the part-time rate was 20 percent. For rural providers, the average full-time staff turnover rate was four percent and the part-time rate was 18 percent. Both urban and rural part-time rates range widely. Average turnover rates were highest for relief staff (urban = 27%; rural = 61%).  However, the extremely wide ranges of turnover rates for relief staff biased the median rural rate.

Job Benefits: Providers indicated whether health insurance, paid vacation and sick leave, and retirement benefits were available to full- and part-time direct service staff (Table 3). No provider offered benefits to relief staff.

In both rural and urban areas, full-time staff were offered more job benefits than part-time staff. Most providers (90-100%) offered health insurance to full-time staff; 60 percent offered health insurance to part-time staff. More rural than urban providers offered all four benefits to full-time staff, and 90 percent of rural providers offered retirement benefits (urban = 60%). More urban (80%) than rural (60%) providers offered paid vacation and sick leave to part-time staff. However, more rural (60%) than urban (40%) providers offered retirement benefits to part-time staff.

Description of Table 3. Job Benefits Offered by Urban and Rural Service Providers to Full-time and Part-time Direct Service Staff

Reasons for Job Exits: Staff left their direct service jobs for various, usually voluntary, reasons. Urban providers had a higher rate of these voluntary "quits" than rural providers, which is consistent with the greater number of urban job opportunities and higher wages offered by other urban job sectors (Research Progress Report #27, 2004). Several urban and rural providers terminated employees, although the number of terminations/firings was relatively small. The third most-common reason for staff leaving direct service was promotion within the organization. The next most-common reasons, in order of frequency, were lateral transfers within the organization, family concerns, health issues, and re-locating.

Replacement Costs: The costs of direct service staff turnover include the costs of hiring and training replacement staff. Training costs are especially sensitive to worker turnover, as employers invest in training new staff and then lose that investment when the trained staff leave.

Hiring costs include recruiting, screening, and interviewing new staff, plus the administrative paperwork required for identifying and hiring new employees. Training costs per hire include orienting supervisors and other staff, job shadowing to teach the job, supervising transition from learning to independent performance, and training costs for CPR, First Aid and other necessary direct service skills.

Hiring costs averaged $1,085 for urban providers, with a wide range of $129 to $3,685 (Table 4). Rural providers had lower hiring costs that averaged $811, with a significantly smaller range than that of urban providers. Average new-hire training costs for both urban and rural providers employers were just over $600. Training costs had a wide range, from a low of $56 (urban provider) to a high of $2,450 (rural provider).

Description of Table 4. Urban and Rural Service Provider Costs of Hiring and Training Direct Service Staff (for 3-month period)

Discussion: These data show significant differences between urban and rural Montana service providers in annual budgets, sizes of direct service staff workforce, and number of consumers served. They also highlight urban-rural differences in consumers' levels of disability and in the types of living environments provided. Each of these factors may affect the working environment of direct service staff workers and how they should be oriented and trained. For example, rural providers and direct service staff may need more training on supporting consumers with severe disabilities. Urban providers might benefit from management training on strategies for supporting direct service staff in larger organizations.

Our findings also confirm that direct staff turnover generates significant costs for providers. Replacement, recruitment, and training costs can consume three to five percent of a service provider's budget (Tables 1 and 4). The reasons for direct staff turnover are complex and may be related to wages, benefits, management/supervision, consumer characteristics, and/or to the larger economic environment. Providers should consider each of these factors when structuring a direct service work environment.

Next Steps: RTC: Rural researchers will analyze service provider characteristics and turnover rates. A separate survey targeted 243 direct service staff employed by six of the fourteen participating providers, and these data measure direct service job characteristics and staff satisfaction; management characteristics; and direct service work experience and other relevant demographic information (Research Progress Report #26, 2004). We will integrate the direct service staff data with the provider survey data and then systematically analyze these variables as determinants of turnover in full-time, part-time, and relief employees. We also plan to relate turnover of direct service staff to health care utilization and to limitations from secondary conditions.

Resources and References:

Bainbridge, D. & Brod, R. (2004). Rural Disability and Rehabilitation Research Progress Report #26: Montana Providers of Adult Developmental Disabilities Services: Direct Service Staff Demographics, Job Characteristics and Job Satisfaction. Missoula: The University of Montana Rural Institute.

Seekins, T., Traci, M.A., & Szalda-Petree, A. (1999). Preventing and managing secondary conditions experienced by people with disabilities: Roles for personal assistance providers. Journal of Health and Human Services Administration, 22, 259-269.

Seninger, S. & Traci, M. (2002). Rural Disability and Rehabilitation Research Progress Report #17: Analysis of Direct Care Staff Turnover: Preliminary Results and Observations. Missoula: The University of Montana Rural Institute.

Traci, M., Szalda-Petree, A. & Seninger, S. (1999). Turnover of Personal Assistants and the Incidence of Injury among Adults with Developmental Disabilities: Rural Disability and Rehabilitation Research Progress Report #3. Missoula, MT: The University of Montana, Montana University Affiliated Rural Institute on Disabilities.

For more information, contact:

Steve Seninger, PhD
Steve.Seninger@business.umt.edu
Bureau of Business and Economic Research
The University of Montana 406-243-2725

Donna B. Bainbridge, PT, EdD, ATC, Director
Health Promotion for Adults with Developmental Disabilities
dbridge@ruralinstitute.umt.edu
406-243-5741

Research and Training Center on Disability in Rural Communities
The University of Montana Rural Institute, 52 Corbin Hall, Missoula, MT 59812-7056
(888) 268-2743 toll-free, (406) 243-4200 (TTY), (406) 243-2349 FAX
rural@ruralinstitute.umt.edu
http://rtc.ruralinstitute.umt.edu
http://mtdh.ruralinstitute.umt.edu

The information provided in this report was supported by Grant #R04/CCR818822-02 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of the funding agency.

This Research Progress Report was written by Donna Bainbridge and Steve Seninger, copyright RTC: Rural, 2004. The Rural Disability and Rehabilitation Research Progress Report Series is edited by Diana Spas. It is available in standard, large print, Braille, and ASCII DOS text formats.

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