2020 Presidential Candidate Survey on Disability: Workforce Shortage

Individuals with disabilities often rely on direct support professionals (DSPs) to provide them with critical supports. Despite the growing demand for DSPs, there are hundreds of vacant positions in New Hampshire and the turnover rate hovers around 30%. New Hampshire also has one of the oldest populations in the nation with the trend predicted to continue for years to come. There is a growing imbalance in the Granite State and nationwide between those needing care to remain in the community and workers to provide that care.

Q: Please explain how you would address this immediate and growing workforce shortage.

Joe Biden

Health care is personal to me. Weeks before I was sworn in to the United States Senate, I got a phone call saying my wife and daughter had just been killed in a tractor trailer accident. My two boys were hospitalized for a long time. And, when my mother’s health was fading in her 90s and when my son Beau was battling cancer – my family had the support and compassion from amazing direct support professionals. Their kindness is something I will forever be grateful for, and will never forget. I mean this sincerely, using an expression of my mom’s, “you all do God’s work.”

Direct support work is uniquely challenging and as you noted, the turnover rate is high. Our direct support professionals must get the support they need to stay in their field, and thrive. My dad had an expression, he said “Joey, a job is worth a lot more than a paycheck, it’s about your dignity, it’s about your respect, it’s about your role in the community, it’s about being able to look your kid in the eye and say, ‘honey, it’s gonna be okay.’” Too many people can’t do that today.

A Biden Administration will focus on efforts to recruit and retain more Americans to join the direct support sector. One way to encourage more people to become direct support professionals is to ensure that it pays a living wage. Those that work in this field should not
have to get a second job to pay household bills. No one should work a full-time job and live in poverty. It’s wrong. As president, I will ensure that professionals providing supports for individuals with disabilities have good jobs, earn a living wage, and have access to affordable health care.

I will secure a $15 minimum wage for all workers, including our direct support professionals who provide care to people with disabilities living in our communities. And, I will support indexing the minimum wage to the median hourly wage so that low-wage workers’ wages keep up with those of middle income workers. Every worker deserves to earn enough to live a middle-class lifestyle, provide for their family, save for retirement, and send their kids to college.

The Obama-Biden Administration extended long overdue overtime and minimum wage protections to nearly 2 million home care workers. As president, I will codify these protections into law and build on them, including by ensuring these workers have the right to organize and
collectively bargain. I will support the Domestic Workers’ Bill of Rights legislation that expands federal protections to the home care  Workforce.

As president, I will defend and build upon the Affordable Care Act to ensure every American, including direct support professionals, has access to quality, affordable health care. My plan takes a number of steps to build on Obamacare, including allowing Americans who are
uninsured or who don’t like their coverage to buy into a public option like Medicare. My plan also increases premium tax credits so more people will have lower premiums and lower deductibles. I also believe that Medicaid plays an absolutely critical role in our health care
system and it must be protected and strongly funded going forward. As president, I will fight all efforts to undermine it, such as work requirements and other tactics to reduce enrollment.

I will also protect Medicaid to ensure that its beneficiaries can access home- and community-based long-term care when they want it, and that home care and direct support professionals get paid a good wage. Medicaid pays for more long-term care than any other insurer in the country. In fact, roughly 6 in 10 individuals residing in nursing homes are enrolled in Medicaid, including many older Americans. Yet, the Trump Administration is reportedly considering a plan to cut Medicaid funding by turning it into a block grant. The Biden Plan will
protect Medicaid funding and make sure the program gives those on Medicaid who need long-term care the flexibility to choose home- and community-based care. In addition, the Biden Administration won’t let states skirt their duties under Medicaid and will take enforcement action against any state that allows profiteering to get in the way of Medicaid beneficiaries’ health.

For many, this is more than a job, it is a vocation and labor of love. Our system should include opportunities to develop in the field with supervisory positions and other mechanisms to advance, so that they can increase their capacity to serve and increase their wages. I will
increase affordable in-person and online training opportunities for direct support professionals. I will also provide two years of community college or other high-quality training program without debt and will invest $50 billion to create and support partnerships between high
schools, community colleges, businesses, unions, and other workers to identify in-demand knowledge and skills in a community, like direct care and support, to develop or modernize training programs. And I will partner with health care workers and accelerate the testing and
deployment of innovative solutions, including new models of upskilling, that improve quality of care and increase wages for low-wage health care workers, like home care workers.

I also recognize that many families have informal caregivers, which allow those needing care to remain in the community. The Biden Plan will help Americans pay for long-term care by providing relief for Americans needing long-term care by creating a $5,000 tax credit for
informal caregivers, modeled off of legislation supported by AARP. These informal caregivers – whether family members or other loved ones – have for too long been doing tireless work without any financial support.

