In 2025, Iowa CareGivers partnered with Iowa Workforce Development (IWD) to conduct the Direct Care Workers of Iowa Wage and Benefit Survey, a repeat of the 2019 study and the first opportunity to compare findings over time. Despite the essential and critical nature of their work, Direct care workers’ real wages grew by only $2.62 over a 15-year period. Consequences are felt statewide: employers struggle to fill vacancies, people with disabilities cannot consistently find or retain caregivers, and family caregivers are forced to leave the workforce because backup care is unavailable. Low wages, limited access to affordable health insurance and benefits, burnout from chronic understaffing, and the lingering effects of the COVID-19 pandemic continue to drive these challenges—creating an uncertain future for thousands of Iowans who depend on this vital workforce.
Direct care workers include certified nurse aides; home care, hospital, and hospice aides; direct support professionals, and others who provide hands-on care to Iowans of all ages and abilities. They work in private homes, group homes, assisted living and nursing home facilities, hospitals, hospices, residential care, and other settings. Iowa CareGivers conducted similar wage and benefit surveys in 2004 and 2010, but the 2019 and 2025 studies mark a significant shift in the way IWD collected information. Rather than collecting data from employers, the surveys captured information directly from workers themselves. “That gives us the opportunity to view the issues associated with low wages through the reality lens of those who are living it every day,” said Di Findley, Executive Director, Iowa CareGivers.
The survey also examined participation in public support programs, including the Supplemental Nutrition Assistance Program (SNAP), childcare assistance, housing assistance, Hawki (Healthy and Well Kids in Iowa/Children’s Health Insurance Program), and the Iowa Health and Wellness Plan – state and federal safety net supports that many direct care workers are eligible for due to low-wages. “Without these supports, many in my field simply wouldn’t be able to afford to stay in the workforce. As someone who is now retired due to pandemic burnout, I can relate to the finding that 30% of those currently working in direct care report they are working more than one job. I worked in the field for 32 years and for 12 of those years, I, too, worked two jobs so I could afford to work in the job I loved…direct care. The need to increase wages for direct care workers can’t be emphasized enough. I hope 2026 is the year policymakers make direct care worker wages a priority and will find the new wage and benefit survey findings helpful in making data-driven decisions, said Fran Mancl, a retired Certified Nursing Assistant and member of Iowa CareGivers’ Direct Care Council.
“We stand alongside people in our region who are overcoming barriers to the opportunities and resources they need to thrive. Iowans are speaking to a need for a direct care work environment that can better serve those who both give and receive care. We’re pleased to support Iowa CareGivers and Iowa Workforce Development, whose important research collaboration is meeting this need with courage and wisdom,” said Kevin Walker, CEO, Northwest Area Foundation.
“As an organization supporting data-driven and community informed decision-making in Iowa, our foundation was proud to support Iowa CareGivers in their most recent care worker survey data collection,” said Dr. Nalo Johnson, President & CEO of Mid-Iowa Health Foundation. “We applaud Iowa CareGivers’ leadership to bring research forward to inform potential community solutions.”
Iowa’s worker-centered research is gaining national attention and may serve as a model for other states. Building on the survey findings, Iowa CareGivers recently convened a Day of Dialogue engaging 50 thought leaders—including workers, consumers, family caregivers, employers, educators, state agencies, and advocates—to explore forming a collaborative network focused on advancing wage improvements for direct care workers.
“Ryan Murphy, Division Administrator, Labor Market Information Division, Iowa Workforce Development, said, “Iowa Workforce Development’s Labor Market Information team partnered with Iowa CareGivers to update a previous Iowa Direct Care Worker Survey and provide key labor market insights that have evolved in recent years. This project delivers measurable, applicable data on key labor market elements in the hopes of providing new insight for employers, workers, and stakeholders. Understanding this critical area of the workforce is important for future strategies surrounding recruitment, retention, and workplace strategy development as demand for health services continues to grow across both Iowa and the nation.”
