Featured Resources

How Poverty Wages Undermine Care -- Spotlights the need to improve home care wages and benefits in order to stabilize the workforce and ensure quality of care.

State Wage Data -- PHI has documented the wages in each state for the three main occupations that make up the direct-care workforce: home health aides, nurse aides, and personal care aides

PHI Campaign for Fair Pay -- After almost 40 years of exclusion, home care workers will finally be covered by the same federal labor protections that apply to almost every other worker in the nation.

Our Position

Improving wages and benefits for direct-care workers is key to stabilizing employment and providing greater economic security for many low-income families.

These investments can play an important role in economic recovery – boosting local economic growth, creating jobs, and spurring community revitalization. Most importantly, improved direct-care worker compensation is critical to meeting the unprecedented recruitment and retention challenge our country faces in meeting the growing demand for eldercare/disability services.

What We're Doing

  • Tracking state wages for different direct-care occupations as reported by the Bureau of Labor Statistics as well as other measures of household economic self-sufficiency.
  • Analyzing the competitiveness of direct-care worker wages and state efforts to improve wages through policies such as wage floors, reimbursement enhancements, and wage pass-throughs.
  • Creating policy options for enhancing wages and benefits through reform of public payment and procurement policies.
  • Advocating for state and federal policy changes including wage and hour protections for home care workers and compensation parity across service settings.


The vast majority of jobs in eldercare and disability services are direct-care jobs—jobs known for poor wages and few opportunities for advancement. Most home care workers earn wages less than $9.50 per hour; nursing aides earn just over $11.00 per hour. Both earn well under the median wage for all workers of $15.10.

These low wages lead to low household incomes: Nearly half of direct-care workers live in households with incomes that make them eligible for public benefits (200% of the federal poverty level), and indeed, over 40% of direct-care households rely on public benefits of one kind or another.

In addition to undermining the ability of direct-care workers to support themselves and their families, low wages also fuel high turnover rates. Each year more than a million direct-care workers leave the field for better compensated, more stable work that is less emotionally and physically demanding. As a result, turnover rates average nearly 70 percent annually in nursing homes and 40 to 60 percent in home care.

Ultimately, this cycle of turnover compromises the quality of care for millions of elders and people with disabilities who rely on direct-care services.

Additional Resources


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