An anecdotal reminder of how we underpay direct care workers

The following anecdote comes courtesy of Kathy Carmody of the Institute on Public Policy for People with Disabilities.
An individual with intellectual disabilities, accompanied by a job coach, went on a job interview. Immediately following the interview, the job coach gave notice at his social service agency and took the job he had tried to get for his client.
The position paid better than he was getting as a job coach. I’m told that it’s not all that rare for job coaches to earn a lower hourly wage than their clients do.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

8 thoughts on “An anecdotal reminder of how we underpay direct care workers”

  1. Everyone who works in a job that involves doing good is supposed to be satisfied with less money than people who work in other jobs, because of the moral glow of righteousness they get along with their paycheck. This is obviously stupid because you can't eat righteousness, or use it to pay off loans, raise a family or save for retirement. But even worse than the stupidity is thinking about what that reasoning implies about the whole rest of the economy.

  2. Wow, what a powerful story. Here is another one: A mental health professional noted that the amount a county paid to house an adult with a psychiatric disability was less than the going rate to house a dog for the same length of time.

  3. There are a lot of people who cannot afford direct care workers at all and family members are forced to provide all care. Therefor you could just as easily say they are overpaid, not underpaid.

  4. Part of this dynamic has to do with the way Job Coach (and other direct care) jobs are structured: they involve very little decision-making (other than in the crucial realm of interpersonal dynamics with the client). They are usually quite cookie-cutter. People who hold this job who also have better analytical and decision-making skills, and who show some initiative, usually move up into supervisory positions or else leave the field entirely. I believe this is partly because there's a need for quite a lot of these positions, since they work one-on-one with clients; that exerts pressure on the agencies that hire or provide direct care workers (and the relevant licensing agencies) to avoid doing anything that would diminish the number of potential hires. That's on top of the fact that the states save money by paying less. Another factor is that with or without good pay, these are occupations that turn over pretty rapidly; investing in these folks doesn't make a lot of sense from that point of view. Said by someone who knows quite a number of direct care providers of various sorts.

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