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

September 6, 2022

NEW YORK — The direct care workforce is larger than any single occupation yet continues to struggle with low wages and other barriers that hinder recruitment and retention in this job sector, 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 of 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 includes 4.7 million workers, including 2.6 million home care workers, 647,500 residential care aides, 471,000 nursing assistants in nursing homes, and about 1 million direct care workers employed in other settings (according to 2021 data). From 2020 to 2021, the home care workforce grew while the residential care and nursing assistant workforces decreased.

“Year after year, our annual research on direct care workers has revealed the continual growth of this workforce, the increased demand for their services, and the profound economic hardships they face,” said Jodi M. Sturgeon, president and CEO of PHI, a national research, advocacy, and workforce innovations organization based in the Bronx, New York.

“It is long overdue for this country to transform the direct care workforce, improving their financial security and long-term services and supports for everyone,” added Sturgeon.


From 2011 to 2021, the direct care workforce added nearly 1.5 million new jobs, growing from 3.2 million workers to 4.7 million. This growth trend will continue as this workforce is expected to add an estimated 1.2 million new jobs from 2020 to 2030—more new jobs than any other occupation in the country.

This job growth will occur primarily in the home and community-based services sector, with the home care and residential care workforces projected to increase in the next decade by 37 and 22 percent, respectively.

In contrast, the nursing assistant workforce is expected to continue steadily decreasing in size. From 2020 to 2021, the year the COVID-19 pandemic emerged and devastated the nursing home sector in particular, the nursing assistant workforce lost 56,320 jobs—the largest single-year decline of nursing assistants in the past decade.

In addition, PHI’s new report shows that when accounting for jobs that must be filled when existing workers transfer to other occupations or exit the labor force, there will be an estimated 7.9 million total job openings in direct care from 2020 to 2030.

“Government and industry leaders alike must expand their investment in direct care workers and the long-term care sector to ensure that we can meet demand in the next 10 years,” said Kezia Scales, senior director of policy research at PHI.


Direct Care Workers in the United States: Key Facts also confirms that the direct care workforce continues to be predominantly comprised of women, people of color, and immigrants, all of whom face heightened risks of discrimination throughout their lives in housing, education, employment, health care, and more. For example, in the home care workforce, immigrants make up 31 percent, compared to 16 percent of the total U.S. labor force.

While the direct care workforce has seen incremental wage growth in the past 10 years, the median wage was just $14.27 in 2021. As a result of low wages and part-time hours, median annual earnings for direct care workers were only $21,700, 40 percent of direct care workers lived in low-income households, and 43 percent relied on public assistance, such as Medicaid, food and nutrition assistance, or cash assistance.

The report also reveals how COVID-19, among other developments, has dramatically altered the long-term care sector’s approach to staffing. For example, more than three in five nursing homes (62 percent) relied on nursing assistants from staffing agencies to fill staffing vacancies in 2021 for a median of 166 days during the year. Nursing home reliance on staffing agencies increased notably from 2020 when 41 percent of nursing homes used contract nursing assistants for a median of 89 days during the year.

“COVID-19’s profound impact on direct care workers has compelled many long-term care employers to approach care delivery differently, yet what’s needed is a sector-wide transformation,” added Scales.

Read the full report here.


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