Why is One of the Most In-Demand Jobs So Low Paid?

Those who care for our elders continue to be stuck at the bottom as far as wages and respect [PDF], despite rapidly growing need for their services. No matter the setting in which they work—nursing homes, assisted living, individual homes—direct care workers are low-paid, often without health insurance and confronted with back-breaking labor and challenging clients with complex medical needs. And, no surprise, nearly 9 out of 10 direct-care workers are women, 28 percent are African-American and 23 percent are immigrants [PDF].

These caregivers provide the most intimate care imaginable to frail and vulnerable people. We depend on them to give competent, compassionate attention to our grandparents—and to us as we age.  Their clients’ lives are literally in their hands. “What we do is important,” says Tracy Dudzinski, a direct-care worker in Wisconsin since 1996. “One of the most rewarding experiences you can have is to go in and help make a difference in a person’s day.”

According to the Bureau of Labor Statistics Occupational Outlook Handbook, the elder care field is among the fastest-growing in the nation, with 50 percent growth from 2008 to 2018 predicted for home-care workers. But we’re doing little to attract people to these critical jobs. We reward women like Tracy with wages of less than $10 an hour. And Tracy, whose husband is on disability, is the sole breadwinner for her family of four children. Like another heavily-female occupation–child care–our nation expects caregivers to subsidize these services with their low wages.

Now, direct care workers are taking matters into their own hands and speaking out.  “People misunderstand us,” says Tracy.  “We’re smart people and hard workers.” Tracy has a leadership role in an emerging movement to transform the lives of direct care workers: She is a staffer at Cooperative Care, a worker-owned co-op of home-care workers based in Wautoma, Wisconsin. She also serves on the boards of both the Wisconsin Direct Care Alliance and the national Direct Care Alliance (DCA), headquartered in New York City. She has traveled to Capitol Hill and the Institute of Medicine of the National Academies to testify about the working conditions of her peers. “I used to be the mouse in the corner,” she says. “Now I’m a changed person.”

Among DCA’s most successful projects is the Voices Institute, a week-long retreat and intensive training session for direct-care workers to become advocates for their profession.

When I asked Tracy what the public can do to support these efforts, she offered, “Show direct-care workers some respect. Get involved with the DCA. Learn about the issues and contact legislators.  The more noise we make, the sooner things will be fixed.”

Photo courtesy of http://www.flickr.com/photos/gregor_y/ / CC BY-SA 2.0


  1. Thanks for covering this important issue. Direct-care workers, by 2018, will our nation’s second largest occupation. It is shameful that these workers earn so little–and it is bad for economic growth. To learn more about the importance of the direct-care workforce and what we can do to improve jobs, check out http://www.phinational.org/policy.

    • Unknown says:

      Is it true that they are the nation’s second largest occupation as of now? The time has come to find out.

  2. Sara Taber says:

    Bravo to Beth Baker for highlighting once again an issue of paramount importance in our society. Why is it that caregivers are so under-valued in our society? The whole situation is shameful. We’ve got to do better.

  3. Eileen Rubinstein says:

    I knew direct care workers were poorly paid, but the situation is worse than I thought. Yet I know, from our experience with my in-laws, that nursing homes are very expensive. Where does the money go to? I’d be very interested in seeing a break down. Perhaps this could be the basis of another article or a congressional investigation.

  4. I never really thought about how invaluable direct care workers are until my parents needed help. They can make all the difference for the elder and their family. Thanks for shedding light on salary issues for these critical workers.

  5. Fiona Gierzynski says:

    My father died in an assisted living home, where he was cared for by angels who flattered him, talked with him, wheeled him out so he could smoke, and changed his diapers. He was humiliated by the indignity of it all, but they made it bearable. My Mom has advanced Alzheimers and is living in the same place. I pay a huge sum of her money each month for her to be there, but I put all of the proceeds from the sale of their house into accounts used just for her. As long as I can afford to pay, I will keep her there. She gets compassion, hugs, activities, and a safe environment. I, also, wonder where all of the money I pay is going, since the loving care-givers and nurses are not getting rich. I joke with them that I’m not sure who they take better care of, me or Mom. Because every time she presents me with new symptoms, I sit and cry and beg them to tell me how to deal with her. For that they deserve to be getting at least a living wage!

