The State of the Direct Care Worker

Present State: Direct Care Work = Low Wages and Lack of Opportunity

Everyone seems to agree, as the President emphasized several times in his state of the Union address, that people who work full-time should not live in poverty. But, the President said, "Our opportunity agenda won't be complete -- and too many young people entering the workforce today will see the American Dream as an empty promise -- unless we do more to make sure our economy honors the dignity of work, and hard work pays off for every single American."

For far too many direct care workers -- the nursing assistants, home care and home health aides, personal care assistants, direct support professionals and others who provide the majority of the paid, hands-on personal assistance and long-term care to older adults and persons with disabilities -- hard work does not pay off, except in the satisfaction it gives them and the relationships they form with the people they assist. Their wages are so low -- about $10 an hour, on average -- that many direct care workers share with Direct Care Alliance (DCA) that they must work two, even three jobs, often working 7 days and as much as 60 or 70 hours a week just to piece together enough pay to support themselves and their families. As a result, hundreds of thousands of direct care workers are unable to afford health care coverage and nearly half rely on some form of public benefits to meet their basic needs.

Direct care workers provide an estimated 70 to 80 percent of the paid hands-on long-term care and personal assistance received by Americans who are elderly or living with disabilities or other chronic conditions. Those needs are growing fast: an estimated 1.6 million new direct care workers will be needed over the next decade. If we don't start paying better wages, and soon, how can we expect to find the people we need to provide that care, let alone to be able to guarantee care recipients the quality and continuity of care that is so important to them?

There are clear opportunities for America to improve direct care as a profession, and thus to respond effectively to the growing need for care workers. An excellent starting point would be ensuring that 2014 is a break-through year for low-wage workers by passing pending legislation that would grant paid family and medical leave to nearly all workers in the U.S., getting immigration reform done, raising the minimum wage, and keeping intact various government safety net programs like food stamps, child care subsidies, WIC, etc. (until such a time when they no longer are needed).

One area that is already showing some promise in leveling the benefits playing field for direct care workers is access to affordable health insurance, though more work is needed to make health care truly affordable for many low-wage workers. The Affordable Care Act (ACA) is helping tens of thousands of direct care workers like Beverly, a home health aide in New York City. After working five years as a home health aide, Beverly found herself no longer eligible for Medicaid and subsequently without health insurance, although she lives with several chronic health conditions that get much worse if she can't afford the medications needed to manage them. Her job offered insurance, but she could not afford the premiums. When she found a plan she could afford through the ACA she was greatly relieved, but paying for the insurance will require a significant portion of her already low wages. Worse, her hours and pay vary from check to check, making it difficult to budget in this new expense. Like a lot other direct care workers, Beverly wishes she could find one stable job with full-time hours. Then budgeting and paying for basic needs like health insurance would simply bring her peace of mind without causing additional stress.

Beverly is relieved that she can now get regular checkups for her high blood pressure, and that she can now go to the ER, if she has an asthma attack, without the worry of ending up with a huge hospital bill. "You definitely have to have insurance," she says, and the ACA has made that possible. But until she can count on higher and more stable wages, maintaining coverage will be a struggle.

Continued Workforce Progress through Collective Efforts

Imagine that the year is 2020 and the largest occupational group in the U.S. -- direct care workers -- has made so much progress that their hard work finally leads to economic stability and health security for them and their families. How can we get from here to there in six short years?

We must apply the same collective organizational efforts that allowed DCA and our allies to undo the federal Fair Labor Standards Act (FLSA) exemption for home care workers, making these workers eligible for minimum wage and overtime pay and other basic labor protections for the first time in FLSA's 75-year history. We must build on this momentum to ensure other advances for the direct care workforce.

Direct care workers just want what other hardworking Americans desire: to be employed at one full-time job that pays enough so they can afford basic benefits like health care coverage, and can pay their bills without relying on public assistance. As the President said in the State of the Union: "We're not doing right by American people." Don't we all want to see every direct care worker get those basic rewards for the important work they do?

Another recurring theme in President Obama's State of the Union address was that progress in America does not stand still -- and neither should our efforts to ensure that direct care workers share in the fruits of the American dream. Direct Care Alliance and our allies will remain on the frontline, advocating for needed changes until direct care work receives the respect, compensation, and benefits they so rightly deserve. We hope you will join us.