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New Research: High Demand Yet Low Wages for Direct Care Workers

September 8, 2020

NEW YORK — As the COVID-19 crisis has emphasized, direct care workers are more valuable than ever, yet new research from PHI shows that they continue to struggle with low wages and other economic barriers, which threaten their economic security and job stability.

“It has taken a significant health crisis for our country to begin seeing the value of our long-term care system and its workforce—but this research shows how much work is needed to address the many barriers facing direct care workers,” said Jodi M. Sturgeon, president of PHI, a national research. advocacy, and workforce interventions organization widely considered the leading expert on the direct care workforce.

“The direct care workforce is on the frontline of this crisis, as essential as ever, and they deserve a significant investment in their jobs,” added Sturgeon.

Every year, PHI releases new data on the direct care workforce, which in 2019 included about 2.4 million home care workers, 735,000 residential care aides, and 566,000 nursing assistants in nursing homes. The total number of direct care workers across all industries tracked by the Bureau of Labor Statistics is 4.6 million workers.

Direct care workers support older people and people with disabilities with activities of daily living, among other responsibilities. Home care workers support their clients in private homes and community settings, and nursing assistants in nursing homes provide services to residents who require 24-hour nursing care and personal care assistance. For the first time, this year’s research includes data on residential care aides, who work in small group homes, assisted living communities, and other residential care settings.


  • A rapidly growing workforce. Over the past decade, this workforce grew from 3 million workers in 2009 to 4.6 million in 2019. The direct care workforce is now larger than any single U.S. occupation.
  • Diverse and marginalized. Most direct care workers are women (87%), and many are people of color (59%) and/or immigrants (27%). Among home care workers, people of color accounted for 62 percent of these workers despite making make up 38 percent of the total U.S. labor force.
  • Persistently low wages. Inflation-adjusted median hourly wages increased only marginally for the direct care workforce over the last decade—from $12.61 in 2009 to $12.80 in 2019.
  • Low-income earnings. Home care workers have the lowest median annual earnings, at $17,200, followed by residential care aides at $21,200 and nursing assistants in nursing homes at $23,300.
  • High demand. From 2018 to 2028, the long-term care sector will need to fill 8.2 million job openings in direct care, including 1.3 million new jobs to meet rising demand and 6.9 million separations caused by workers who transfer to other occupations or exit the labor force altogether.


The COVID-19 pandemic has raised this workforce’s visibility and deepened their challenges, from low compensation to inadequate training and career advancement opportunities.

The virus—coupled with longstanding underinvestment in and lack of support for long-term care providers—has endangered and claimed the lives of both workersand consumers. In the first four months of COVID-19, more than 144,000 nursing homes residents and about 600 nursing home staff have died of the virus. (Similar data is unavailable for other segments of the long-term care industry

“COVID-19 has compelled to take a closer look at these workers and the entire industry, and this data provides valuable insights to inform this moment and beyond,” said Stephen Campbell. PHI’s data and policy analyst.

“However, we also need more data and new studies on this workforce to inform the solutions that will transform these jobs in the long term,” added Campbell.


By 2060, the number of people aged 65 and older will nearly double—from 49.2 million in 2015 to 94.7 million in 2060, according to the U.S. Census Bureau. Older adults will also become more diverse in the decades ahead; from 2016 to 2060, the proportion of older adults of color aged 65 and older will increase from 23 percent to 43 percent, and the proportion of older immigrants will grow from 14 to 23 percent.

As people live longer, direct care workers are supporting more people with complex chronic conditions. As one example, the number of people with Alzheimer’s disease will more than double from 5.8 million to 13.8 million by 2050. Already, more than one third of long-term care consumers have Alzheimer’s disease or another form of dementia—a population served in part by direct care workers.

Read the latest research on U.S. direct care workers here.



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