    • Sandra Francklin says:

      I am a qualified Advanced Caregiver in South Africa. It is my calling to be one and I have taken it upon myself to pay thousands of rands to pass all the necessary courses required to be a Professional Caregiver. The people/patients that we work for are not prepared to assist or support us at all to study. We take that initiative upon ourselves so that we may deliver the best expertise to our clients. To add insult to injury, we are paid pittence for the work that we do and in my experience, I find it very degrading to sit at an interview and hear a potential client trying to cut the lowest deal that they can with regards to my salary. We don’t receive any additional perks for what we do, no bonuses or medical aid and are then also required to use our own motorvehicles vehicles for the job and pay for the maintenance of our vehicles ourselves. We work very long hours and are denied proper time off and do not get legal working contracts with our clients. Sometimes, we are not even offered meals and have to pay for our own food. I really think.that Caregivers should stand together and speak up for themselves and their rights. We are very important people and we work hard to take good care of our patients with love and integrity while their families enjoy the relief of being able to carry on with their own lives and careers. And the saddest part of the story is that the families do not take nearly enough time to visit enough or get more actively involved in the needs of their loved ones who are being cared for so well by us Caregivers. We just get left in isolation to do our jobs with very few rewards and almost no thanks for all our hard work and efforts!!

  6. Thank you, Beth, for giving this phenomenon some attention. I know, from friends who have done this work for (low) pay and from doing it myself, that “back-breaking” is a literal term. Now that I am a widow with no relatives within several hundred miles, I pay a lot of money for long-term care insurance, in the hope that I can hire someone to do for me what I did for my late husband when my time comes. These angels of mercy deserve a living wage. I cannot get past the conviction that, if this were not largely women’s work, it would be valued more highly.

  7. Thank you, Beth, for highlighting a critical problem, indeed. I’ll never understand why our society chooses to pay its most important workers not even a living wage; it’s not only unconscionable, it’s unwise. It seems to me prudent, as well as fair, to compensate such sensitive, difficult, sometimes extremely demanding work adequately, if not generously. I, for one, would not want an overly stressed, possibly resentful, individual being responsible for the happiness and well being of a loved one and low wages along with no compensatory benefits could be cause for both possibilities.

    Teachers have fought long and hard and are still fighting to receive just compensation for the crucial work that they do…I hope the DCA and projects like the Voices Institute are successful in spotlighting a cause equally worth fighting for.

  8. Home health aid who bathes 90+ old woman at my house bills $22 per hour w/2 hr min. This is through an agency which means she probably gets about half that. Another interesting fact is that our contract with agency requires us to pay a finder’s fee of $2k if we directly hire the worker. This seems like a good business decision, but bad for underpaid workers.

  9. Elders and disabled, as well. (I’m now a “two-fer”, aging disabled feminist.) It is an issue that I can delay as long as my spouse can be my caregiver. There is a good reason for an alliance between elders/disabled and care workers, also called aides, attendants and whatever the euphemism of the day is. I am an artist = low income. Nursing homes/assisted living (and other euphemisms, and note that LTC long term care facilities use the same word, “facility” as prisons’ euphemism – “correctional facility” for prison.) have priority in funding. See http://www.adapt.org whose motto is “Free Out People” – that is, giving choice to those of us who would automatically be put into nursing homes of whether we wish to live at home with “direct care” as the article notes or in a nursing home. It is many times cheaper to live at home with “direct care”, long term, than in a nursing home.

    As noted in another comment, agencies who send out care givers/direct care persons, make a profit and the hourly rate is high for those who are not affluent, but the care worker is not getting much of the hourly fee. Please see http://www.adapt.org and know that many of the activists in the group are women.