Finally, a Biden Administration will ensure that people with disability have increased access to home and community-based services. The ACA strengthened the Money Follows the Person program by including additional states to apply for funding. I will work with Congress to secure long-term re-authorization of the Money Follows the Person program to ensure that we bring people with disabilities out of institutions and into the community.

*The following responses are from candidates who are no longer running

Michael Bennett*

Michael believes that need to create an economy in which every American who wants to work can get a good job that pays a living wage. Too often, critical roles like direct support professionals do not pay enough for people to make ends meet, resulting in high rates of turnover and job openings. Michael would raise the minimum wage, dramatically expand the Earned Income Tax Credit, increase the Child Tax Credit through the American Family Act, and put in place paid family and medical leave to help direct support professionals achieve the stability in their jobs and lives that allows them to play the important role that they do without worrying about their own ability to support themselves and their families. Michael would also protect vital programs like Medicaid and Social Security Disability Insurance that have been under threat by Donald Trump and Republicans in Congress.

*No longer running

Cory Booker*

We can start by offering competitive wages to direct support professionals who are too often overworked and under appreciated. Most direct support professionals are making around $10 an hour, roughly the same amount they were making a decade ago, while many less demanding jobs are offering higher pay. We can address this growing workforce shortage by restructuring Medicaid reimbursement rates to offer competitive wages starting at $15 an hour.

*No longer running

Steve Bullock*

In order to improve provider capacity and serve people in hard-to-reach areas, my administration would:
– Increase the federal role in student loan repayment for mental health professionals and direct support professionals.
– Increase incentives for direct care workers in rural and underserved communities.
– Create a new grant program for training physician assistants in psychiatry (only 1.3% of PAs are currently trained in psychiatry). This training program can have special attention paid to recruiting minority PAs – as more than 90% of psychiatry-trained PAs today are white. Additional diversity in the field can help to break down barriers that can prevent people from obtaining needed care.
– My administration would work with care providers to encourage apprenticeships for direct support professionals to further develop a needed workforce.
– Since mental health issues present at a higher rate among Medicaid patients than the overall population, we would incentivize accountable care organizations and managed care organizations to create accountability in state Medicaid programs for integrating behavioral health and physical health care.

* No longer running

Pete Buttigieg*

In addition to private insurance policies that have not kept up with the times, there are an unprecedented number of people reaching retirement age in need of in-home-support such as home health aides.

I would work with the private sector to address the critical independent living supports and home and community-based services that many private insurance programs do not cover for people with disabilities of all ages.

Good direct care jobs mean that as we age, we can do so with dignity and care. Moreover, by refocusing our resources on turning care jobs into better jobs, we will reshape our economy while lowering health-care costs. The only way we can get better care for our loved ones, better support for our families, and better jobs for caregivers is by shifting how our culture values care.

*No longer running

Julian Castro*

As president, I will work to ensure people with disabilities are provided with the support they need to live fulfilled lives and access opportunities in their communities. I will invest in rural and underserved communities to expand health care access, including DSPs. My education plan also calls for addressing the shortage of skilled workers in the economy by establishing dedicated trade programs in high schools and partnerships between schools and employers. I will expand work-based learning opportunities, inform program design-at both the secondary and postsecondary levels–according to labor-market needs, and provide federal tax credits to support hiring and on-the-job educational opportunities.

*No longer running

John Delaney*

Candidate did not submit a response to this question.

*No longer running

Tulsi Gabbard*

The most important way we can address workforce shortages of DSPs — especially in states with older populations like New Hampshire — is through market incentives. We will provide targeted student debt cancellation and cost of living subsidies to attract high-quality DSPs to underserved regions.

*No longer running

Kirsten Gillibrand*

The critical services of DSPs do not get enough attention. Direct Support Professionals would be covered under my national service plan for free college, helping to pay for training and an education. This national service plan not only would eliminate the barriers to entering the field while providing a pathway to the middle class, but also would give DSPs greater recognition for the tremendous value of their services to our communities and country. My plan would also offer a bonus financial award to qualified graduates who locate in communities in particular need such as New Hampshire.

Inadequate pay and benefits for DSPs also drives high turnover and must be addressed, in tandem with providing increased government investment in services to pay for better wages, benefits, and support of the workforce without impacting programs.

To address the broader workforce shortage in health professions that impacts the disabled community, I am a cosponsor of the Community Health Center and Primary Care Workforce Expansion Act of 2019  which is a five-year renewal and expansion of funding for community health centers and the National Health Service Corps and have fought in Congress to ensure these initiatives are adequately funded.

*No longer running

Kamala Harris*

When people talk about the future of work in America they often ignore the fact that we already know what a large part of that future will look like: It will be home care workers and other direct support professionals.

