Fair Compensation is Essential to the Direct Care Job

Last week, PHI introduced its new framework—The 5 Pillars of Direct Care Job Quality—which is meant to guide employers, policymakers, and industry leaders in designing high-quality jobs for direct care workers. The framework covers 29 elements across five pillars: quality training, fair compensation, quality supervision and support, respect and recognition, and real opportunity. The excerpt below on fair compensation, the second pillar, is taken from Would You Stay? Rethinking Direct Care Job Quality.

Fair Compensation

A quality direct care job should enable workers to achieve economic stability, safeguard their health, and plan for the future.

Living wage as a base wage

A quality job for direct care workers requires a living wage that accounts for the local and regional cost of living (a formula based on common expenses such as housing, food, clothing, transportation, and more). This living wage should be set as a base wage, with benefits, raises, bonuses, and other job supports layered on top. As noted earlier, direct care workers earn a median hourly wage of about $12, which has remained virtually stagnant over the last decade, and this substandard wage drives many of these workers into poverty or out of this sector. Establishing a base wage for direct care that is aligned with the cost of living makes it affordable for workers to pursue these jobs.

Access to full-time hours

Direct care workers should have access to full-time hours that increase their earnings, promote economic stability, and decrease the need to obtain multiple jobs to make ends meet. Of note, 31 percent of direct care workers work part time, including 26 percent who work part time due to family or personal obligations and five percent who work part time because of economic conditions in their employer or the economy. As well as ensuring access to full-time hours for workers who desire them, these figures show the importance of providing additional supports such as childcare and eldercare—described in the next element—that would allow workers to meet their personal and family needs, take on additional hours, and thereby boost their incomes.

Consistent scheduling and notice of scheduling changes

As an essential aspect of direct care job quality, consistent scheduling (including notifying workers about schedule shifts) promotes job stability and reduces stress for workers, ensuring they can plan their lives outside of work. Research shows promotes irregular or unpredictable scheduling among low-wage workers can contribute to work-family conflict, work-related stress, and income instability. For consumers, more consistent schedules for workers can improve care outcomes for consumers. To ensure consistent scheduling, employers need reliable systems and processes that track their staff, including schedules, hours worked, worker and consumer preferences, and more—a need that technology could help fulfill.

Access to employment-based health insurance

Access to employer-sponsored coverage (or plans offered through unions, where applicable) is crucial for direct care workers to manage their health and remain productive. When these entities provide health coverage, workers avoid the stress of finding health plans on their own or financial catastrophe when illness or injury strikes. Business leaders have also observed that employer-sponsored plans can improve job satisfaction and promote recruitment and retention. Nationwide, while 52 percent of direct care workers have health coverage through their employer or union, 13 percent lack any form of health insurance, including public coverage or an individually purchased plan.

Paid sick days and paid family and medical leave

Paid sick days allow workers to take time off to recover from an illness, while paid family and medical leave supports workers to manage care for themselves or a family member through a severe medical challenge or to bond with a new child. Unfortunately, many employers do not offer these benefits, and federal and (most) state policy options are limited in scope. Offering these benefits would also improve recruitment and retention for employers by making the job more attractive to workers.

Grief support and bereavement leave

Direct care work is emotionally demanding, especially when a worker loses a client or resident (a pronounced reality in a COVID-19 era, given the staggering mortality rates across long-term care settings). Likewise, direct care workers experience deaths in their own lives, as family members and friends pass away, which can affect their emotional presence on the job. A quality direct care job includes access to grief support programs and paid bereavement leave, both of which can help workers cope with loss and manage their mental and emotional health over time.

Financial support and asset development programs

Direct care workers, like other low-wage workers, may not have had the opportunity to access financial products or to develop financial literacy skills that can help maximize their economic stability, build their assets, weather short-term economic challenges, and plan for the future. A quality job in direct care can overcome this barrier by connecting workers to financial support and asset development programs. These programs typically assist workers in opening checking and savings accounts, obtaining tax credits (such as the Earned Income Tax Credit), and managing financial matters slate budgeting, building credit, debt management, savings plans, and more. Empowering workers with financial supports can also reduce poverty for generations and improve their overall health.

Access to merit, longevity, and other base pay increases

Many direct care jobs offer the same wage regardless of a worker’s training, skills, experience, or performance. A quality direct care job should offer additional levels of compensation—beyond the base wage—to recognize workers’ contributions and commitment, as well as to support their economic well-being and promote recruitment and retention. Merit pay rewards direct care workers for their success on the job, while longevity pay honors the long-term contributions of employees; both offerings encourage high performance and help reduce turnover. Workers could also receive other types of additional pay, such as bonuses tied to a company’s year-end performance or a holiday, which would promote job satisfaction and longevity on the job.

Download The 5 Pillars of Direct Care Job Quality here.