Training Article: Direct Support Professional (DSP) vs. Caregiver in Non-Medical Home Care in Ohio

Introduction

Direct Support Professionals (DSPs) and caregivers both provide essential support to people who need assistance to live safely and independently in their homes and communities. Although the titles are sometimes used interchangeably, they are not always the same job in Ohio.

The primary difference is often the population served, purpose of the service, funding/program requirements, and the individual’s service plan. A caregiver in non-medical home care may primarily assist an older adult or person with physical limitations with activities of daily living (ADLs), personal care, homemaking, and companionship. A DSP often supports a person with an intellectual or developmental disability (I/DD) with daily living, independence, community participation, skill development, relationships, and implementation of an individualized service plan.

Ohio’s rules also distinguish among different provider programs. For example, Ohio Department of Aging (ODA) rules define personal care as hands-on assistance with ADLs and certain instrumental activities of daily living (IADLs), while Ohio Department of Developmental Disabilities (DODD) rules govern services such as homemaker/personal care for people receiving certain Medicaid waiver services. (Ohio Laws)

Important training note: Job titles can vary from one agency to another. This article describes common distinctions and Ohio regulatory concepts; an employee must always follow the applicable Ohio law, the employer’s policies, the individual’s authorized service plan, and the scope of the specific service being provided.

1. What Is a Caregiver?

In a non-medical home care setting, a caregiver generally provides practical, personal, and supportive assistance that helps a person remain safe and independent at home.

Depending on the agency, payer, and authorization, caregiver responsibilities may include:

Assistance with bathing, dressing, grooming, and toileting
Assistance with eating and drinking
Mobility and transferring assistance within the worker’s authorized duties
Meal preparation
Light housekeeping
Laundry
Changing bed linens
Shopping and errands
Assistance with routine household activities
Companionship and social engagement
Assistance with appointments and community activities
Observation and reporting of changes in the individual’s condition
Assistance with self-administration of medication when specifically permitted
Respite for a family caregiver when the applicable service permits it

Ohio’s rules specifically recognize homemaker activities such as meal planning, meal preparation, shopping, laundry, cleaning, changing bed linens, and certain errands when authorized under the applicable service plan. (Ohio Laws)

Ohio also defines personal care as including hands-on assistance with ADLs and IADLs, assistance managing the home and personal affairs, assistance with self-administration of medications, certain homemaker activities, and specified errands. (Ohio Laws)

The caregiver’s primary objective

The caregiver’s focus is generally:

“What assistance does this person need to remain safe, comfortable, and as independent as possible at home?”

2. What Is a Direct Support Professional?

A Direct Support Professional (DSP) provides direct assistance to an individual, often a person with an intellectual or developmental disability, to help that individual live as independently and meaningfully as possible.

A DSP’s responsibilities can include many of the same practical tasks performed by a caregiver, but the role often goes beyond simply completing tasks for the person.

The DSP may help the individual:

Develop and maintain daily living skills
Make choices and exercise self-direction
Participate in the community
Develop relationships and social connections
Practice communication skills
Participate in employment or volunteer activities
Manage household responsibilities
Prepare meals
Maintain personal hygiene
Participate in recreational activities
Access community resources
Follow an individualized service plan
Maintain health and safety
Recognize and report changes, incidents, or concerns
Build greater independence

Ohio DODD rules require DSPs to know the individual’s service plan and implement services in accordance with that plan and in a person-centered manner. (Ohio Laws)

The DSP’s primary objective

The DSP’s focus is often:

“How can I support this person to make choices, develop skills, participate in the community, and achieve greater independence?”

3. The Biggest Similarity: Both Are Direct-Care Professionals

Despite differences in terminology and service models, DSPs and caregivers have many responsibilities in common.

