PHI PolicyWorks | Massachusetts

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Size of Workforce: Totaling approximately 104,000 workers, Massachusetts’ 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 Massachusetts, demand for direct-care worker positions is expected to increase by 21 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 3 percent. Direct-care workers employed in home and community-based settings are a growing segment of Massachusetts’ workforce in both size and significance.

Median Wages: Direct-care workers in Massachusetts earn significantly less than the average wage across all occupations in the state.

Wages Adjusted for Inflation: Over the past decade, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in Massachusetts increased by 7 percent, from $9.93 to $10.63. Real wages for Personal Care Aides and Home Health Aides both declined over this time period.

Health Insurance: Compared to the national civilian workforce, fewer of Massachusetts’ 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. But in New England, several state-based initiatives have been successful in helping low-wage workers gain access to health insurance coverage, thereby reducing the rates of uninsurance.

Employer-Sponsored Insurance: Compared to the national civilian workforce, fewer of Massachusetts’ 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 percent of direct-care worker households in Massachusetts 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

SB 45: Introduced by Sen. Pat Jehlen, this legislation calls for the creation of a task force to assess the Commonwealth’s readiness for the CLASS program and workforce implications thereof. (Introduced January 21, 2011)

Notable Initiatives

PHCAST Grant (pdf): Massachusetts was one of 6 states awarded a 3-year grant by the federal government to develop a training and credentialing program for personal care attendants (PCAs), as part of the Personal and Home Care Aide State Training Program, a provision of the Affordable Care Act of 2010.

Earn, Keep, Save MORE! Campaign: This program aims to educate direct-care workers in Massachusetts about the availability of federal and state tax credits that could be worth thousands of dollars, and to encourage these workers to take advantage of free tax preparation services through VITA sites.

Massachusetts PCA Directory: Operated by Rewarding Work Resources, Inc. and overseen by the PCA Workforce Council, this matching service registry connects consumers and independent providers through an internet-based search service.

Best Practices

Leonard Florence Center for Living: The Leonard Florence Center for Living represents the first urban-based network of skilled nursing facility centers sponsored under The Green House Project, a leading initiative in the “culture change” movement to provide feasible alternatives to traditional nursing homes.

Resources

Coverage for Caregivers (pdf): This study examines the impact of Massachusetts’ health care reform on one of the state’s largest and fastest-growing industry groups: the eldercare/disability services sector and its primary workforce of direct-care workers.

PHI State Facts: Massachusetts’ Direct-Care Workforce (pdf): This fact sheet, issued by PHI in September 2009, gives an overview of the direct-care workforce in Massachusetts.

Long-Term Supports in Massachusetts: A Profile of Service Users (pdf): This report, issued in April 2009, presents information on the users of long-term services and supports in Massachusetts including future demand projections.

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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