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PHI Releases New Annual Data on the U.S. Direct Care Workforce

September 7, 2021

NEW YORK — In 2020, as this country began grappling with the COVID-19 pandemic, direct care workers nationwide continued to struggle in poverty-level jobs across all long-term care settings, according to a new report from PHI, the nation’s leading expert on the direct care workforce.

Direct Care Workers in the United States: Key Facts provides a new annual snapshot on the direct care workforce, including its demographics, occupational roles, job quality challenges, and projected job openings. The report includes detailed overviews of three segments of this workforce: home care workers, residential care aides, and nursing assistants in nursing homes.

Every year, PHI releases new data on the direct care workforce, which in 2020 included 4.6 million workers, including 2.4 million home care workers, 675,000 residential care aides, 527,000 nursing assistants in nursing homes, and about 1 million direct care workers employed in other settings.

“Our new report emphasizes how longstanding poor job quality in direct care has prevented our country from effectively responding to the COVID-19 crisis and keeping workers and the people they support healthy and safe,” said Jodi M. Sturgeon, president of PHI, a national research, advocacy, and workforce innovations organization based in the Bronx, New York.

“This data should serve as a call to action to further invest in this essential workforce,” added Sturgeon.


The direct care workforce expanded rapidly over the last decade, growing from 3.1 million workers in 2010 to 4.6 million in 2020. This new report projects that from 2019 to 2029, the direct care workforce will add an estimated 1.3 million new jobs to meet rising demand, more new jobs than any other single occupation.

However, long-term care employers will face even more pressures with recruiting and retaining workers, given high turnover in this job sector. When including jobs that must be filled when existing workers transfer to other occupations or exit the labor force, this report estimates that long-term care employers will need to fill 7.4 million job openings in direct care from 2019 to 2029.

“It’s difficult to imagine how the long-term care sector will meet demand for direct care workers without dramatically improving their jobs,” said Kezia Scales, director of policy research at PHI.

Direct Care Workers in the United States: Key Facts also shows that the direct care workforce continues to be largely comprised of women, people of color, and immigrants. For example, immigrants constitute 31 percent of the home care workforce, compared to 17 percent of the total U.S. labor force.

Workers in these jobs also persistently struggle with poverty; the median wage for direct care workers was $13.56 in 2020, median earnings were $20,200, and 44 percent of these workers relied on some form of public assistance, such as Medicaid, nutrition support, or cash assistance. For example, among residential care aides, 32 percent do not have affordable housing and 17 percent lack health insurance.

According to the new report, direct care workers also face heavy workloads and high injury rates, which have made their jobs even more dangerous during the COVID-19 pandemic. On average, nursing assistants support 13 residents during a typical shift and are more than three times likelier to experience workplace injuries than the typical U.S. worker.


How has the COVID-19 pandemic impacted future demand for direct care workers?

PHI’s analysis from earlier this year showed that jobs in long-term care (including but not limited to direct care) fell five percent from February to December 2020—nearly 342,000 jobs lost.

However, these figures differed across long-term care settings: home care employment was only three percent lower in December 2020 than it had been in February 2020, while residential care employment was seven percent lower and nursing home employment was nine percent lower.

According to PHI, while the total number of direct care jobs will increase in the years ahead, this job growth will be concentrated in home and residential care—while the number of nursing assistant jobs in nursing homes will shrink. As this report illustrates, public and private sector leaders must improve these jobs to ensure they get filled.

“Direct care workers are essential to the lives of millions of older adults and people with disabilities, and they deserve high-quality jobs that reflect their enormous value,” said Stephen McCall, data and policy analyst at PHI.

Read the full report here.


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