Both may:

Provide personal assistance
Assist with ADLs
Assist with household activities
Prepare meals
Provide companionship
Assist with community activities
Promote safety
Respect privacy and dignity
Protect confidentiality
Observe the person for changes or concerns
Report incidents and significant changes
Follow an individualized plan of care/service plan
Maintain professional boundaries
Document services provided
Support the individual’s independence
Communicate with supervisors and other members of the support team

Ohio’s regulatory framework emphasizes person-centered services and following the individual’s authorized service plan. (Ohio Laws)

4. Major Differences Between a DSP and a Caregiver

Area	DSP	Non-Medical Caregiver
Typical population	Frequently individuals with intellectual/developmental disabilities	Frequently older adults, adults with disabilities, or individuals needing assistance at home
Primary focus	Independence, skill development, choice, community inclusion, and implementation of the service plan	Personal care, safety, daily living assistance, homemaking, companionship, and maintaining the person’s home routine
Service philosophy	Often strongly focused on habilitation and skill development	Often focused on assistance, maintenance, comfort, and safety
Service plan	Individual Service Plan (ISP) or other applicable plan is central	Plan of care/service plan or authorized tasks are central
Community participation	Often a major part of the role	May be part of the role depending on the service and agency
Skill building	Often an explicit responsibility	May be less prominent, depending on the client and service
Behavioral support	May be part of the role when properly trained and authorized	Usually limited unless specifically part of the service and worker’s training
Documentation	Documents services, progress, incidents, and implementation of the plan	Documents care/tasks performed, observations, and changes or concerns
Medication	Generally cannot administer medication unless legally authorized and appropriately qualified	May assist with self-administration when permitted; cannot independently perform nursing functions
Medical care	Not automatically a medical provider	Not automatically a medical provider
Relationship with individual	Professional support relationship emphasizing self-determination and independence	Professional caregiving relationship emphasizing assistance and safety

5. DSPs Should Not Simply “Do Everything for the Person”

One of the most important training distinctions is the difference between assistance and doing a task for someone when the person could participate.

For example:

Caregiver approach

A caregiver may be assigned to help an individual get dressed. The caregiver might provide the necessary physical assistance so the person can complete the task safely.

DSP approach

A DSP may ask:

“What part of getting dressed can you do independently?”

The DSP might allow the person to select clothing, provide verbal prompts, demonstrate a step, or provide physical assistance only when necessary.

The objective is not merely to complete the task.

The objective may be to support the person’s ability to complete more of the task independently over time, when that is consistent with the individual’s service plan and preferences.

This is consistent with Ohio’s person-centered approach to services. (Ohio Laws)

6. Person-Centered Care Is Important for Both Roles

A professional caregiver or DSP should never assume:

“I know what’s best for this person.”

Instead, the professional should ask:

What does the individual want?
What choices can the individual make?
What assistance has the individual requested?
What does the service plan authorize?
What can the individual do independently?
What support does the person need?
How can I preserve dignity and privacy?
Am I promoting independence or unnecessarily creating dependence?

Ohio’s DODD framework specifically requires services to be implemented in accordance with the individual’s service plan and in a person-centered manner. (Ohio Laws)

7. Activities of Daily Living

Both DSPs and caregivers may assist with ADLs, depending on the applicable service and authorization.

Common ADLs include:

Personal hygiene

Bathing
Showering
Oral care
Grooming
Hair care

Dressing

Selecting clothing
Putting on and removing clothing
Fastening clothing
Putting on shoes

Toileting

Getting to and from the bathroom
Assistance with toileting
Hygiene following toileting

Eating

Meal assistance
Positioning
Assistance with eating when authorized and appropriate

Mobility

Walking assistance
Transfers
Positioning
Mobility-related support within the worker’s training and authorization

Important: The exact tasks permitted depend on the service, the worker’s training, the individual’s plan, and Ohio law.

8. Instrumental Activities of Daily Living

Both roles may also involve IADLs, depending on the service.

Examples include:

Meal preparation
Grocery shopping
Laundry
Housekeeping
Managing appointments
Handling routine household responsibilities
Community errands
Assistance with personal affairs when authorized
Transportation or travel assistance when specifically permitted

Ohio’s ODA rules expressly recognize homemaker and personal-care activities involving household management, meals, laundry, cleaning, shopping, errands, and certain other activities. (Ohio Laws)

9. Medication: A Critical Boundary

One of the most important areas for training is medication.

A DSP or caregiver should never assume that being asked to give medication means they are legally permitted to administer it.

Ohio rules distinguish between administering medication and helping an individual self-administer medication.

