Size of Workforce: Totaling approximately 38,000 workers, Colorado’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 Colorado, from 2009 to 2019, demand for Personal Care Aide and Nursing Aide positions is expected to increase by 44 and 22 percent, respectively. In contrast, jobs overall are expected to increase by only 8 percent. Direct-care workers employed in home and community-based settings are a growing segment of Colorado’s workforce in both size and significance.
Median Wages: Direct-care workers in Colorado earn significantly less than the average wage across all occupations in the state. Furthermore, wages for Personal Care 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 Colorado increased by 17 percent, from $8.84 to $10.32. Real wages for Personal Care Aides increased by 8 percent while those for Home Health Aides increased by less than 2 percent.
Health Insurance: Compared to the national civilian workforce, more of Colorado’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 Colorado’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: Thirty-five percent of direct-care worker households in Colorado 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.
Resources
Colorado Certified Nurse Aide Workforce Survey Findings (pdf): This 2009 report by the Colorado Health Institute presents the results of a survey of certified nurse aides conducted in 2006. The survey gathered information about: education and training, employment status, demographic characteristics, and the future plans of CNAs.
Sector Initiatives for Colorado’s Long-Term Healthcare Industry (pdf): The purpose of this 2007 report by the National Economic Development and Law Center is to assist organizations to develop sector initiatives for the long-term healthcare industry in Colorado. It reviews the challenges faced by Colorado’s direct-care workforce.
