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Size of Workforce: Totaling over 20,000 workers, Vermont’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 Vermont, from 2008 to 2018, demand for Personal Care Aides and Nursing Aides, Orderlies, and Attendants is expected to increase by 47 percent and 19 percent, respectively. 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 Vermont’s workforce in both size and significance.

Median Wages: Direct-care workers in Vermont earn significantly less than the average wage across all occupations in the state. Furthermore, wages for Personal Care 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 Vermont increased by 14 percent, from $8.21 to $9.40. Real wages for Personal Care Aides and Home Health Aides increased during this time as well.

Health Insurance: Compared to the national civilian workforce, fewer of Vermont’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, fewer of Vermont’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 Vermont 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

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

Direct Service Workforce Resource Center – Intensive Technical Assistance: In 2008, the DSW Resource Center provided CMS-funded technical assistance to Vermont to strengthen the organizational capacity and sustainability of the Vermont Association of Professional Care Providers and to market the direct-care worker registry to direct service workers, employers, and consumers.

Caregiver Champion Award: As part of Vermont’s Healthy Aging Awards, sponsored by the Governor’s Council on Healthy Aging, the Caregiver Champion award is given annually to outstanding caregivers who exemplify the profession.

Rewarding Work – Vermont: Operated by Rewarding Work Resources, Inc. and overseen by the Vermont Department of Disabilities, Aging and Independent Living, this matching service registry helps connect consumers and independent providers through an internet-based search service. It is free for all consumers and workers.

Resources

Legislative Study of the Direct-Care Workforce (pdf): This 2008 legislative study conducted by the Department of Disabilities, Aging & Independent Living, the Community of Vermont Elders, and PHI shows that improved wages, benefits, and training are critical to retaining workers.

Northern New England LEADS Institute: An Evaluation (pdf): This report evaluates the outcomes of the LEADS Institute, an initiative that sought to improve the quality of direct-care jobs at 7 nursing homes and 5 home care organizations in Maine, Vermont and New Hampshire between 2006 and 2008.

PHI State Facts: Vermont’s Direct-Care Workforce (pdf): This fact sheet, issued by PHI in March 2009, provides an overview of Vermont’s direct-care workforce.

Reimbursement Practices and Issues in Vermont’s Long-Term Care Programs (pdf): This 2006 report, prepared by PHI for the Long-Term Care Committee of the Community of Vermont Elders, surveys public reimbursement methods used in each of Vermont’s long-term care settings and programs.

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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