For example, Ohio’s rules governing certain personal-care services permit assistance with self-administration under specified circumstances. Ohio’s home-care waiver rules also state that personal care aides do not administer prescribed or over-the-counter medications but may, when permitted, assist with self-administration. (Ohio Laws)

Likewise, DODD rules state that a DSP may not administer medication or perform health-related activities unless the DSP meets the applicable legal requirements. (Ohio Laws)

Training rule of thumb

When in doubt, stop and ask the supervisor.

Never perform a medication or health-related task simply because:

The family asks you to;
Another employee says it is okay;
You have performed it in another job;
You have personal experience doing it;
The individual says they want you to do it.

The applicable Ohio requirements and your employer’s policies control.

10. Medical vs. Non-Medical Care

Both DSPs and caregivers in a non-medical setting must understand their boundaries.

Generally non-medical support includes:

Personal care
Homemaking
Companionship
Meal preparation
Assistance with ADLs
Community support
Skill development
Observation and reporting

Examples of activities that may require additional qualifications or authorization include:

Medication administration
Nursing assessments
Injections
Wound care
Complex medical procedures
Clinical decision-making
Other health-related activities

Ohio defines “nonmedical home health services” to include home health aide and personal care services, while separately regulating skilled nursing and other health-related services. (Ohio Laws)

11. Documentation Responsibilities

Documentation is an essential responsibility for both DSPs and caregivers.

A professional record should accurately reflect:

Date of service
Start and end time, as required
Services provided
Assistance provided
Activities completed
Individual’s participation
Significant observations
Changes or concerns
Incidents that must be reported
Progress toward authorized goals, when applicable

Documentation should be:

Accurate: Record what actually happened.

Objective: Describe observable facts rather than assumptions.

Timely: Complete documentation according to agency requirements.

Professional: Avoid judgmental or disrespectful language.

Confidential: Protect the individual’s personal information.

For DSPs, documentation can be particularly important because it may demonstrate how the worker implemented the individual’s service plan.

12. Incident and Safety Reporting

DSPs and caregivers have an important responsibility to recognize and report safety concerns.

Examples include:

Falls
Injuries
Suspected abuse
Suspected neglect
Exploitation
Missing medications
Unsafe environmental conditions
Significant changes in behavior
Significant changes in physical condition
Emergency situations
Other incidents required by the applicable program or agency

DSPs working under Ohio DODD rules have specific responsibilities related to preventing and responding to major unusual incidents and unusual incidents. (Ohio Laws)

Never hide a mistake.

A professional should report an incident even when:

The worker caused the mistake;
The worker is embarrassed;
The individual says not to report it;
The worker believes “nothing serious happened.”

Timely reporting protects the individual, the employee, and the agency.

13. Professional Boundaries

Both caregivers and DSPs must maintain professional boundaries.

A professional should not:

Borrow money from an individual
Lend money to an individual
Use the individual’s property without permission
Become financially dependent on the individual
Engage in inappropriate personal relationships
Share confidential information
Post information about clients on social media
Bring unauthorized people into the individual’s home
Use the individual’s vehicle without authorization
Accept inappropriate gifts
Become involved in the individual’s family conflicts

The individual receiving services is a person receiving professional support—not a friend, customer to be controlled, or family member to be taken advantage of.

14. Respect, Dignity, and Choice

Every person receiving services should be treated with dignity.

That means:

Knock before entering a bedroom or bathroom.
Protect privacy during personal care.
Explain what you are doing.
Ask permission before providing hands-on assistance when appropriate.
Use respectful language.
Avoid talking about the individual as though they are not present.
Allow reasonable choices.
Respect cultural and personal preferences.
Encourage independence.
Never shame someone for needing assistance.

For DSPs, respect for individual rights, dignity, privacy, choice, and person-centered planning is particularly important within the Ohio developmental-disabilities service system. Ohio’s rules require services to be delivered in a person-centered manner. (Ohio Laws)

15. Example: How the Roles Can Overlap

Imagine an individual named John who has difficulty preparing meals and maintaining his home.

Caregiver

The caregiver may:

Help John plan a meal.
Assist with grocery shopping.
Prepare the meal.
Clean the kitchen.
Do laundry.
Assist John with personal care if authorized.
Provide companionship.
Document the services provided.