As our population ages, we must finally recognize the value and dignity in this work. That’s how we address this shortage. That’s why I plan to introduce a Domestic Workers Bill of Rights Act in the Senate, a sweeping proposal to strengthen protections, increase supports, and finally raise wages for home care workers.

We also must recognize this work is often done informally by parents, grandparents, spouses, and other caretakers. They need support too. That’s why as president, I’ll fight to finally make paid family and medical leave a reality in America, and strengthen Social Security to ensure the hard work of family giving is included when determining retirement benefits.

*No longer running

Jay Inslee*

Direct Support Professionals (DSPs) are a crucial resource for some individuals with disabilities. Despite growing demand for this resource, DSPs are generally paid slightly above minimum wage, making it a challenge to recruit individuals to employment as DSPs.

We’ve taken a critical step in Washington state to connect patients with disabilities with the care that they need: the nation’s first publicly-funded Long-Term Care Benefit. This groundbreaking program will help families with up to $36,500 worth of costs associated with the of cost of providing long-term care for a loved one. Importantly, the program not only helps with the cost of care for an aging relative, but for the care of someone of any age recovering from an injury or living with a disability. Our new law will help every Washingtonian to get the long-term care that they need – and save billions in Medicaid costs in the decades to come.

As president, I explore opportunities to encourage individuals to work as DSPs, working with stakeholders to identify avenues through which to accomplish that, inclusive of tax credits, incentive programs, increased Federal assistance to the states, and other means.  And I believe that Washington state’s breakthrough on Long-Term Care is a model for America.

* No longer running

Amy Klobuchar*

Senator Klobuchar is focused on connecting people to the job openings and opportunities we have today and understands that our country needs more direct support professionals. She is a strong supporter of tuition-free one and two year degrees for community college or technical certifications, as well as apprenticeships that combine on-the-job training with relevant academic instruction. She also supports student loan forgiveness for in-demand occupations and comprehensive immigration reform that will help ensure we have the workers we need.

*No longer running

Beto O’Rourke*

In many states, institutional bias and long waitlists are a significant barrier to accessing Medicaid waivers to qualify for community-based direct support staff professionals (DSP) services. As in New Hampshire, the average wage in many states for DPSs are near the poverty level or minimum wage, and often DSPs earn less than those working in institutional settings. As a member of Congress, Beto supported the Disability Integration Act as well as the EMPOWER Care Act (formerly Money Follows the Person) to ensure that people with disabilities can live in the least restrictive setting and free from forced institutionalization. It is paramount that we work to ensure the civil right of individuals with disabilities to live in their home and community. To achieve this goal, we must address the increasing demand for DSPs, the workforce shortage, and the high turnover rate. Beto will propose state and federal workforce incentives and tackle low wages by passing a $15 minimum wage to ensure we have a robust workforce and retain those critical direct support staff professionals, who are vital to ensuring that people with disabilities can live in their community and in their own home, where they belong.

* No longer running

Tim Ryan*

Throughout the country, we are seeing this same trend in a variety of fields. Jobs are available, but potential workers lack the education or skills needed to fill the positions. I believe we must invest in our workforce to address these growing challenges with a shrinking workforce. This is why I am introducing a plan to help encourage workers to seek additional training by giving them a voucher towards the training and by taking care of additional barriers such as childcare or transportation. I believe in supporting our workers in order to strengthen our workforce.

* No longer running

Bernie Sanders*

We need 7.8 million home health and personal care aides by 2026 to meet our needs. In order to meet the growing demand, we need to make direct care a quality job that pays a living wage. Direct care workers, who are overwhelmingly women – in particular, women of color and immigrants, too often do not receive health insurance through their employment. We will guarantee them high-quality health care under my Medicare-for-All, single payer health insurance system.

We must ensure our care workers are afforded a living wage and a safe working environment. Bernie will provide strong protections for collective bargaining, workers’ rights, and workplace safety for all workers, including caregivers. We will provide our caregivers guaranteed vacation leave, sick leave, and family and medical leave. And we will enact the Social Security Caregiver Credit Act to compensate the more than 43 million unpaid caregivers for their work.

We will also address our health workforce shortage crisis by increasing funding for the National Health Service Corps, which provides scholarships and loan repayment to clinicians working in underserved communities.

We will bring more providers to underserved communities by increasing federal funding for community health centers, which currently serve over 28 million people in underserved communities.

Bernie’s Medicare for All plan requires an evaluation of health disparities, including geographic disparities, and a plan for addressing the disparities found in the evaluation. It also creates an Office of Primary Health to figure out how to increase access to care, including how to train the workforce we need to address these disparities.

Bernie has also worked to expand access to caregiving programs provided by the Older Americans Act (OAA). As you know, OAA provides critical funding for a wide variety of social and legal services such as home-delivered meals, employment opportunities for low-income seniors, and caregiver support. The National Family Caregiver Support Program provides caregiver counseling, training, support groups, and respite care so caregivers can have a break for a few hours to help avoid burnout.

