Data Sources & Definitions

Workforce Size

Occupational employment estimates for Nursing Aides, Orderlies & Attendants, Home Health Aides, and Personal Care Aides are from the U.S. Department of Labor, Bureau of Labor Statistics, Occupational Employment Statistics (OES) Program.

More about the OES Survey: The OES survey is a semi-annual mail survey of employers, selected from the list of non-farm establishments maintained by State Workforce Agencies (SWAs) for unemployment insurance purposes. The OES survey covers all full-time and part-time wage and salary workers in non-farm industries. The survey does not cover the self-employed, household workers, or unpaid family workers, which leads to the exclusion of many individuals who participate in the direct-care workforce.

OES estimates of occupational employment are derived from a sample that pools six semi-annual panels for three consecutive years. Thus, the resulting estimates constitute a conservative moving average calculated from a pooled sample, rather than one employment estimate reported at a specific time of the year.

Independent Providers: Since they are not captured by the OES survey, the State Data Center is committed to obtaining employment estimates for independent providers (IPs) working in publicly-funded in-home care programs that allow consumers to directly employ their own providers. As of September 2011, had obtained these estimates for publicly-employed IPs in 18 states totaling over 626,000 workers. Additional state estimates of publicly employed independent providers will be added as we identify them. The sources for these estimates are varied and are provided directly at the Workforce Size tab in the chart titled “Size of Direct-Care Workforce.”

The Undercounting Problem: While official statistics on their own establish the direct-care workforce as one of the largest, fastest growing workforces in America, at the same time this workforce struggles with serious undercounting problems. The end result is that official figures, whether at the state or federal level, can severely underestimate the numbers of workers providing services and supports, particularly in in-home settings.

The undercounting has three main sources: a) officially defined settings and occupations poorly correspond to actual work; b) work performed under private, non-agency arrangements may often go unreported; and c) state government, the largest employer of direct-care workers, typically does not monitor or track the workforce it employs through the eldercare and disability services programs that it supports. Additional information on the undercounting problem is available in a report from the National Direct Service Workforce Resource Center (pdf) on the need for better monitoring of the direct service workforce.

The third source of undercounting is being addressed by the State Data Center. As part of our FY 2012 research activities, we are investigating the number publicly-employed independent providers across all states. Estimates of publicly-employed IP providers in 18 states were posted as of September 2011. These otherwise uncounted workers total over 626,000 for these 18 states.

Employment Projections

Occupational employment projections are based on PHI analysis of 2008-2018 occupational employment projections available from each state labor department. U.S. projections were obtained from the U.S. Department of Labor/Bureau of Labor Statistics, Employment Projections Program, 2008-2018 National Employment Matrix.

• State-by-State Projected Demand for Direct-Care Workers 2006-2016 (pdf)
• State-by-State Projected Demand for Direct-Care Workers 2008-2018 (pdf)

Wages

Occupational wage estimates for Nursing Aides, Orderlies & Attendants, Home Health Aides, and Personal Care Aides are from the U.S. Department of Labor, Bureau of Labor Statistics, Occupational Employment Statistics (OES) Program.

More about the OES wage estimates: The OES hourly wage estimates are derived from a sample that pools six semi-annual panels for three consecutive years. Thus, the resulting estimates constitute a conservative moving average calculated from a pooled sample, rather than one wage reported at a specific time of the year. However, in spite of estimating wages from more than one year’s data to reduce sampling error, some state data show significant variation which may be attributable to high mean square errors. Therefore, caution should be used in interpreting these estimates, since they may be at variance with actual wages for these occupations.

Inflation adjustements: Adjustments for inflation were made using the regional Consumer Price Index for urban wage earners and clerical workers (1982-84=100), also from the Bureau of Labor Statistics (BLS).

Health Coverage & Public Assistance

Statistics on health insurance coverage and public assistance are from PHI analysis of U.S. Census Bureau, Current Population Survey, pooled data from the 2008, 2009, and 2010 Annual Social & Economic (ASEC) Supplements, with statistical programming and data analysis provided by Carlos Figueiredo.

State-specific estimates for health insurance coverage and public assistance reliance are presented for 7 of the most populous states in the country: California, Florida, Illinois, Michgian, New York, Pennsylvania, and Texas. All other estimates are provided at the Census division level.

Census Bureau Divisions

The Census Bureau collects and analyzes data from nine geographic regions, which it calls “divisions”. We have used this division data to analyze the status of direct-care worker health coverage and public assistance across the country. The Census Bureau’s nine geographic divisions are defined as follows:

• New England: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont
• Middle Atlantic: New Jersey, New York, Pennsylvania
• East North Central: Illinois, Indiana, Michigan, Ohio, Wisconsin
• West North Central: Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota
• South Atlantic: Delaware, District of Columbia, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia
• East South Central: Alabama, Kentucky, Mississippi, Tennessee
• West South Central: Arkansas, Louisiana, Oklahoma, Texas
• Mountain: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming
• Pacific: Alaska, California, Hawaii, Oregon, Washington