Direct Care Workers Face Persistent Wage Gap Across All 50 States
How do direct care wages compare to occupations with similar or lower entry-level requirements, such as fast food, retail sales, and housekeeping? New research by PHI reveals that, in 2023, the median wages of direct care workers lagged behind these comparable occupations in all 50 states and D.C. The wage gap was greater than $2.00 per hour in 39 states, with the largest gap in Texas—$5.56 per hour.
Indeed, PHI’s updated Competitive Disadvantage report shows that direct care workers in every state experienced this wage gap each year from 2014 to 2023. In 13 states, the wage gap has actually widened over the past decade, making direct care jobs even less competitive in these states. These states include Delaware, Texas, and Vermont; in each of these states, the hourly wage gap has deepened by over $2.00.
While concerning, these findings are also unsurprising, given persistently low hourly wages for direct care workers—which were less than $17.00 per hour in 2023. These wage trends serve as barriers to recruiting and retaining direct care workers, who also experiences few employment benefits, limited training and career ladders, and often-hazardous working conditions, among other challenges.
In order to meet rapidly growing demand for care, direct care wages must be raised to a competitive level. Given that Medicaid is the largest payer of long-term services and supports, state policymakers can reform their Medicaid rate-setting processes to fully account for competitive compensation and pair any related rate increases with wage pass-throughs or minimum wage floors to ensure that workers benefit.
These efforts must be combined with other strategies to improve job quality for this essential workforce, including expanded employment benefits, enhanced entry-level and ongoing training, improved supervision and support, better respect and recognition, and new opportunities for career advancement.
Click here to read Competitive Disadvantage: Direct Care Wages Lag Behind (2024 Update).