  10. So glad this was brought up.
    My mother went back to school when I was 9 or 10, and she became a home health aid. She soon after got pregnant, and my little brother came along.
    In a profession that is largely female-occupied, it is an utter shame that maternity leave wasn’t even offered or discussed. she spent so much money, worked so hard, put in so many hours, helped so many people… Her reward?
    She couldn’t go back to the job, she was away from it for 2 years raising my little brother (11 years younger than me) and she would have had to pay to go back to school and do it all over again. My Dad had an unpredictable job, currently has another unpredictable one, and my mother needed a steadier paycheck to pay the bills and support three kids.

    The lack of help these womyn get is a crying shame.

  11. Frank & Karen says:

    I am SO glad to know that there is movement afoot to get these valuable workers more respect and awareness. We need to honor these workers as the noble and valuable people that they are. After a long and very toubled experience with my very aged father, I can attest that good direct caregiving makes or breaks the last years we spend on this earth.

    • Sandra Francklin says:

      I am a caregiver and I agree that, we are not financially rewarded enough for the long hours and hard work that we put our heart and soul into caring for other peoples family members so that they can live a more free life while we do all the hard work into assuring that their Moms, Dads, Grannies, etc,,,,, are well cared for !!! Its quite an eye opener, how many of the family members neglect their ill and aged family members and only visit or phone them once in a blue moon. But when they pass on then the family are very quick to emerge and argue over who gets the inheritance!!!

  12. I own a Home Care agency and am striving to change the culture and the service that boomers are going to expect and I’m starting today. In order to hire motivated, qualified individuals I can almost guarantee I am paying more than most agencies, but understand, that when I clients will only pay between 17-19/hr, which is quite a sum of money, there is little left over for the company after payroll taxes, training, insurance, and incidentals. Perhaps the CLASS ACT coupled with more people purchasing Long Term care policies will change this eventually, but the reality today is that margins are tight with what people can afford. I would love to pay my workers 13-15 hour, but for now that is impossible and still run a business. I do agree that our employees are the face of our business and our most important asset. Hopefully, the intangibles I can offer along with a higher than average salary will keep them on board. I do think offering them other types of work within the agency also helps with retention. I often go visit senior communities for movies, donuts, health fairs, etc. I think it is advantageous to everyone to include the caregivers in some of these functions. Pay above avg., keep the work interesting, and treat them right and everyone wins.

  13. Medicare requires a “Cost Report” be done annually for each facility. The question about “where the money goes” is answered in this cost report. This report can be purchased from Medicare.
    The majority of revenue in a facility, is spent on labor.
    I agree that good, caring, compassionate, “CNA’s” are underpaid. If facilities could afford to pay better wages to the CNA’s we could attract a better group to this carreer choice. So, many are high school dropouts, no work ethics, have criminal records, have little or no respect for our elders etc. Many of these people could not work in a fast food restaurant, because they dont have “people skills”, but we have them caring for our most frail elderly.

    • Greg I am shaking my head in disbelief at your comments, what company n there right mind would even consider hiring a caregiver, with criminal records and no respect for the elders, most have some type of education above a high school diploma.

    • Dvorah Sigurgeirsson says:

      It is not possible to be a direct care worker with a criminal background. A fingerprint clearance card from the state is required before work can start with clients.
      And you are wrong about the people skills part, Greg. DC work is all people skills, all day long, and with disabled, elderly, sometimes nonverbal clients. My goal every day is to make my clients either laugh or smile during my time with them. I tell jokes, sing, whatever it takes to make their day a fun one.
      An honest person who respects their clients and works hard–even enjoying their work!– helping others, should not be insulted by someone who only “kinda” knows what direct care work is about.

    • If they have criminal records, how are they allowed to care for our mothers and fathers?

