Sign Up to Receive PHI Alerts

Our New Data Is Out on Direct Care Workers—and It’s Disturbing

September 15, 2020

PHI recently released its annual research report on the direct care workforce, which provides detailed profiles of three direct care occupations: home care workers, nursing assistants, and, for the first time, residential care aides.

The report echoes past findings—direct care workers are in extremely high demand, but their compensation and other job quality measures remain poor. However, this year’s findings take on added significance in the midst of the COVID-19 pandemic, when direct care work has become more essential than ever.


Direct care workers are on the frontlines of the COVID-19 pandemic, supporting millions of older adults and people with disabilities—in most cases without sufficient access to personal protective equipment (PPE), paid time off, or other critical employment supports. Although it is not possible to quantify the full impact of the virus on the direct care workforce—given the paucity of data available from residential care and home care settings—we know that at least 153,300 nursing assistants in nursing homes have had COVID-19 (either suspected or diagnosed) and over 600 have died from the disease as of June 21, 2020. Residential care aides, who work in assisted living communities and other congregate settings, have likely experienced similarly high infection rates—and many home care workers have also been exposed and infected in the course of their work.

Notably, since most direct care workers are people of color—including 62 percent of home care workers and just over half of nursing assistants and residential care aides, according to our new research—this workforce been particularly vulnerable to COVID-19, given the disparate impact of the virus on Black and Latino communities.

These workers have been putting their health and lives on the line during the pandemic for persistently poor compensation. Our new data show that median wages are just $12.12 per hour for home care workers, $12.69 for residential care aides, and $13.90 for nursing assistants. One promising trend: while wages are unequivocally low, they increased for all three direct care occupations in the past decade; in 2009, median hourly wages were $11.21 for home care workers, $12.27 for residential care aides, and $13.39 for nursing assistants.

Nonetheless, direct care wages still fall far short of lifting these workers out of poverty. According to our new data, 47% of home care workers live in low-income households (defined as 200 percent of the federal poverty level), followed by 42% of nursing assistants and 41% of residential care aides. Over half of home care workers rely on some form of public assistance, and so do nearly 40 percent of nursing assistants and residential care aides.

What do all these findings tell us? While direct care workers may have received public accolades for their heroism during this crisis, they have not been adequately supported in the field nor compensated at a level that meets their basic needs.

Layered Crises

The COVID-19 pandemic has also severely exacerbated the existing direct care workforce crisis. Many workers have taken time off to tend to their health or their loved ones, while others have stayed home due to safety concerns. In addition to health-related reasons, other workers have reduced their hours or left their jobs entirely to take care of their children during school closures. Our new report shows that 31 percent of nursing assistants, 28 percent of residential care aides, and 25 percent of home care workers have children under the age of 18 at home.

But even as the pandemic pushes direct care workers out of their jobs (temporarily or permanently), demand for their services continues to rise due to a growing population of older adults. As detailed in our new report, the long-term care field will need to fill 8.2 million job openings from 2018 to 2028—including 1.3 million new jobs plus nearly 6.9 million jobs that become vacant as workers change careers or leave the labor force altogether. The pandemic will likely make these openings more difficult to fill because it has brought to the forefront the dangerous nature—and the poor quality—of direct care jobs. With this new awareness, job seekers might think twice before applying for these positions in the months and years ahead, which would be disastrous for this sector.

Many leaders in our sector have long recognized that the combination of growing workforce demand and poor job quality has caused a nationwide direct care workforce shortage. The COVID-19 pandemic has only worsened the field’s recruitment and retention challenges. Our report makes clear that this critical workforce must be strengthened and stabilized to address the current health crisis and ensure that consumers have quality care for years to come.

Read Direct Care Workers in the United States: Key Facts here.

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.