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PHI Releases Research Series on Racial Disparities in Direct Care

February 6, 2018

NEW YORK — Today PHI released the first research brief in a three-part series looking at the job-related and economic characteristics of people of color in direct care. The first brief—Racial Disparities in the Direct Care Workforce: Spotlight on Black/African American Workers—takes a closer look at Black/African American direct care workers, finding that while they make up one-third of the workforce and they struggle with higher levels of poverty than other workers.

“The diversity of direct care workers is an asset to the long-term care industry, bringing a wide range of skills and perspectives to the people they support. Unfortunately, our new research vividly illustrates how people of color in this sector continue to struggle with racial discrimination, which must be addressed by our field,” said Jodi M. Sturgeon, president of PHI, a national research and consulting nonprofit widely considered the nation’s leading authority on direct care.

The direct care workforce includes about 4.4 million home care workers and nursing assistants employed in nursing homes.

Key findings include:

  • From 2005 to 2015, Black/African American workers consistently made up approximately 30 percent of the direct care workforce.
  • During this period, the number of U.S.-born Black/African American workers in direct care increased from 624,000 to 799,000 workers (28 percent growth).
  • The median family income for U.S.-born Black/African American workers is just $37,000, compared to $52,100 for Black immigrants and $53,800 for white workers.
  • One in four U.S.-born Black/African American workers lives in poverty, compared to one in eight Black immigrants and one in six white workers.

“This study is a stark reminder that the history of racial discrimination in this country has affected the employment options and economic stability of people of color. Long-term care leaders must adopt race-explicit solutions that resolve these inequities, improving both the quality of direct care jobs and the services they deliver,” said Robert Espinoza, vice president of policy at PHI.

The brief argues that while all direct care workers need jobs with livable wages, good benefits, appropriate training, and advancement opportunities, people of color in this sector need targeted support, given the additional obstacles they face because of racial discrimination.

To support this segment of the workforce, the brief recommends that long-term care leaders collect data on racial disparities in their settings, build training and advancement opportunities to help Black direct care workers improve their economic stability, and set hiring and retention goals to diversify the long-term care field—among other recommendations.

Future briefs will examine Asian/Pacific Islander and Hispanic/Latino workers in direct care. In November 2017, PHI issued a study on racial and gender disparities in direct care, finding that women of color in direct care have smaller family incomes and are more reliant on public benefits than their white counterparts.

This brief is part of PHI’s #60CaregiverIssues campaign, an education campaign focused on the growing workforce shortage in direct care. Since its launch in February 2017, the campaign has generated widespread media coverage and released the first 31 issues, available at


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