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New PHI Report Provides Comprehensive Analysis of Home Care and Personal Assistance Workforce, the Largest and Fastest Growing in the Nation

December 14, 2011

Home Care: Largest and Fastest Growing Workforce in the Nation

Bronx, NY — PHI has published the first in-depth analysis of the largest and fastest-growing workforce in the nation — the 2.5 million home care and personal assistance aides who provide long-term services and supports to elders and people living with disabilities in home and community-based settings.

The report, Caring in America — A Comprehensive Analysis of the Nation’s Fastest-Growing Jobs: Home Health and Personal Care Aides, uses the best data and research available today to present the most complete picture of the home care workforce possible.

"Carework in America is at a crossroads," said PHI Director of Policy Research Dorie Seavey, Ph.D., a labor economist who is the nation's leading expert on the home care workforce and authored the report with PHI Policy Associate Abby Marquand, M.P.H.

"We can continue the status quo of poorly supported and poorly compensated jobs, consigning home care workers to near-poverty earnings and home care to a revolving door of caregivers," Seavey said. "Or, we can leverage this workforce's enormous potential as both an underutilized asset in our health care system and as one of the strongest job growth engines that our economy has to offer."

Between 2008 and 2018, the home care workforce is expected to grow at rates four to five times faster than jobs in the overall economy.

"Despite its size, and the essential services it provides, the home care workforce remains largely invisible," PHI National Policy Director Steve Edelstein writes in the Foreword.

The numbers of home care and personal assistance aides have reached historic proportions as a result of several trends: the preference of the rapidly-rising aging population to continue to live in their homes and communities despite complex medical conditions; medical innovations that allow people with disabilities to live longer and, with assistance, independently in their communities; and state and federal policies that increasingly support home and community-based services as alternatives to traditional, more costly institutional care.

In nine footnoted sections, with an array of tables, charts, and graphs, the 121-page report covers:

  • The Workforce – basic facts on the size of the home care and personal assistance workforce and its demographic characteristics along with a description of job titles and tasks performed;
  • The Industry Sector — an analysis of the employers in the in-home care industry sector;
  • Service Delivery Systems — an examination of the complex of service delivery systems that provide daily services and supports to millions of elders and people with disabilities;
  • Training — the state of training for home care and personal assistance workers;
  • Job Hazards — the hazards accompanying this work and the high incidence of injuries and illnesses;
  • Workforce Compensation — a review of wages and benefits that leave home care workers struggling with basic conditions of employment and heavily reliant on public assistance programs;
  • Hours Worked — the part-time employment patterns of aides and low rates of over time worked;
  • Workforce Instability & Labor Shortages — review of turnover and vacancy data;
  • Status of Wage & Hour Protection — the current status of federal and state wage and hour protections for this workforce, including the "companionship exemption" in the federal Fair Labor Standards Act that excludes home care and personal assistance aides.

The report concludes that despite being the nation’s most high-demand occupation, the home care and personal assistance workforce is characterized by:

  • Poor wages
  • Inconsistent training requirements poorly aligned with wages
  • Inadequate health care coverage
  • High injury rates
  • Unpredictable hours, often part time
  • Heavy reliance on public benefits

As a result, our nation is unprepared to meet the needs of its rapidly aging population, the report warns.

"Our hope is that this resource will promote a better and broader understanding of the workforce, as well as the large and growing eldercare/disability services industry it supports," Edelstein wrote.

"We also hope that it will facilitate a more informed public discussion of key issues shaping the future of in-home services, aiding the development of both effective policy solutions and a targeted industry response."

For more information on the direct-care workforce, including the PHI State Data Center, Chart Gallery with downloadable graphs and charts, and Fact Sheets, visit PHI PolicyWorks.

* * *

PHI ( is a national organization that works to improve the lives of people who need home or residential care — and of the direct-care workers who provide that care. PHI's work is grounded in the philosophy that quality jobs for direct-care workers will lead to quality care for long-term care consumers.

Deane Beebe, PHI Media Relations Director
718-928-2033; 646-285-1039 (cell)

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