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Wage Comparisons: You Get What You Pay For

Given the very poor quality of direct-care jobs—and how much workers must rely on public assistance even when attempting to work full time—it is little wonder that staffing vacancies are now occurring across the front lines of our long-term care system. A 1999 national survey, conducted by the North Carolina Division of Facility Services, indicated that nearly 90 percent of all states reported recruitment and retention of paraprofessional aide workers were major workforce issues.xxviii

Clearly, low pay and few benefits are not the only obstacles to attracting a stable direct-care workforce—direct-care work is not only difficult, but dangerous as well. Between 1993 and 1999, nurse aides have consistently ranked third (behind truck drivers and laborers) as having the largest number of work-related injuries and illnesses resulting in time away from work. These injuries range from back strain due to lifting patients without the proper assistance equipment to assaults from combative patients and the overall burn-out associated with emotionally draining work. More than 75,000 injuries and illnesses were reported for nurse aides in 1999.xxix

However, the harsh reality is that our health care system now functions within a highly competitive labor market, and therefore we must at the very least offer direct-care workers a competitive wage. Compared to the 1999 average median wage of direct-care staff, the following positions offered far safer, less physically/ emotionally demanding work—at higher pay:


Comparison of Job Compensation: 1999 

 Job Category

 Median Hourly Wage



File Clerks


Production workers — Helpers


Direct Care Workers


Source: U.S. Bureau of Labor Statistics, 1999 Occupational Wage Estimates by service occupation code.

Yet we must do far more than simply compete with file clerks and production helpers. Direct-care workers are the people we entrust each and every day to care for our aging fathers, our ill relatives, our friends who are living with life-long disabilities.

Our vision for the kind of society we want to live in includes giving our aging and disabled individuals the ability to live in comfort and safety, with dignity and the greatest amount of autonomy and personal choice possible. Direct-care workers are the linchpin that can make this vision a reality. We must implement policies that support their dignity, rather than cheat it as many current policies do and indirectly undermine the dignity of those for whom they care.

The Washington, D.C.-based organization, Wider Opportunities for Women, has developed a sophisticated analysis to determine self-sufficiency income. This analysis determines what wage rates are required for a family to meet basic needs, adjusted for family size and the specific county or city in which the family resides. Since the Self-Sufficiency Standard is so specific to region, we provide below just one example for the City of Milwaukee, Wisconsin:

Self Sufficiency Monthly Expenses / Hourly Wage Required:
Milwaukee, Wisconsin, 1999 


One Adult

One Adult
One Infant

One Adult
One Infant
One School Age

Two Adults
One Infant
One School Age

Monthly Expenses 





Hourly Wage Required




$11.21 per adult

Average Median Direct Care Hourly Wage: $7.97

Source: Education Fund of the Wisconsin Women’s Network
The Self-Sufficiency Standard for Wisconsin, Winter, 2000

Therefore, the hourly wage for a typical direct care worker ($7.97/hour) is only 51 percent of that needed for a single mom with one child ($15.52/hour) and less than 40 percent required for a single mom with two children ($20.12). Unfortunately, Milwaukee is not an isolated instance: Wider Opportunities for Women has helped to complete studies in 11 other states and found similar gulfs between what is required to live without subsidies, and what low-wage workers earn. These can be downloaded from their webpage at: The Economic Policy Institute has also developed similar region-specific family budgets at:

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