PHI PolicyWorks | Rhode Island

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Size of Workforce: Totaling over 14,000 workers, Rhode Island’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 Rhode Island, 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 8 percent. Direct-care workers employed in home and community-based settings are a growing segment of Rhode Island’s workforce in both size and significance.

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

Wages Adjusted for Inflation: Over the past nine years, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in Rhode Island increased by 11 percent, from $10.00 to $11.05. Real wages for Home Health Aides and Personal Care Aides decreased .

Health Insurance: Compared to the national civilian workforce, fewer of Rhode Island’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. 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, slightly fewer of Rhode Island’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 percent of direct-care worker households in Rhode Island 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

H 7169: This Nursing Home Culture Change legislation preserves a cap on the number of nursing home beds, but also provides that, as they become available due to the closure or reduction of facilities, the majority of those beds will be transferred to home-like facilities that reflect culture change values. (Adopted June 2010)

Notable Initiatives

Rewarding Work – Rhode Island: Operated by Rewarding Work Resources, Inc. and overseen by the Rhode Island Department of Human Services (DHS), this matching service registry connects consumers and independent providers through an internet-based search service. The service is free for consumers in the following programs administered by DHS: PersonalChoice, Respite, or PASS.

Resources

Rhode Island Culture Change Legislation (video): This 8-part Capitol TV video describes the events leading to the passage of H 7169, legislation passed in 2010 in Rhode Island that provides for the transfer of nursing home beds to more home-like long-term care facilities.

The Impact of a Regulatory Intervention on Resident-Centered Nursing Home Care: Rhode Island’s Individualized Care Pilot (pdf): This 2010 study by the Commonwealth Fund examines the impact of a regulatory initiative developed by the Rhode Island Department of Health to promote resident-centered care in the state’s nursing homes.

Quality Partners of Rhode Island: Quality Partners is a nationally recognized leader in healthcare quality improvement. It contracts with both government and private healthcare clients to provide healthcare professionals with strategies, tools, and resources to improve the quality of services delivered to patients. Quality Partners has become a leader in areas such as quality improvement, coalition building, culture change, and health information technology.

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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