Community Attendants

4-5 minute read

Community Attendant icon. Two simplified figures hover in front of a house.Our Position

Community attendants are a critical support for enabling people with disabilities and seniors to remain independent and in their chosen communities. Recruitment and retention of this crucial workforce is at high risk due to an extremely low base wage, no benefits, increasing demand, and alternative employers paying much higher wages.

Stabilizing this workforce comes down to a competitive wage. For many years, wages have been removed from the free market and been set by the Legislature. CTD recommends that the Texas Legislature:

  1. Increase the base wage to $15 per hour.
  2. Build in an adjuster mechanism that will increase wages in accordance with free markets.
  3. Promote the consumer directed services (CDS) option. In this cost-neutral option, more of the Medicaid rate goes to the direct care worker. CDS is very undersubscribed in Texas.
  4. Increase by 50% the administrative rate to Home Health Agencies and Financial Management Services Agencies. These agencies have had no increase in rates for administrative services for 14 years, which has weakened oversight and compliance.

The Latest

October 28, 2022: Our Dennis Borel and long time CTD member Gene Rodgers speak to the worsening home caregiver shortage ahead of the 2023 Legislative Session, on KVUE.

June 6, 2022: Release of our updated Crushing the Workforce 2.0 report on attendant wages in Texas.

January 21, 2022: our Dennis Borel in the Austin American-Statesman: Lawmakers set 'poverty' wages for community attendants.



After decades of advocacy and changing attitudes, people with disabilities and seniors are better able than ever to be active in their communities and contribute to society. Part of this progress is due to community attendants, who assist their care-recipients with a wide variety of daily tasks in their own homes, allowing them to avoid unnecessary, expensive hospitalization or institutionalization.

Sisyphus graphic. A human figure (labeled $8.00/hr) pushes a boulder (labeled 178,000 Texans) up a hill. The top of the hill reads Cost-effective community services and the bottom reads institutions. Community attendants are the key to making cost-effective community services successful for approximately 178,000 individuals with disabilities and seniors in Texas, but our state is one of the worst in the country when it comes to supporting them. Thanks in part to advocacy efforts by CTD and our partners, the lowest paid attendants make $8.11 per hour in 2020, up from $8 per hour in 2019, $7.86 in 2015, and $7.25 in 2013 (the Legislature made no increase in 2017). While this is a step in the right direction, it's far from a livable wage. Plus, these workers receive no sick leave, no paid vacation, and no health insurance. In fact, the Texas Workforce Commission (TWC) won’t refer jobseekers to this high growth occupation: federal regulations require that job referrals lead to economic self-sufficiency and these jobs do not.

Demographic shifts underscore the urgency for a well-supported attendant work force. Texas has the third largest older adult population in the US, totalling 3.1 million in 2014 and projected to increase 90% by 2030 to 5.9 million. Many of these seniors will need attendant support and services in their later years, as do younger people with physical disabilities and/or intellectual and developmental disabilities. 

With more and more people in these populations opting to age in place or stay in their homes, demand for attendant service will rise. TWC has already has identified personal care aides and home health aides as two of the fastest growing occupations in Texas. The increase in these jobs is projected to reach 102,030 by 2024.

As demand rises, a number of economic forces have an increasingly negative impact on the attendant workforce. For over 50 years, community attendants in Texas have seen their real wages decline. Wages have not kept up with inflation, undergoing a 30% erosion since 1968 (below).

Community Attendant Wages in 2020 US Dollars (adjusted to Consumer Price Index). Graph with hourly wage along y axis ($6-13$), years along the x axis (1968-2020). Blue line starts at $13.74 in 1968 and zig zigs downward to $8.11 in 2020.

Adjustments for inflation made using the Consumer Price Index Inflation Calculator, Bureau of Labor Statistics

Meanwhile, other entry-level jobs are paying more and even offering benefits, making alternative employment much more attractive. A quick drive around CTD's hometown of Austin reveals that El Tacorrido starts their employees at $13-$15 per hour; Wheatsville Coop at $13.22; Buc-ees at $12-15.

With better employment options elsewhere, it comes as no surprise that attendants are leaving the sector. In droves, it turns out: Home Care Pulse reports that the median caregiver turnover rate across the industry was 66.7% in 2017, the highest rate since 2013.

All of these factors—a growing population that requires attendant services; decades of wage stagnation; attractive employment options elsewhere; high turnover—put Texas seniors and citizens with disabilities in a very precarious position. A modest wage increase will improve reliability and care which correlates to better health, less acute care, fewer ER visits, and fewer unnecessary institutionalizations.

In the COVID-19 pandemic, it bears mentioning that 100% of the service population in community care falls within the group labelled “with underlying medical conditions”, the most likely to have a bad outcome, or death, from COVID-19. These citizens should avoid dangerous congregate settings like nursing homes and remain healthy enough to stay out of hospitals, which are highly risky for a non-COVID patient. Reliable community attendants provide excellent value to those served, their families and communities, and the state budget.

Take Action

Further Reading