Hiring and vetting direct support staff

Renee’s first three direct support hires all quit within four months, two of them without notice, leaving her scrambling for coverage on a Tuesday with no warning either time. She had hired all three the same way: someone seemed warm in conversation, had some vague experience, and needed the work. That was the entire process. By the fourth hire, exhausted and out of instinct-based faith, she built something closer to an actual hiring system. This is the post about what changed, and about the fact that self-directing your family member’s care quietly turns you into an employer nobody trained you to be.

You are running an HR department you never applied for

Let me be absolutely clear about what I’m saying, because families in self-directed care models rarely hear it stated this plainly: if you are hiring your own direct support staff, you are now performing recruiting, interviewing, background screening, onboarding, training, scheduling, and performance management, the entire function of an HR department, with none of the institutional infrastructure, and considerably higher stakes than most HR departments ever face. A bad hire in a corporate office costs productivity. A bad hire in your home affects your family member’s daily safety and dignity.

Nobody trains family caregivers for this role, which means most of us learn it the way Renee did: by making the mistakes first, three times, before building the process that should have existed from the start.

Structured interviews catch what gut feeling misses

An unstructured interview, “so tell me about yourself and why you want this job,” selects for people who interview well, which correlates only loosely with people who perform well under the specific, sometimes difficult, always intimate conditions of direct support work. A structured interview, the same set of scenario-based questions asked to every candidate, catches something different: how a person actually thinks under a realistic version of the job’s pressure.

“What would you do if he refused to get in the car for a medical appointment?” is a better question than “are you patient?” because everyone claims patience in an interview. The scenario question reveals the actual instinct: does the answer default to negotiation and de-escalation, or does it jump straight to physical intervention or punishment? That instinct, revealed before the hire rather than discovered after, is the entire point of the exercise.

Background checks: verification, not accusation

A criminal background check, a driving record check if transportation is part of the role, and direct phone calls to at least two prior employers are not expressions of distrust. They are the minimum diligence any organization hiring someone into a vulnerable person’s home and daily life would run as a matter of course. Reference letters, written by the candidate’s chosen advocates, tell you what someone wants you to hear. A phone call, where you can ask a direct follow-up question, tells you considerably more.

The written training plan replaces the verbal walkthrough

A verbal walkthrough on day one, however thorough it feels in the moment, relies entirely on a new hire’s memory of a single overwhelming conversation. A written training plan, two pages covering specific routines, communication style, sensory needs, and emergency procedures, becomes a reference document the new hire can actually return to in week three when they’ve forgotten half of what was said on day one.

Renee’s second attempt at this included a written plan for the first time: what her son’s morning routine looked like step by step, which words and phrases worked and which triggered distress, what to do if he became overwhelmed in public, and exactly who to call in three different levels of emergency. The document took an evening to write. It has saved dozens of confused text messages since.

The three factors that predict who stays

Respect, meaning being treated as a skilled professional rather than a babysitter, sits at the top of every direct support workforce retention study that’s ever surveyed the field, consistently ranked above pay in exit interviews, though pay obviously matters too. Predictable scheduling, knowing your hours two weeks out instead of getting a text the night before, is the second factor, because DSP work is rarely anyone’s only job, and unpredictable hours make it impossible to hold a second one. Clear expectations, stated in writing rather than assumed or discovered through trial and error, round out the three. Families who build all three into how they manage their hired staff see meaningfully longer tenures than families who treat each hire as an emergency to survive rather than a role to manage well.

Renee’s fourth hire is still working with her son three years later. Nothing about that hire was luckier than the first three. The process around the hire was simply, finally, built to last.

Jim Palasty is the founder of OASIS for Autism and a single father of an adult autistic daughter in Michigan.