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Size of Workforce: Totaling approximately 8,000 workers, Delaware’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 Delaware, from 2008 to 2018, demand for Personal Care Aides and Nursing Aides, Orderlies, and Attendants is expected to increase by 49 and 25 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 Delaware’s workforce in both size and significance.

Median Wages: Direct-care workers in Delaware 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 Delaware increased by 18 percent, from $9.10 to $10.72. Real wages for Personal Care Aides increased by 9 percent and those for Home Health Aides increased by 3 percent.

Health Insurance: Compared to the national civilian workforce, more of Delaware’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, fewer of Delaware’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-eight percent of direct-care worker households in Delaware 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.

Notable Initiatives

Recruitment and Retention of Direct Support Workers: A Values-Based Approach (PDF): In In 2003, with support from a CMS Direct Service Community Workforce Demonstration Grant, the College of Human Services at the University of Delaware worked with five participating employer agencies to launch several recruitment and retention initiatives, including a career lattice, a mentorship program, and a supervisory training program. In addition, several recruitment and realistic job preview videos were created.

Direct Service Workforce Resource Center – Intensive Technical Assistance: In 2008, the DSW Resource Center provided CMS-funded technical assistance to Delaware to help develop a statewide recruitment and retention initiative for direct support professionals.

Resources

Delaware’s Direct Service Workforce in 2008: This October 2008 presentation by PHI provides an overview of Delaware’s direct service workforce and assesses the frontline workforce challenges that the state faces.

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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