PHI PolicyWorks | Wisconsin

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Size of Workforce: Totaling approximately 81,000 workers, Wisconsin’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 Wisconsin, demand for direct-care worker positions is expected to increase by 26 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 3 percent. Direct-care workers employed in home and community-based settings are a growing segment of Wisconsin’s workforce in both size and significance.

Median Wages: Direct-care workers in Wisconsin earn significantly less than the average wage across all occupations in the state. Furthermore, wages for Personal Care Aides and Home Health Aides fall below 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 Nursing Aides, Orderlies, and Attendants in Wisconsin increased by 11 percent, from $8.90 to $9.86. Real wages for Home Health Aides and Personal Care Aides increased less noticeably.

Health Insurance: Compared to the national civilian workforce, more of Wisconsin’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 Wisconsin’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: Forty-one percent of direct-care worker households in Wisconsin 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.

Notable Initiatives

Direct Care Competency Assessment and Training Program (pdf): The Wisconsin Personal Services Association designed this curriculum for personal and home care aides and, in 2007, presented it to the Department of Health Services as a recommended training program for direct-care workers.

Direct Care Worker Initiative: Under this recruitment initiative, the Concentrated Employment Program (CEP) of Northwest Wisconsin pays for training for people wanting to become direct-care workers and provides stipends to help pay for their first uniforms and other supplies. This funding comes from Health Resources and Services Administration.

Direct Service Workforce Resource Center – Intensive Technical Assistance: In 2007, the DSW Resource Center provided CMS-funded technical assistance to the Wisconsin Division of Disability and Elder Services regarding its implementation of a College of Direct Support Pilot Project. This pilot aimed to improve the quality and accessibility of training available to direct support professionals in the state.

Wisconsin Long Term Care Workforce Alliance: A coalition of public and private organizations and individuals, the Alliance develops and implements statewide community based strategies to improve the recognition, retention, and recruitment of the long-term care workforce.

Wisconsin Quality Home Care Authority- Care Registry: Provides a free internet-based matching service registry to consumers looking to employ independent providers authorized to provide service under two Medicaid Home and Community-Based Services waivers in Wisconsin.

Best Practices

Cooperative Care: Cooperative Care is a worker-owned cooperative providing homecare services to elders and people with disabilities in east central Wisconsin. A unique collaboration between public and private sectors, Cooperative Care provides a stable, committed, and professional workforce to meet the homecare needs of consumers while providing quality jobs for direct-care workers.

Wisconsin Veterans Home at King: At the largest nursing home in Wisconsin, nursing aides are trained in the Mather LifeWays’ LEAP program, a career ladder program that focuses on leadership, communication, and collaboration. The resulting improved collaboration and consistent nursing assignments have increased job satisfaction and helped staff provide better, more person-centered care for members.

Resources

PHI State Facts: Wisconsin’s Direct-Care Workforce (pdf): This fact sheet, issued by PHI in December 2011, gives an overview of the direct-care workforce in Wisconsin.

Ready to Serve? PFund Foundation Report of the Aging Network and Lesbian, Gay, Bisexual and Transgender Older Adults (pdf): This 2010 report, issued by the University of Minnesota and the PFund Foundation, reports on results from a survey of 15 aging agency directors from Iowa, Minnesota, Wisconsin, and North Dakota on lesbian, gay, bisexual, and transgender (LGBT) training for their workers. The report makes recommendations on how to address the needs of LGBT elders.

The Caregiver Abuse and Neglect Prevention Project (pdf): The Caregiver Abuse and Neglect Prevention Project, through its website at the University of Wisconsin-Oshkosh, offers about 25 hours of multi-media, ready-made training material for direct-care workers. These materials are downloadable for free.

ABOUT THE CENTER: The PHI State Data Center provides state-by-state data and resources relating to nursing aides, home health aides, and personal care aides (including direct support professionals). These occupations are known collectively as the direct-care workforce (learn more).
DATA SOURCES: See our page on data sources and definitions.
CONTACT: For more information or to suggest a resource for addition to this page, contact Abby Marquand, PHI policy research associate, at amarquand@phinational.org
CREDITS: The PHI State Data Center was developed with support from The SCAN Foundation and Centers for Medicare and Medicaid Services/National Direct Service Workforce Center.

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