7.4M Direct Care Jobs Will Need to Be Filled by 2029, with Most in Home Care

The U.S. population is rapidly aging — a topic frequently visited by home-based care providers.

But as they do age, direct care workers are going to need to care for them. And that won’t just require 1.3 million more individuals to enter the direct care workforce by the decade’s end; it will also require another 6.2 million additional workers to fill the empty slots made up by those who left, according to a new report from PHI.

About 4.5 million of those will specifically be home care jobs.


“This year’s employment projections are not that different than previous years, but that doesn’t make them any less shocking,” Stephen Campbell, a data analyst at PHI and the lead author of the report, told Home Health Care News in an email. “There will be more new jobs in home care than in any other occupation, but this workforce is among the least visible and most undervalued.”

PHI is a New York-based advocacy organization for direct care workers. The organization launched a direct care workforce initiative itself in 2020, aimed at advocating for better policy at the state level when it comes to the caregiver workforce.

The report is based on data released by the Bureau of Labor Statistics (BLS) in September.


“Poor job quality is causing home care workers and other direct care workers to leave the field in droves at a time when we need them the most,” Campbell said. “It will be necessary for states, payers, employers and other long-term care leaders to leverage every strategy at their disposal to strengthen recruitment and reduce turnover.”

The new jobs that need to be created to care for America’s seniors include 1 million home care jobs, 163,000 residential care jobs and 119,000 direct care jobs in places like hospitals and elsewhere in the post-acute care fields.

Despite the troubles in nursing homes during the COVID-19 pandemic, only about 10,000 jobs will be lost in nursing homes over the next eight years, according to the report. Still, a switch to home- and community-based services is likely to continue to be a trend in the coming years.

Home care employment was 3% lower in December 2020 than it was in February 2020, while residential care employment was 7% lower and nursing home employment was 9% lower over the same time period.

“Before the pandemic began, home- and community-based services were already more popular than nursing homes among consumers and policymakers,” Campbell said. “COVID-19 sped up that trend, as thousands of nursing home residents died and as safety and care quality issues raised concerns among consumers. When the COVID-19 crisis comes to an end, consumers will continue to choose home care over nursing homes at a high rate and the beds left vacant by COVID-19 victims will likely remain unfilled.”

Overall, there are about 7.4 million jobs that will need to be filled by 2029. The additional 6.2 million jobs will largely be a natural phasing out of workers who can no longer physically perform the job or are just retiring.

The concerning departures, however, will be the workers leaving for other jobs with better pay and conditions in other industries.

“If we are ever going to fill 7.4 million direct care jobs, we’ll have to start by increasing wages,” Campbell said. “Home care wages are not competitive with jobs in fast food or retail, and that’s a huge contributor to high turnover. We also need to think about job quality holistically. We need to value and support home care workers through high-quality training, supportive supervision, and new opportunities for advancement.”

President Joe Biden’s administration is trying to help spearhead that effort in its recently unveiled $2 trillion infrastructure proposal. Dubbed the American Jobs Plan, it would set aside $400 billion for home- and community-based services and aim to improve caregiver recruiting and retention.

“The far-reaching transformative interventions that are needed often have associated costs, and a significant federal investment would undeniably help,” Campbell said. “Plus, home care is among the most important forms of national infrastructure … a multi-billion investment in this critical workforce would go a long way toward stabilizing care, both now and in the future.”

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