Size of Workforce: Totaling approximately 36,000 workers, Oklahoma’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 Oklahoma, demand for direct-care worker positions is expected to increase by 22 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 10 percent. Direct-care workers employed in home and community-based settings are a growing segment of Oklahoma’s workforce in both size and significance.
Median Wages: Direct-care workers in Oklahoma earn significantly less than the average wage across all occupations in the state. Furthermore, wages for all direct-care workers 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 nine years, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in Oklahoma increased by 5 percent, from $7.40 to $7.71. Real wages for Home Health Aides stagnated while those for Personal Care Aides increased by 6 percent over the same time period.
Health Insurance: Compared to the national civilian workforce, significantly more of Oklahoma’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 Oklahoma’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: Fifty-three percent of direct-care worker households in Oklahoma 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 1819: This bill created a direct-care worker advisory board. (Adopted May 4, 2010)
Notable Initiatives
CNA Training: The Oklahoma Health Care Authority (OHCA) pays the tuition for CNA training administered by Oklahoma State University, Oklahoma City. In return, students must sign a contract with OHCA stating that they agree to work in a long-term care facility that accepts SoonerCare/Medicaid funds for at least 12 months during the 24 months after class completion. This item is financed with state and federal Medicaid dollars.