  14. Maybe the job does deserve greater pay, but it also should demand greater education. I feel sorry for anyone who has to trust their care or the care of their loved ones to someone with the same education as a short order cook.
    How hard is it to get an RN (only 2 years of schooling) or an LPN (even less!)? If someone couldn't manage to pass these courses/exams, do you really want "your life in their hands"? When I was a teenager I was a "Home health aide" , I didn't know my ass from my elbow. I was compassionate and tried my best, but the fact that someone with zero education or experience could be in that position is the real tragedy, NOT that their pay is in line with their education (or lack thereof) .

    • How dare you be little a group of honest hard workers’ honey lease don’t confuse your education with being intelligent because you really lack it.

    • To become a RN you have to go to a 4 year university and apply to get into the oh so competitive program that usually takes 5 years or more; talking classes a long side of people in Pre-health programs (Aka future doctors) with concentrations of Science, psychology and humanities. You don’t even know what you are talking about sir.

    • Dawn Wilson says:

      First off it costs a lot of money to go to nursing school and most places require an RN to have a bachelors. I am a home health aide with an associates degree in medical assisting which is more than an lpn as they only get a diploma. I do home health because I love working in geriatrics and home health gives me one on one time with my patients.

  15. TR Johnson says:

    I’m a CareGiver…..
    With Integrity, Honesy, Compassion & Love I attend to the Health, Hygiene and Saftey of Someone’s Parents,Grandparents, even GreatGrandparents.

    I Wake Them, Dress Them, Feed Them, Wash, Fold & Put Away Their Clothes, Walk with Them, Push Them in Their wheelchairs, Guide Them with their walkers, Talk with Them (even if it’s repetitive), I Laugh with Them, I Listen to Them, I take HITS from Them, I Comfort Them, I Lift Them (Physically & Emotionally), I Serve Them, I Read to & for Them, I Assist Them, Change Them, Check On Them, and I Leave Them WITH THEIR DIGNITY.

    That’s ALOT, isn’t it?

    Then, WHY am I being paid LESS THAN $9 an hour???!!!!????….YES, not even $9!!!!….And NO INSURANCE.
    Familes are charged THOUSANDS of DOLLARS a month with ONLY 2 PSAs (at my ALC) serving 25-35 residents, many with Alzheimer’s, Dementia and other disabilities.


  16. This article is right-on. I worked in corporate America most of my career. When I was suddenly paralyzed I needed assistance from health care aides. I could not believe the wages they receive for the amount of work they do, no vacation or sick time pay, no medical or dental plan. It’s dispicable that we in America allow these positions to be so devalued. These are the people with whom we entrust our loved ones. Maybe someday even ourselves. Do we want overworked and underpaid aides to help us? Valuing their service is important, but it doesn’t pay the bills!

  17. In order to get decent pay and respect, direct care workers will have to collectively demand better treatment and pay. Nurses were paid diddlysquat until they started picketing and refusing to work for subpar wages.

    • I am a senior care in a private residential home, we have 16 service users at present and many are nursing care, the staff ratio to 16 is legal but as the service users are coming to us with mental health problems the task set for caring them is mentally and physically challenging for all staff, many staff are pushed to their limit at times trying to care for these service users. Our home has a good name as we all have worked there for a long time 26 years myself and many others 20 yrs or more, we are all dedicated staff but as for pay it is pretty poor for what we have to do, we would all like at least £15 – £20 per hour but at present it is £6.50 – £8.50 per hour which I find in this day and age is appalling and no pension at the end of it just a hand shake. We have nothing but bad press about our type of work, we should be proud of doing what we do but no we hang our head in shame due to bad news reports about other homes, it is about time Britain looked after its workers and paid us what we do deserve and that is a decent rate of pay for what we do and for all the studying courses we have to do. We do not get a rise in pay for all the qualifications we have.

  18. Stephanie says:

    I worked at an assisted living facility making $7.25 a few years ago! No, I didn’t have a CNA license. I was just thrown in. I only lasted two months, but I experienced frustration and exhaustion from it all. I loved the clients, but it was just the way I was expected to do a million things during my 12-hour night shift and was made to feel like a failure if I didn’t get to my cleaning tasks after taking care of 12 residents by myself for 12 hours. A lot of them were bed-ridden or extremely fragile. I was in charge of making all the food for the next day too, but I never even had time to take a lunch break myself! It was non-stop running around making sure residents didn’t fall. I put I couldn’t provide those poor old people the care that I wanted to because there was no way…. Nobody died on my watch though. Phew.

