Direct Support Workers: An Essential Workforce Surviving on Poverty Wages

medical needs and putting her at increased risk of hospitalization and institutionalization. Stakeholders on our advisory board also report an increase in nursing home referrals from care coordinators due to consumers not being able to find any home care staff. Unmet care needs have clear adverse health outcomes that increase the risk of institutionalization.

Worker wages are not competitive, and payment systems prevent addressing low wages.

Direct support staffing was an issue prior to the pandemic due to low wages and poor benefits, but this has only grown more difficult during the pandemic as other sectors saw wage increases for entry-level workers, but direct support staff wages largely remained stagnant. This has made it increasingly difficult to compete for good workers. Providers report an increase in vacancy rates and staff turnover, as well as having to turn away more client referrals due to lack of staffing capacity. Self-directed consumers, who hire and manage their own workers, are also struggling. A Financial Management Services (FMS) provider, who supports self-directed consumers, reported, “We’re just so very limited on what you can do [to increase wages]. I talked to [a client] today whose worker went to Pizza Hut because they can make $14 an hour driving delivery for Pizza Hut…. There’s a ton of really good workers out there who want to do this kind of work, they have a passion to do this kind of work, but they can’t afford to do it and support their family.”

A consumer on the PD waiver lost a worker early in the pandemic, who informed him that while he enjoyed this work, the risk of catching COVID-19 as a DSW who served four different households just was not worth $9.00 an hour. The consumer found a way that he may have been able to increase this worker’s wages to $11 an hour, but this was still not enough to entice him to stay in light of the risk and higher wages offered elsewhere. This worker left for a completely different industry, which is unfortunate as the consumer described him as a highly skilled employee who excelled in this line of work. Over a year later, this consumer still has not been able to find a replacement for this worker and is now getting less than half of their hours filled.

As one home care agency provider stated plainly, “We need higher pay, period. All of our other issues at this point will be resolved by higher pay. It’s one thing when you ask somebody to put themselves in harm’s way for a livable wage, but when you ask them to do that for under a livable wage, that’s awful.”

The current systems do not have the ability to increase worker wages, especially for people working for self-directed consumers. Home care agencies turned to CARES funds to help strengthen their workforce through hazard pay (to increase wages), paid sick leave (to support staff staying home when ill or quarantining), or overtime pay (to continue serving clients with fewer staff). Although this financial support was very helpful, it did not solve their staffing struggles nor do these funds offer a long-term solution to the low reimbursement rates in this industry. Medicaid specifically prohibits using funds to offer paid leave. Reimbursement rates limit the ability of employers to offer health insurance as a worker benefit. Additionally, self-directed consumers largely did not have access to CARES funds or other resources to offer hazard or sick pay to their workers during the pandemic. Consumers did not have direct access to these funds and FMS agencies were instructed that neither Medicaid or CARES funds could be used to offer hazard pay for DSWs in the consumer directed program.