DSP

A DSP supporting John might perform many of the same tasks but incorporate skill development:

Ask John what meal he wants.
Help John create a shopping list.
Support John in choosing groceries.
Teach or reinforce safe food preparation.
Allow John to complete the steps he can perform independently.
Prompt John rather than automatically doing the task for him.
Encourage John to participate in cleaning.
Support John in making choices.
Document the individual’s participation and implementation of the service plan.

The physical tasks may look very similar. The purpose and approach can be different.

16. Example: Personal Care

Suppose Mary needs assistance getting dressed.

Caregiver

The caregiver may provide hands-on assistance according to Mary’s authorized care plan and agency policy.

DSP

The DSP may determine what Mary can do independently, provide prompts or cues, and provide only the assistance necessary to help Mary complete the task, consistent with her service plan.

The DSP’s goal may be:

“Support Mary to do as much as she safely can for herself.”

The caregiver’s goal may be:

“Provide the authorized assistance Mary needs to complete the activity safely.”

In practice, both approaches can overlap substantially.

17. Training Expectations

Employees should receive training appropriate to the specific service they provide.

Depending on the employer and program, training can include:

Person-centered care
Individual rights
Abuse, neglect, and exploitation prevention
Incident reporting
Infection control
Emergency procedures
First aid
CPR
Medication-related limitations
Personal care
Transfers and mobility
Communication
Professional boundaries
Documentation
Confidentiality
Cultural competence
Behavioral support
Community integration
Individual-specific training

Ohio DODD rules establish training requirements for DSPs providing services under the DODD system, and additional training may apply to particular services. (Ohio Laws)

18. A Simple Way to Remember the Difference

A useful training distinction is:

Caregiver

Assist, protect, maintain, and support.

DSP

Support, empower, teach, encourage, and promote independence.

However, these are not mutually exclusive.

A caregiver may promote independence.

A DSP may provide extensive hands-on personal care.

The actual duties depend on the individual’s needs, authorized services, applicable Ohio rules, and the employer’s policies.

19. What Both Professionals Should Never Do

Whether you are called a DSP, caregiver, home health aide, personal care aide, or another title, never:

Perform a task outside your training or authorization.
Perform a prohibited medical task.
Ignore an injury or safety concern.
Fail to report suspected abuse or neglect.
Falsify documentation.
Claim to have provided services that were not provided.
Violate an individual’s privacy.
Use threatening or degrading language.
Force an individual to participate in an activity without lawful authorization.
Make decisions that belong to the individual, guardian, care team, or qualified professional.
Provide services that conflict with the individual’s authorized plan.

20. Key Takeaways for Employees

Remember these five principles:

1. Know the person.
Learn the individual’s preferences, needs, abilities, communication style, and goals.

2. Know the plan.
Know what services and tasks you are authorized to provide.

3. Know your boundaries.
Do not perform tasks outside your training, legal authority, or agency policy.

4. Promote independence.
Whenever appropriate, help the individual participate rather than automatically doing everything for them.

5. Report and document.
Accurately document services and promptly report incidents, injuries, abuse, neglect, exploitation, or significant changes.

Conclusion

A DSP and a non-medical caregiver have many overlapping responsibilities, including assisting with personal care, household activities, community participation, safety, and daily living. The key difference is often the purpose and context of the service.

A caregiver’s role commonly centers on helping a person safely manage daily activities and remain independent in the home. A DSP, particularly within Ohio’s developmental-disabilities system, commonly has the additional emphasis of person-centered planning, skill development, community inclusion, self-determination, and supporting the individual to achieve greater independence. Ohio DODD requires DSPs to understand and implement the individual’s service plan in a person-centered manner. (Ohio Laws)

At the same time, Ohio has multiple home- and community-based service systems, and terminology can differ. ODA personal-care rules, DODD waiver rules, and Ohio Department of Health requirements can impose different requirements depending on the provider, service, and population served. (Ohio Laws)

The best professional practice is therefore simple: know your role, know the individual’s plan, respect the individual’s choices, stay within your scope, promote independence, and ask a supervisor whenever you are unsure.