Direct Care and the High Cost of Low Wages

Direct care is one of the fastest growing areas of healthcare employment, but low wages, nonexistent benefits, and a lack of opportunity for advancement threaten to jeopardize outcomes and disrupt quality of care.

"Can you believe how little they pay such important workers?"

I was having lunch with a friend who has been considering making a career change. A naturally caring, kind, and empathetic person, direct care appealed to her. Job prospects look good. The bureau of labor statistics anticipates employment growth for personal care aides to grow by 26% through 2024, and that of home health aides to grow by 38%.

Then, she saw the hourly wage.

"Twelve dollars an hour," she told me, shaking her head in disbelief. "That's what they pay them. I earned more than that when I worked in retail. And God forbid the car breaks down or you need dental work."

Given the high levels of responsibility entrusted to these providers, my friend couldn't believe the pay for these jobs was so low. Many direct care workers start at as little as $8.00 per hour in some places. (My friend and I live in a state where the minimum wage is $11.00 per hour.)

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She's not alone; many are surprised to learn about the low wages and paltry benefits commonly paid to providers of direct care.

Recently, the American Network of Community Options and Resources (ANCOR), a non-profit trade association that represents more than 1,000 private community providers of services to people with disabilities, published a research paper examining the current situation of workers in the direct care field.

The results weren't pretty.

"We compared direct care providers to several different fields, including retail, food servers, and janitors," says Esme Grant Grewal, senior director of government relations at ANCOR. "We found that direct support professionals are making less than those careers are making in terms of hourly wages."

In short: The guy who made your latte this morning likely earns more than many direct care providers. Considering the value and importance of quality of care along the continuum, that's a problem.

Beyond Penny Pinching
You don't have to be a do-gooder or obsessed with the hot-button topic of wage equality to see the very practical downsides of keeping wages for these workers low, says Gabrielle Sedor, chief operating officer at ANCOR.

High turnover isn't just an annoyance for direct care workers or the health systems that employ them; it impacts the quality of care patients receive, too.

"It's very difficult [for patients] to go from worker to worker," says Grewal. These workers bathe, feed, and dress them; every time a direct care worker leaves, the patient must start over and learn to trust a new person.

And high turnover is expensive for the organization employing the worker, says Sedor. "Every time someone leaves, the organization must spend thousands of dollars onboarding a replacement."

Additionally, finding qualified workers willing to work for these wages isn't easy. The regulatory requirement for these roles are rigorous, and a criminal background check is an absolute must.

Sedor describes the current situation as a staffing crisis, which she says she expects to only intensify as the Baby Boom generation reaches the age when they need greater support and become consumers of direct care in greater numbers.

And as health systems consolidate and become responsible for more services, including long-term care, care coordination, and care transitions, more healthcare leaders will find themselves making decisions regarding providing livable pay and benefits.

Fair Trade
But HR leaders are in position to ease this crisis and improve quality of care, and not just by increasing direct care provider wages, although that's a good start.

Another way to say thank you is to provide these workers with something they can use, such as benefits.

"The majority of direct support professionals are women of working age, and many have young children. Many don't have a lot of support outside of work. Any assistance with childcare or health benefits are very important," says Grewal.

Creating career options matters, too. But obstacles to this goal are inherent to the system. Moving from an hourly to a salaried position could mean the loss of much needed overtime pay, or loss of Medicaid benefits to these workers.

"Sometimes, it feels like we're stuck in a hamster wheel," says Sedor.

It's important to recognize the areas that need improvement and to attempt to close these gaps by increasing wages, creating a career path, and offering competitive benefits.

If you're willing to do that, I just might know a caring, kind, and empathetic aspiring direct care worker I can send your way.