By Carli Friedman, CQL Director of Research
Direct support professionals (DSPs) are critical for the quality of life and community integration of people with disabilities. While DSPs provide a wide range of services and are required to balance a complex set of competencies, they typically receive low wages which do not reflect the important supports they provide. In fact, Medicaid reimbursement rates for DSPs can serve as a significant gatekeeper to DSP retention. “Decisions about dedicating revenues, including if, and how, DSP wages are prioritized, are impacted by factors such as states’ stances on taxation, ideas of ‘entitlements,’ and disability attitudes, among others…In addition to care work and the associated wages being gendered and racialized, more broadly, there is also a long and historied relationship between employment discrimination and racism and sexism in the United States” (Friedman, 2020, pp. 5-8).
For these reasons, the aim of this study conducted by CQL | The Council on Quality and Leadership was to explore the relationship between ableism, racism, and sexism, and states’ personal care aide1 wages in the United States. To do so, we analyzed data about personal care aide wages, and prejudice data from 4.7 million people.
The findings from our study revealed, the more sexist a state was, the lower its personal care aide hourly wages were, regardless of the state’s size, wealth, political orientation, ableism, racism, or the prevalence of the occupation (see Figure). For example, a moderately sexist state (0.40) is expected to have an average personal care aide wage of $10.71 per hour, whereas a slightly sexist state (0.20) is expected to have an average personal care aide wage of $20.24 per hour.
The Relationship Between States’ Sexism and Hourly Personal Care Aide Wages
“The prioritization of resources does not happen in a vacuum, especially when those resources are limited. It is important to remember that the prioritization of personal care aide wages is often based on more than their efforts and contributions alone, or even the states’ ability to pay said wages, but rather factors like sexism, including what and whose labor is considered valuable and important… While we hope our research will help call attention to this relationship and related structural barriers to personal care aide wages, we do not intend to suggest that by tackling sexism alone the personal care aide crisis will be fixed – it is but a piece of a very complex problem decades in the making; as such, we recognize a multipronged approach is necessary… Regardless of the strategies utilized to stabilize, grow, and recognize the profession of personal care aides, it is important to examine the role sexism plays in the wages of personal care aides. Until structural oppressions are addressed, there will be no justice – for personal care aides, or the people with disabilities they support” (Friedman, 2020, pp. 248-249).
1 While the term DSP is more commonly used, personal care aide is the term used by the Department of Labor, and the Bureau of Labor Statistics data used in this study.
Sexism Contributes to Low Direct Support Professional (DSP) Wages