found that in most cases DCWs earn less than workers in jobs that require less education, experience, and
training (i.e., job zones 1 and 2).
Our analyses found wide variation across states in the wage gap between DCWs and other entry-level workers.
Our descriptive analyses cannot explain these differences, but there are several possible explanations that
could be explored in future research. For example, unionization among DCWs varies by state and previous
research has shown that collective bargaining increases wages (PHI, 2021; Sojourner et al., 2014). State
minimum wage laws also vary widely; changes in the state minimum wage would affect DCW wages (Weiner et
al., 2017) and may affect the wage gap, especially in states with policies tying the minimum wages of DCWs to
the state minimum wage (i.e., wage floor policies) (Dawson & Rodat, 2014). Some states have attempted to
improve the wages of DCWs using Medicaid wage pass-throughs, where a proportion of increases in the
Medicaid payment made to providers, such as nursing homes and home care agencies, is directed toward DCW
wages (Baughman et al., 2010).
Other differences in state Medicaid policy--such as the funds available to the state from the federal match or
through Medicaid expansion--may also affect the wages of DCWs. Many states have also worked to rebalance
care away from nursing homes and toward home and community-based settings. This rebalancing may affect
both the money available in the Medicaid system that can be used to pay DCWs and the number of DCWs
needed to provide care (Vardaman et al., 2021), both of which could affect DCW wages. Previous research has
also shown that gender and racial bias affects DCW wages (Campbell et al., 2021; Shippee et al., 2020),
therefore, the wage gaps in some states may be explained by the proportion of DCWs who are women, people
of color, or immigrants. Finally, differences across states in geography or demographics, such as rurality and
median age of the population, may affect demand for services and availability of DCWs, which could impact
wages.
In this analysis, we assessed differences between DCWs and other entry-level workers in just one component
of total worker compensation--wages. Employment benefits, including paid time off, full-time hours,
retirement benefits, and health insurance are other important elements of total compensation. Only about
one-half of DCWs have access to health insurance coverage through their employer or union (Campbell et al.,
2021). Many DCWs are only offered part-time hours and lack retirement benefits, making it challenging to
financially support themselves and their families (PHI, 2018). In addition, high rates of injury, heavy workloads,
and few opportunities for advancement affect job quality (PHI, 2020; OSHA, 2014). Addressing overall
compensation, as well as other job characteristics, will be key to recruiting and retaining these workers.
CONCLUSION
Our results show that home health and personal care aides earn lower wages than other entry-level workers in
all states and nursing assistants earn lower wages in 40 states and DC. This finding is prevalent despite the
growing need for these workers and their essential place in the health care system highlighted during the
COVID-19 pandemic. We also found great variation across states in the gap between DCW wages and the
wages of other entry-level workers. Additional research is needed to explain this variation and further assess
the impact of state policies and other factors on DCW wages.
END NOTES
1. Nursing assistant category is defined in the Standard Occupational Classification as workers who “provide
or assist with basic care or support under the direction of onsite licensed nursing staff. Perform duties such
as monitoring of health status, feeding, bathing, dressing, grooming, toileting, or ambulation of patients in
a health or nursing facility.” This includes certified nursing assistants, but may include job titles.