    I am a teacher now and facing the same frustrations of low wage. Although teachers at least make pretty decent comparatively. Don’t you love being a female?

    • I’m a male cna in a nursing home and can tell you I don’t get paid a dime more than females. It’s not that your female honey, it’s the job.

      • It’s a female dominated field, honey.

        • Katie, your attitude towards your fellow CNA is disappointing. No wonder the situation with pay and respect is what it is. Maybe instead of taking cheap shots you might try to make substantive changes in the industry.

          Ted, I’m a woman and I agree with you. This isn’t about gender because in my district in the South of the USA, 59% of our CNA’s are male. The pay is still abysmal. It’s that our culture doesn’t value service work. THAT is where the fight should be–not gender vs gender. If a man had ended a rant with, “Don’t you love the pressures of being a man,” people would have chewed him out for it. Equal is equal. So we women shouldn’t pull the gender card either.

  19. I work with adults who have developmental disabilities and in all honesty, no state governments gives a shit about them. There is an extremely high turn over in my line of work because our clients are not respected, therefore we, the the direct care staff, are under-respected and paid only $12-$13.00 an hour. And school teachers complain about their so-called “low-paying” jobs?! “Oh, boo hoo! I only make $40,000 a year, and get four vacations, and every Federal holiday off”. I have a Bachelor of Arts in Sociology and I’m making the same amount of money as someone who barely graduated from high school. Just yesterday we had an issue with my boss, our behavior specialist, and four direct care staff absent. This meant that each group room had at least 15 clients to one staff member, and our program ends at 2:30. One of our case managers, the nurse and myself stayed until 5:45pm because that’s when the last van came to pick up the clients.

  20. William R Johnson says:

    The personal care of your loved one’s is worth LESS than someone who flips hamburgers. This is an outrage. I’m NOT a caregiver but the one’s I know and I have known are overworked, under appreciated and shown complete disrespect by their employer’s and family members who visit their facilities when they visit and the caregiver is ALWAYS wrong! It should be they are held in high esteem. Wipe someone’s rear-end after a blowout and tell ALL OF US what YOU think its worth, Mr/Ms. Employer!?

  21. It’s 2017 and it’s still the same thing, residents getting inadequate care because we are overworked and given like more than 20 patients a piece and treated poorly by our employers.

  22. Allen mayeske says:

    My daughter is 41 years old.She is a CNA.
    Makes $ 9.00 an hour.They only allow her to work 32 hours.Her schedule is so messed up she can’t worka second job.Her rent is $510.00 a month. The cheapest she could fine in her town.She is divorced with 2 children. Gets no help from her ex.The nursing home where she works gets between $3000.00 To $4000.00 per person.It averages around 350 to 400 elderly. Last week she was evicted from her apartment. Now sleeping on her parents couch.Her parents are elderly and living on a fixed income with health issues. She has worked there 3 years with no raise.they say she is a excellent hard worker.

  23. In spite of what some people say about CNAs being one of the most important jobs in the health care team, obviously they are not or this job would pay a heck of a lot more than it does. A job pays what it is worth. CNAs are a dime a dozen and easily replaced with high school dropout types or GED recipients. Home health care workers can eke out their lousy pay by stealing anything they can get their hands on, which was shown about 20 or so years ago on one of those network TV evening magazine programs.

    • Vik, you’re expressing an opinion and a cultural value, not some universal truth. No, we don’t value the people who care for those we “love the most”–our children and our ailing parents. But we pay hundreds of millions a year to athletes to play. Or gyrating “entertainers.” Or corporations that destroy the planet we all depend on for survival. These things continue to happen because enough people think the way you do. When they’re old and feeble, though, they likely take on a different perspective. Too late. Maybe karma is real after all.


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