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About the Workforce

Overview

The direct-care workforce (also known as the direct service workforce) is statutorily defined by the federal government in the Patient Protection and Affordable Care Act (Pub. L. No. 111−148, 124 Stat. 119, H.R. 3590, Title V, Subtitle A, §5002 (2010)). That definition encompasses four Standard Occupational Classifications developed by the Bureau of Labor Statistics (BLS) at the U. S. Department of Labor (DOL): Home Health Aides [31–1011], Psychiatric Aides* [31–1013], Nursing Assistants [31–1014], and Personal Care Aides [39–9021]. According to the BLS, Personal Care Aides include Direct Support Professionals who assist individuals with developmental or intellectual disabilities. Some states may also include Direct Support Professionals in other human service occupational classifications, leading to challenges in estimating the size of the workforce (see “the Undercounting Problem“).

Occupations Featured at the PHI State Data Center
Nursing Aides	Nursing Aides generally work in nursing homes, although some work in assisted living facilities, other community-based settings, or hospitals. They assist residents with activities of daily living (ADLs) such as eating, dressing, bathing, and toileting. They also perform clinical tasks such as range-of-motion exercises and blood pressure readings. NOTE: Beginning in 2012, the BLS will treat Nursing Aides as a separate occupation from Orderlies and Attendants.
Home Health Aides	Home Health Aides provide essentially the same care and services as nursing aides, but they assist people in their homes or in community settings under the supervision of a nurse or therapist. They may also perform light housekeeping tasks such as preparing food or changing linens.
Personal Care Aides (including Direct Support Professionals)	Personal Care Aides (PCAs) work in either private or group homes and include workers with other titles such as personal attendants, direct support professionals, and home care aides. In addition to providing assistance with ADLs, these aides often help with housekeeping chores, meal preparation, and medication management. They also help individuals go to work and remain engaged in their communities. A growing number of PCAs are employed and supervised directly by consumers. Direct Support Professionals (DSPs) work with individuals who have intellectual or developmental disabilities, and may also have titles such as job coach, community living assistant, and direct support specialist. DSPs provide a broad range of supports to individuals with intellectual or developmental disabilities to enable them to live to their fullest potential in the community. These supports include: assisting with self-care, teaching home and community living skills, promoting self-determination, and supporting friendships and relationships in the community. NOTE: Until 2011, Personal Care Aides were classified as “Personal and Home Care Aides”.

Occupations Featured at the PHI State Data Center

Nursing Aides

Nursing Aides generally work in nursing homes, although some work in assisted living facilities, other community-based settings, or hospitals. They assist residents with activities of daily living (ADLs) such as eating, dressing, bathing, and toileting. They also perform clinical tasks such as range-of-motion exercises and blood pressure readings.

NOTE: Beginning in 2012, the BLS will treat Nursing Aides as a separate occupation from Orderlies and Attendants.

Home Health Aides

Home Health Aides provide essentially the same care and services as nursing aides, but they assist people in their homes or in community settings under the supervision of a nurse or therapist. They may also perform light housekeeping tasks such as preparing food or changing linens.

Personal Care Aides (including Direct Support Professionals)

Personal Care Aides (PCAs) work in either private or group homes and include workers with other titles such as personal attendants, direct support professionals, and home care aides. In addition to providing assistance with ADLs, these aides often help with housekeeping chores, meal preparation, and medication management. They also help individuals go to work and remain engaged in their communities.

A growing number of PCAs are employed and supervised directly by consumers.

Direct Support Professionals (DSPs) work with individuals who have intellectual or developmental disabilities, and may also have titles such as job coach, community living assistant, and direct support specialist. DSPs provide a broad range of supports to individuals with intellectual or developmental disabilities to enable them to live to their fullest potential in the community. These supports include: assisting with self-care, teaching home and community living skills, promoting self-determination, and supporting friendships and relationships in the community.

NOTE: Until 2011, Personal Care Aides were classified as “Personal and Home Care Aides”.

Why Psychiatric Aides Are Not Included in the PHI State Data Center: Nationally, Psychiatric Aides—aides who, working under the direction of nursing and medical staff, assist mentally impaired or emotionally disturbed patients–number only 62,000, making them among the smallest occupations in most states. Because of their modest official counts, the State Date Center currently does not provide state-by-state analysis of these aides. A national profile of Psychiatric Aides is available at the BLS.

For information on direct-service workers in the behavioral health workforce and issues relating to their undercounting, see A Synthesis of Direct Service Workforce Demographics and Challenges (pdf) and resources available at the Annapolis Coalition on the Behavioral Health Workforce.

Additional Resources

The following resources provide additional statistical and descriptive information about the different components of the direct-care workforce:

A Synthesis of Direct Service Workforce Demographics and Challenges (pdf), October 31, 2008	This national white paper developed by the DSW Resource Center presents an overview of direct service workforce challenges and practices across across intellectual and developmental disabilities, aging, physical disabilities, and behavioral health. It includes recommendations for cross-sector action steps that could be taken in partnership to address workforce challenges.
FACTS 3: America’s Direct-Care Workforce (pdf)	Provides a thorough overview of the direct-care workforce and its significance as one of the largest and fastest-growing occupations in the United States.
BLS Occupational Definitions	Provides the definitions of standard occupations used by the U.S. Department of Labor–see materials relating to the 2010 Standard Occupational Classification.
BLS 2010-2011 Occupational Employment Handbook	The Occupational Employment Handbook, issued biannually, provides information on individual job titles, what workers do on the job, training and education needed, and employment prospects.

Links to Organizations

For additional statistical and descriptive information about the different components of the direct-care workforce, visit the following organizations:

ABOUT THE CENTER: The PHI State Data Center provides state-by-state data and resources relating to nursing aides, home health aides, and personal care aides (including direct support professionals). These occupations are known collectively as the direct-care workforce (learn more).
DATA SOURCES: See our page on data sources and definitions.
CONTACT: For more information or to suggest a resource for addition to this page, contact Abby Marquand, PHI policy research associate, at amarquand@phinational.org
CREDITS: The PHI State Data Center was developed with support from The SCAN Foundation and Centers for Medicare and Medicaid Services/National Direct Service Workforce Center.

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About the Workforce

Overview

Additional Resources

Links to Organizations