Size of Workforce: Totaling approximately 35,000 workers, South Carolina’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 South Carolina, from 2008 to 2018, demand for Personal Care Aides and Nursing Aides, Orderlies, and Attendants is expected to increase by 34 percent and 16 percent, respectively. 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 South Carolina’s workforce in both size and significance.
Median Wages: Direct-care workers in South Carolina 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 decade, inflation-adjusted median hourly wages for Nursing Aides, Orderlies, and Attendants in South Carolina increased by 7 percent, from $7.42 to $7.93. Real wages for Home Health Aides stagnated while those for Personal Care Aides decreased by 8 percent.
Health Insurance: Compared to the national civilian workforce, more of South Carolina’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, fewer of South Carolina’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: Thirty-eight percent of direct-care worker households in South Carolina 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.
Notable Initiatives
Direct Service Workforce Resource Center – Intensive Technical Assistance: In 2006, the DSW Resource Center provided CMS-funded technical assistance to South Carolina to develop a statewide educational program for managers and supervisors to provide best practices and strategies for improving recruitment and retention of DSWs in home and community-based services. The program also provided tools for measuring the effectiveness of the recruitment and retention interventions.
South Carolina Personal Care Worker Listing: This state-wide matching service registry provides consumers with contact information for available independent providers by county. It is operated by the South Carolina Department of Health and Human Services and the Lieutenant Governor’s Office on Aging, and is free for all consumers.
