Size of Workforce: Totaling approximately 10,000 workers, Hawaii’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 Hawaii, demand for direct-care worker positions is expected to increase by 40 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 7 percent. Direct-care workers employed in home and community-based settings are a growing segment of Hawaii’s workforce in both size and significance.
Median Wages: Direct-care workers in Hawaii earn significantly less than the average wage across all occupations in the state. Furthermore, wages for both Personal Care Aides and Home Health Aides fall at or below 200 percent of the 2009 federal poverty line for a single individual working full time and living in Hawaii ($11.98). 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 Hawaii increased by 8 percent, from $10.60 to $11.46. Real wages for Home Health Aides increased by 10 percent while those for Personal Care Aides decreased by nearly 30 percent.
Health Insurance: Compared to the national civilian workforce, more of Hawaii’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 Hawaii’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-eight percent of direct-care worker households in Hawaii 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.
Legislation/Regulation
HR 184 10: This bill calls for an evaluation of programs for adults with special needs, including reviews of the qualifications and wages of direct care workers. (Adopted April 9, 2010)
Notable Initiatives
Paradise Home Care Co-op: Paradise Home Care Co-op (PHCC), in Volcano, Hawaii, is a worker-owned home care cooperative that provides co-op owners with increased wages—$2 more per hour than the average wage of businesses where they previously worked—and health insurance coverage for those working more than 20 hours a week.
