Size of Workforce: Totaling approximately 35,000 workers, Alabama’s direct-care workforce provides daily services and supports to elders and individuals with disabilities who need assistance with personal care and other daily activities. Direct-care workers fall into three main categories tracked by the U.S. Bureau of Labor Statistics: nursing aides, home health aides, and personal care aides. Personal care aides include workers with many other titles—for example, personal attendants, direct support professionals, and home care aides. The estimates shown below for each occupation may heavily undercount independent providers hired directly by households.
Occupational Growth: Direct-care workers constitute one of the nation’s largest occupational groupings. Moreover, across the country, direct-care jobs are among the fastest growing occupations and those expected to produce the largest numbers of new jobs over the coming decade. In Alabama, demand for direct-care worker positions is expected to increase by 23 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 11 percent. Direct-care workers employed in home and community-based settings are a growing segment of Alabama’s workforce in both size and significance.
Median Wages: Direct-care workers in Alabama earn significantly less than the average wage across all occupations in the state. Furthermore, wages for Personal Care Aides and Home Health Aides fall below 200 percent of the 2009 federal poverty line for a single individual working full time ($10.42). The 200 percent poverty level is low enough to qualify households for many state and federal assistance programs.
Wages Adjusted for Inflation: Over the past decade, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in Alabama increased by 7 percent, from $7.22 to $7.69. Real wages for Personal Care Aides remained relatively stagnant while those for Home Health Aides declined.
Health Insurance: Compared to the national civilian workforce, more of Alabama’s direct-care workers are uninsured. Because of low wages, direct-care workers often have difficulty affording private health insurance coverage; however, many earn too much to qualify for Medicaid.
Employer-Sponsored Insurance: Compared to the national civilian workforce, significantly fewer of Alabama’s direct-care workers have access to and use employer-sponsored insurance. Some work for employers that do not offer health insurance. Others work for employers that limit eligibility for health insurance to full-time employees. This creates a barrier for many direct-care workers, especially those in home and community-based settings, who often work only part-time due to the episodic nature of direct-care work. Even workers who do have access to insurance from their employer may find the co-pays and premiums unaffordable.
Public Assistance: Forty-one percent of direct-care worker households in Alabama rely on some form of means-tested public assistance, particularly Medicaid or food and nutrition assistance. This reliance reflects the generally poor quality of direct-care jobs in terms of wages and benefits, and the part-time nature of many direct-care jobs.
Best Practices
The Cottages at St. Martin’s in the Pines, a Green House Facility: St. Martin’s in the Pines transformed part of its 60-year old nursing facility complex into small households and reorganized how care is delivered. The Cottages, Alabama’s first Green House, opened in November 2008 with 60 residents, 10 residents per house. These changes have resulted in higher satisfaction rates among staff, elders and their families, as well as lower CNA turnover.
