Size of Workforce: Totaling approximately 7,000 workers, Washington, DC’s direct-care workforce provides daily services and supports to elders and individuals with disabilities who need assistance with personal care and other daily activities. Direct-care workers fall into three main categories tracked by the U.S. Bureau of Labor Statistics: nursing aides, home health aides, and personal care aides. Personal care aides include workers with many other titles—for example, personal attendants, direct support professionals, and home care aides. The estimates shown below for each occupation may heavily undercount independent providers hired directly by households.
Occupational Growth: Direct-care workers constitute one of the nation’s largest occupational groupings. Moreover, across the country, direct-care jobs are among the fastest growing occupations and those expected to produce the largest numbers of new jobs over the coming decade. In Washington, DC, demand for direct-care worker positions is expected to increase by 19 percent from 2006 to 2016. In contrast, jobs overall are expected to increase by only 9 percent. Direct-care workers employed in home and community-based settings are a growing segment of Washington, DC’s workforce in both size and significance.
Median Wages: Direct-care workers in Washington, D.C. earn significantly less than the average wage across all occupations in the District. Furthermore, wages for Home Health Aides hover around 200 percent of the 2009 federal poverty line for a single individual working full time ($10.42). The 200 percent poverty level is low enough to qualify households for many state and federal assistance programs.
Wages Adjusted for Inflation: Over the past decade, inflation-adjusted median hourly wages for Personal Care Aides in Washington, D.C. increased by 26 percent, from $7.65 to $9.66. Real wages for Nursing Aides, Orderlies, and Attendants increased by 14 percent and those for Home Health Aides increased by 10 percent.
Health Insurance: Compared to the national civilian workforce, more of Washington, DC’s direct-care workers are uninsured. Because of low wages, direct-care workers often have difficulty affording private health insurance coverage; however, many earn too much to qualify for Medicaid.
Employer-Sponsored Insurance: Compared to the national civilian workforce, fewer of Washington, DC’s direct-care workers have access to and use employer-sponsored insurance. Some work for employers that do not offer health insurance. Others work for employers that limit eligibility for health insurance to full-time employees. This creates a barrier for many direct-care workers, especially those in home and community-based settings, who often work only part-time due to the episodic nature of direct-care work. Even workers who do have access to insurance from their employer may find the co-pays and premiums unaffordable.
Public Assistance: Thirty-eight percent of direct-care worker households in Washington, DC rely on some form of means-tested public assistance, particularly Medicaid or food and nutrition assistance. This reliance reflects the generally poor quality of direct-care jobs in terms of wages and benefits, and the part-time nature of many direct-care jobs.
Legislation/Regulation
Living Wage Act of 2006: This act requires the recipients of District contracts or government assistance in the amount of $100,000 or more to pay an inflation-indexed living wage. Employees of nonprofit organizations that employ no more than 50 individuals are exempt as are Medicaid provider agreements for direct care services that are not provided through a home care agency, a community residence facility or a group home for persons with intellectual disabilities. The latest annual wage adjustment provides for an hourly wage of $12.50 effective March 2011.
D.C. Law 6-99; D.C. Official Code § 3-1201.01 et seq.: Legislation passed in D.C. in 2009 establishes a registration system and definition for universal direct-care workers called “Nursing Assistant Personnel.” It also provides the Board of Nursing with oversight and the authority to promulgate training requirements.
Notable Initiatives
DC Coalition on Long Term Care: The Coalition is a group of consumers, advocates and health care providers who work with the government in the District of Columbia on long-term care issues. The Coalition has successfully advocated for raising the wages of home care workers and also issued training recommendations to the Board of Nursing for “Nursing Assistant Personnel,” including a career ladder proposal.
