Size of Workforce: Totaling over 40,000 workers, Oregon’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 Oregon, demand for direct-care worker positions is expected to increase by 24 percent from 2008 to 2018. In contrast, jobs overall are expected to increase by only 9 percent. Direct-care workers employed in home and community-based settings are a growing segment of Oregon’s workforce in both size and significance.

Median Wages: Direct-care workers in Oregon earn significantly less than the average wage across all occupations in the state. Furthermore, wages for Home Health 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 Oregon increased by 16 percent, from $8.75 to $10.18. Real wages for Personal Care Aides increased by 10 percent while those for Home Health Aides remained virtually unchanged.

Health Insurance: Compared to the national civilian workforce, more of Oregon’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 Oregon’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 Oregon 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

HB 3618: This bill modifies the definition of home care workers to include some independent providers for the purposes of providing workers compensation to certain individuals paid by the Department of Human Services, area agencies on aging, or other public agencies. It also requires the Home Care Commission to maintain a registry of home care workers. (Adopted March 29, 2010)

Notable Initiatives

Better Jobs Better Care (BJBC): Beginning in 2002, the Robert Wood Johnson Foundation and Atlantic Philanthropies funded a 4-year demonstration and research project that aimed to improve the direct-care workforce in 5 states: Iowa, North Carolina, Pennsylvania, Oregon, and Vermont. A variety of studies and publications are available.

Oregon Home Care Commission: The Commission promotes quality home care services through four major responsibilities: defining the qualifications of homecare workers, creating a statewide registry of homecare workers, providing training opportunities for homecare workers and consumers, and serving as the “employer of record” for purposes of collective bargaining for homecare workers whose pay comes from public funds.

Oregon Home Care Commission Online Registry and Referral System: Operated by the Oregon Home Care Commission, this matching service registry is a labor market intermediary that connects consumers and independent providers, free of charge, through an internet-based search service.

Oregon STEPS: STEPS is an Oregon Home Care Commission program that promotes successful working relationships between consumer-employers and homecare workers. Since 2007, more than 2300 consumer-employers have participated in STEPS to learn about their rights and responsibilities as employers, and to receive help with making the most of in-home services.