Direct Care Workforce Grows to Nearly 5.8 Million as Demand for Care Accelerates and Federal Rollbacks Threaten Job Quality

The direct care workforce has grown to nearly 5.8 million, the largest occupation in the United States. The long-term care sector will need to fill an estimated 9.6 million direct care jobs over the next decade as the U.S. population ages, according to Direct Care Workers in the United States: Key Facts 2026, released this week by PHI. PHI’s authoritative annual report on the workforce shows direct care jobs themselves still paying a median of $17.99 per hour—with annual earnings leaving nearly half of the workforce reliant on public assistance to make ends meet.

Direct care workers assist older adults and people with disabilities with daily tasks such as bathing, dressing, and eating, in private homes, assisted living communities, and nursing homes. Competing trends compound the challenges of growing demand: The number of adults aged 85 and older is expected to nearly triple by 2060, while the number of working-age adults available to provide care, paid or unpaid, remains nearly flat.

Pressures on this sector are being deepened by federal policy. Medicaid cuts enacted through H.R. 1, new restrictions on public benefits, the rollback of wage and overtime protections for home care workers, the repeal of nursing home staffing standards, and immigration enforcement are converging on a workforce that is majority women, majority people of color, and nearly one-third immigrants.

“Direct care workers have held our long-term care system together through years of underinvestment,” said Jodi M. Sturgeon, president and CEO of PHI. “At a moment when more families than ever rely on care, federal policies are making these already difficult jobs less secure and workers’ livelihoods more uncertain.  The consequences extend far beyond the workforce, it reaches every person who needs care.”

Key findings:

• The direct care workforce added nearly 2.1 million jobs from 2015 to 2025, with home care more than doubling to nearly 3.5 million workers.
• Of the 9.6 million projected job openings through 2035, only 886,000 are new positions. Low wages and other job quality concerns continue to drive recruitment and retention challenges, and direct care jobs must compete with similar occupations that pay more.
• Median hourly wages rose $2.94 over the decade after inflation, but remain $2.55 below similar occupations. Median annual earnings are just under $28,500.
• Thirty-four percent of direct care workers live in low-income households, and 45 percent rely on Medicaid, SNAP, or other public assistance, programs now facing new federal restrictions.
• The ratio of working-age adults to adults 85 and older will fall from 31 to 1 today to 12 to 1 by 2060, as the number of older adults with Alzheimer’s disease nearly doubles.

The report also documents recent progress in nursing homes.  Nursing assistant employment in nursing homes has rebounded since 2022, and reliance on contract staff has dropped from 62 percent to 51 percent, a shift toward stable, permanent staffing that the repeal of federal minimum staffing standards now puts at risk.

PHI calls on federal and state policymakers to protect Medicaid funding for home and community-based services, preserve wage and overtime protections for home care workers, and support the immigrant workers who make up a growing share of the workforce.

“The path forward is clear,” Sturgeon said. “When direct care jobs are quality jobs, with family sustaining wages, high-quality training, and meaningful opportunities for advancement, workers stay, and families get the care they are counting on. That is the investment this moment demands.”

While working to address these immediate challenges, PHI is also advancing a future-focused, transformational vision through its Universal Direct Care Workforce Initiative™, which is aligning states, providers, and payers around shared standards and sustainable financing to build a system where training counts, credentials travel, and careers can advance.

Read the full 2026 Key Facts report at https://www.phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2026/