ANALYSIS: Direct-Care Workforce Projected to Be Nation’s Largest

By 2020, the direct-care workforce — nursing assistants, home health aides, and personal care aides — is projected to be the nation’s largest workforce at 5 million workers, according to a new PHI analysis available in PHI FACTS 3: America’s Direct-Care Workforce (pdf).

Home care jobs — both home health aide and personal care aide positions — are the nation’s fastest-growing jobs, projected to increase over the decade 2010-2020 at an astounding 69 and 71 percent, respectively. Nursing aide, orderly, and attendant positions are expected to increase by 20 percent. Together these jobs will add an additional 1.6 million jobs to the economy.

Comprising nearly a third (30.6 percent) of the entire U.S. health care workforce, direct-care workers far outnumber other health care practitioners, including physicians, nurses, and therapists. These workers also outnumber all those employed in allied health occupations, such as medical and dental assistants, and physical therapy assistants and aides, by nearly three to one.

Shift Toward Home and Community-Based Settings

The analysis found that there were at least 4 million direct-care workers in 2011, with the majority employed in home and community-based settings. The workers employed in these settings are expected to outnumber facility workers by more than two to one by 2020.

PHI researchers estimate that there are at least 800,000 independent providers who provide personal care services for consumers who are enrolled in public programs. These workers, who are employed directly by consumers and their families in home and community-based settings, are not tracked by the U.S. Bureau of Labor Statistics and have been heavily undercounted in government surveys, the researchers explain.

Wages and Benefits Worsen

The PHI analysis also found that the wages and benefits of direct-care workers continue to worsen.

The median wage of $10.59 in 2011 for all direct-care workers is far below $16.57, the median wage for all U.S. workers that year. Moreover, adjusted for inflation, wages for all direct-care workers have declined over the last decade.

In addition, more than one third of aides employed by home care agencies and one quarter of nursing home aides lacked health care coverage.

Poverty Increases

With wages and benefits declining, an increasing number of direct-care workers live in poor households. Since 2008, direct-care workers living in households with incomes below 200 percent of the federal poverty line have increased from 44 percent to 47 percent.

At this income level, many of these workers are eligible for — and rely on — public benefits such as Medicaid and food stamps to support their families.

To learn more about the direct-care workforce, download PHI FACTS 3: America’s Direct-Care Workforce (pdf).

— by Deane Beebe