*No longer running

Joe Sestak*

For one, we must increase the federal minimum wage so that it is a living wage. Many at-home health professionals are paid at or near the minimum wage, so they are often forced to look for and accept higher paying work — even if this means changing fields. Increasing the minimum wage will make the workforce more stable. We also need to expand guest worker visa programs to expand the number of immigrants coming to this country to work as home health workers. Passing the Disability Integration Act will help ameliorate the situation as well by increasing funding.

* No longer running

Tom Steyer*

Creating and expanding the workforce pipeline in the health services arena requires investment and creation of opportunity. I will reduce the burden of student loan debt by guaranteeing two years of free college, refinancing student loan at lower interest rates, passing a Student Borrowers Bill of Rights, and forgiving the student loan debt of teachers and other public servants who have dedicated their time and energy to serving our communities.

As president, I will conduct a comprehensive review to address the underfunding of our healthcare system and workforce needs so that we can properly resource health systems, recruit and retain service professionals and providers, and close our nation’s healthcare gap.

*No longer running

Eric Swalwell*

As President I would advocate for better wages, better working conditions, and regulations in the direct support profession. This industry has a very high turnover rate which negatively impacts skills development, and by extension, the health and safety of those being provided care.

Current Medicaid provider rates must be increased to allow for higher wages. Educational incentives, including student loan debt forgiveness, are needed to attract and retain a more diverse and skilled workforce. Career models that provide opportunities for promotion and specialization must be introduced to prevent burnout and people leaving the profession. And going forward, we need better data on DSP wages to inform and update our policymaking.

* No longer running

Elizabeth Warren*

Direct Support Professionals provide essential support to people with disabilities to help them lead meaningful, productive, and independent lives. As you point out, there is an increasing shortage of DSPs throughout the United States. That’s why, every year since I entered the Senate, I’ve co-sponsored a resolution that recognizes the important work DSPs do and more recently calls on the Department of Labor to collect data specific to DSPs. I’ve also cosponsored the Disability Integration Act, which would require insurance providers that cover long-term supports and services to allow people with disabilities to access home and community-based services and lead an independent life.

Additionally, Medicare and Medicaid are lifelines for millions of people who rely on these programs for essential health coverage and economic security, especially people with disabilities and long-term care needs. I will fight to preserve and strengthen these programs, and I won’t back down when it comes to making sure Medicare and Medicaid are there for those who need it. I am also deeply committed to both protecting and expanding Social Security. After shrinking budgets forced the Social Security Administration to cut thousands of jobs and close more than 60 offices, leading to outrageously long wait times that left many Americans with disabilities struggling to get their benefits, I fought to get a $480 million increase for the agency – the first increase to its operating budget in almost a decade.

Finally, to ensure people with disabilities can live full, independent lives we must also invest in big structural change. My proposal to confront America’s housing crisis –the American Housing and Economic Mobility Act — would result in over 3 million new low- and moderate-income housing units, bringing rents down for people with disabilities and their caregivers and ensuring that they can afford to live in the communities that they call home. The bill would also expand the Fair Housing Act to prohibit discrimination against people for gender identity, sexual orientation, marital status or source of income, including government assistance, or housing vouchers.

*No longer running

Marianne Williamson*

People with disabilities have often been both misunderstood and victimized with institutionalization, lack of adequate funding and resources and less than the measure of respect they deserve in a just and moral society.

By default, those who directly work for them as direct support professionals have suffered from low wages, lackluster benefits and stigmatization, with an average national wage of approximately $11.00 per hour. Direct support professionals are critical to providing care, support and a reasonable quality of life for those with disabilities with whom they work. Raising the minimum wage to a livable wage, starting at $15.00 is a first step. Strengthening a workforce with universal, affordable and portable access to healthcare is another important step. The current administration has proposed tens of millions of dollars of cuts to federal programs that support those with disabilities. https://www.nytimes.com/2019/04/17/opinion/disability-budget-cuts-trump.html. This is unconscionable. A Williamson administration will propose and support Increasing federal funding assistance for disability resources.

*No longer running

Andrew Yang*

This is a tough question and one that no one has provided a great answer for. I think we need to find ways to subsidize this work in order to encourage more people to go into it. We can also do a better job of making this one step in a career track, which wouldn’t help with turnover but could increase the volume of assistance available. There are also programs that allow individuals to earn care credits for helping out when they’re young, and then trading them for care when they’re old, that are worth investigating.

*No longer running


Disability Rights Center – New Hampshire is a statewide non-profit organization dedicated to eliminating barriers for people with disabilities across New Hampshire. DRC is the federally designated protection and advocacy agency for New Hampshire and has authority under federal law to conduct investigations in cases of probable abuse or neglect.

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