The Issue of Low Wages in Direct Care




When we talk about low wages for direct care workers, it’s important not to confuse two separate issues. The first has to do with our personal satisfaction regarding the work, best summed up by the regularly repeated phrase: “It’s not about the money.” The second issue is about the impact of low wages on the quality of care and on the workers who provide it.

Many caregivers will tell you that they experience significant emotional benefits from the work. They find meaning and fulfillment in making an immediate and real difference in the lives of other people. However, personal satisfaction with the “work” doesn’t always mean contentment with the “job.” The work we find so fulfilling is only one aspect of the job, which also includes things like wages and the work environment.

For some caregivers, the emotional benefits outweigh all other considerations. They find the work so deeply meaningful that they are willing to endure the impact that low wages and difficult work environments have on their lives. It is a noble sentiment.

While the sentiment is genuine, it is also a highly personal one. Meaning is not so much found as created and how we create meaning in our lives is an intensely individual enterprise. It is not something one person can do for another; the most we can do is accept and respect another person’s sense of what brings meaning to his or her life.

It is not a contradiction to accept and even admire the notion that caregiving “is not about the money” on the one hand while condemning low wages and poor working environments on the other. The former is about the choices and perspective of individual caregivers, the latter is about a bigger picture.

Low wages is a major contributing factor to high turnover rates for direct care workers. This has a profound effect on the continuity and quality of care. In her May 5th blog post “Addressing the Difficult Issue of Money,” Paraprofessional Health Care Institute’s (PHI) National Director of Coaching & Consulting Services, Susan Misiorski, sums it up thusly:

“Low wages for direct-care workers has a trickle-down effect on the elders and people with disabilities for whom they provide care. We know that care continuity correlates strongly with care quality, but low wages encourage high turnover rates. Organizations that continually must hire — and train — new staff members likely aren’t providing the best possible care.”

Beyond quality and continuity problems, the issue of low wages has wider social implications. Since wages and benefits in long-term care are impacted by inadequate government reimbursement rates, the issue of low wages is a matter of social policy and a true reflection of the value society places upon direct care work. Misiorski tells us that 22% of direct care workers fall below the poverty line and 43% live in households that rely on some form of public benefits. The very people we depend on to provide quality care often struggle to take care of themselves and their own families. Does it really make any sense to tell workers how much you value what they do and then expect them to live near or below the poverty line?

Yes, we want workers to be properly motivated. But expecting to be compensated fairly for what you do does not equal a lack of compassion. We are all motivated by different things and genuine compassion is expressed through action, not good intentions. While we can admire the notion that “it’s not about the money,” we must reject the idea that caregivers who express concern about their wages don’t belong in the business. We lose too many good workers that way.