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These Stats on Direct Care Workers Should Galvanize Everyone

By Robert Espinoza | September 13, 2022

Every year around Labor Day, PHI releases a statistical snapshot of the U.S. direct care workforce, including its demographics, occupational roles, job quality challenges, and projected job openings. This yearly research report looks closely at three segments of this essential workforce: home care workers, residential care aides, and nursing assistants in nursing homes.

Here are some eye-opening statistics from this year’s research report that should galvanize all of us to act in support of these workers.

WORKFORCE SIZE

The home care and residential care workforce is expected to increase by 37 and 22 percent in the next decade, respectively.

As the number of older adults has continued to grow, so has the demand for direct care workers. As evidence, our new report shows that between 2020 and 2030, the direct care workforce will add more than 1.2 million new jobs in total. However, not all direct care occupations are expanding—notably, the number of nursing assistants in nursing homes is expected to decrease in that period. More startling is the report’s finding that the long-term care will need to fill 7.9 million jobs in direct care over the next decade, when accounting for both new jobs and job openings created by people leaving the direct care field or the labor force altogether.

WAGES

Even though the median wage for direct care workers has increased incrementally over the last decade, it was only $14.27 in 2021.

Our report shows that the median hourly wage for direct care workers increased very modestly in the past 10 years, mainly in recent years due to COVID-19 federal relief funds. Unfortunately, this modest wage increase isn’t enough, as too many workers still live in low-income households and rely on public assistance to survive. Additionally, low wages (combined with part-time hours) drive many direct care workers out of this job sector, at a time when employers struggle to compete with higher-paying industries to fill these jobs.

IMMIGRANTS

Immigrants represent 31 percent of the home care workforce, compared to 16 percent of the total labor force.

Our report shows that immigrants remain a significant part of the direct care workforce, especially in home care. Despite their value to this sector and the broader economy, direct care workers bear the brunt of anti-immigrant sentiment, as evidenced by the many hostile policies under the Trump administration, the Right-Wing discourse on immigration, and the litany of negative comments on PHI’s immigration-related social media posts, to name a few. In contrast, some leading organizations are recognizing that immigrants deserve good jobs (both in direct care and beyond) and calling for immigrant-friendly supports to curb the workforce shortage in this job sector.

FINANCIING

Residential care aide jobs in assisted living and continuing care retirement communities are typically funded through private sources, whereas other direct care jobs are predominantly government-funded.

According to our report, although the number of residential care aide jobs decreased from 2020 to 2021, this segment of the direct care workforce otherwise grew consistently over the last 10 years, adding more than 94,000 jobs. This trend should compel practice and policy leaders alike to consider the needs and value of this workforce. But there’s another reason policymakers should pay attention to residential care trends: given the limited public financing of residential care, the policy avenues to regulate job quality in this sector are not as strong as in other long-term care settings. In the short term, policymakers should consider ways to study and incentivize job quality improvements in residential care jobs. And in the long term, they should revisit the extent to which residential care should be regulated and held to higher standards related to jobs and care.

STAFFING

On average, nursing assistants support 13 residents during each shift, while one in 10 nursing assistants typically assists 19 or more residents.

Inadequate staffing in nursing homes makes it difficult for nursing assistants to meet their residents’ complex needs and for residents to receive high-quality, person-centered care. In addition, supporting large numbers of residents can take its toll on the physical and mental health of nursing assistants, placing them at high risk of injury. In fact, our report also shows that annual injury rates for nursing assistants are far higher than for all other U.S. occupations. The three leading causes of injuries among nursing assistants are infection, overexertion, and falls.

COVID-19

Compared to nursing home residents, nursing home staff are less likely to be fully vaccinated (i.e., have received a booster shot).

According to the report, more than 1 million nursing home residents and more than 1.1 million nursing home staff have contracted COVID-19 since its start. Yet, despite the widespread availability of vaccines and concerted efforts to increase vaccine uptake among direct care workers, only 52 percent of nursing home staff have received a booster shot, compared to 81 percent of residents. As a result, future vaccination strategies must continue to consider how to effectively reach this critical segment of long-term care.

Read our new annual research report on the direct care workforce here.

Robert Espinoza
About The Author

Robert Espinoza

Executive Vice President of Policy
Robert Espinoza oversees PHI's national advocacy and public education division on the direct care workforce, and contributes vision and leadership to the organization's strategies.
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