Disability Support

Direct Support Professionals: What They Do and How Hiring Works

Learn what a direct support professional does each day and how to hire one through an agency or by self-direction.

Updated November 1, 2026 · 6-minute read

Key takeaways

A direct support professional is often called a DSP for short.
The same kind of worker may be called a direct service worker, or DSW for short.
The job can include help with bathing, dressing, meals, and housework.
The job can also include rides, job skills, and help to take part in community life.
The worker follows the plan of the person who gets the help.
A family can hire through an agency that employs the worker.
Some programs let the person hire and manage the worker. This is called self-direction.
Training, background checks, and pay rules vary by state and by program.

A direct support professional helps a person with a disability live at home and in the community. The worker helps with daily tasks. The worker also helps the person learn skills and make choices.

Some families hire this help for the first time and do not know where to start. This guide explains what the job looks like each day. It also explains the main ways to hire a worker. Our disability support hub gives the wider picture.

What these workers are called

The direct care workforce includes many job titles. You may see ads or program forms with any of these names.

The titles can change from state to state and from program to program. The core of the job is the same. The worker gives support so the person can live the life the person wants. The worker does not take charge of that life. The person keeps the right to make choices and to direct the help.

Personal care attendant
Job coach
Home health aide
Residential worker
Direct support professional, or DSP
Direct service worker, or DSW

What a DSP does each day

The tasks change with the needs of the person. No two days look just the same. Most DSP work falls into a few clear areas.

Help with daily living

Help at home

Health and safety

Work and community life

The worker takes direction from the plan of the person. The worker also takes direction from the choices of the person. If the plan says the goal is to learn to cook, the work is to teach and support. The worker does not just do the task while the person watches. Good support builds skill and trust over time. Our guide to organizing personal assistance while protecting choice and privacy shows how to set up help in a way that keeps choice and privacy safe.

Help with bathing, dressing, and grooming
Help for the person to eat meals in a safe way
Help to move around the home in a safe way
Make meals and clean up after meals
Do light housework, such as laundry and dishes
Help with money skills, such as a simple budget or a trip to the store
Watch health and safety each day and note changes
Help with health tasks, such as support with medicine, as state law permits
Follow steps in the plan for health needs and for risks at home
Support job skills and job training
Give rides to work, to care visits, and to community events
Teach skills for a more independent life, such as use of a bus or care of a home
Support self-advocacy, so the person can speak up for needs and rights
Support community inclusion, so the person can take part in local life

Who pays for this help

Pay for DSP help can come from a few sources. The source depends on the program and on the state.

A center for independent living can help you learn what programs exist near you. Our guide to finding a center for independent living and local support explains how to find one.

Medicaid: Medicaid home and community based programs can pay for DSP support for people who meet program rules. The state runs the program, and each state sets its own rules for who can get help.
Medicare: Medicare does not pay for long-term DSP support. Medicare pays for some short-term skilled care at home when a doctor orders it. That care is not the same as long-term daily support from a DSP.
Private pay: A person or family can pay a worker or an agency with their own funds. The terms are set by the hire terms the family and the worker or agency agree on.

Two ways to hire a DSP

Most families hire in one of two ways. The right way depends on the program and on how much control the family wants.

Hire through an agency

An agency or provider employs the worker. The agency hires and trains the worker. The agency sets the schedule and sends a worker to the home. If a worker is sick, the agency may send a fill-in worker. The family tells the agency what help is needed. The agency handles pay and tax forms. This path asks less of the family. It can give the family less choice about which worker comes.

Hire by self-direction

Some Medicaid home and community based programs allow self-direction. In self-direction, the person or the family finds the worker. The person or family hires the worker and manages the work. The person sets the tasks and the hours, based on the plan and the program rules. This path gives the person more choice and more control. It also asks more of the person and the family. They must recruit, train, and keep good workers.

CMS runs a free training course on how to recruit, select, and retain direct service workers for self-directed services. The course is made for people who direct their own services. It can help a family learn to write a job post and ask good questions.

Training, checks, and rules

Rules for this work vary a lot. Training needs vary by state and by program. Background check rules vary by state and by program. Pay rules vary by state and by program. An agency may add its own training on top of state rules. A self-directed hire must still meet the rules of the program that pays for the help.

Ask the program or the agency what rules apply before you hire. Ask what training the worker must have. Ask what checks the worker must pass. Ask who pays for training time. Do not assume the rules in one state match the rules in the next state.

Sample situation

Maya is an adult who lives in her own flat. She uses a wheelchair and needs help to start her day. Her sister helps her look for support. They talk about what Maya wants. Maya wants help with bathing and dressing in the morning. She also wants help to learn to cook simple meals. She wants rides to her job and to a swim class she likes.

Maya is in a program that allows self-direction. She and her sister write a short job post. They meet a few workers and ask how each one would help Maya learn to cook. Maya picks the worker she trusts most. They set a weekly plan based on the goals in her support plan. The worker helps in the morning and teaches cooking steps in the late day. Maya gives feedback each week. She says what works and what should change. Over time, she cooks more meals on her own and feels more at ease with her worker.

Steps to hire with care

Write down the help you need and the goals in the support plan.
Check which programs in your state can pay for this help.
Choose the hire path that fits you: an agency hire or self-direction.
Ask about training needs, background checks, and pay rules for your program.
Meet more than one worker if you can, and ask how they would do the tasks.
Set a clear schedule and a clear list of tasks before work starts.
Give feedback often, and update the plan when needs change.