Home Care Workforce Still Facing Widespread Economic Instability

The home care workforce more than doubled in size over the past 10 years, jumping from just over 1 million workers in 2010 to more than 2.4 million in 2020.

Similar growth will be needed during the coming decade, with the population of U.S. adults 65 and older projected to skyrocket from 49.2 million individuals to 94.7 million.

In order for the home care workforce to meet this demand, serious investments will need to be made in direct care jobs across the board, a new report from New York-based advocacy group PHI claims.


“This workforce is still facing the long list of challenges that we’ve studied in the past,” Stephen McCall, a PHI data and policy analyst, told Home Health Care News. “This workforce is in extremely high demand, driven primarily by the growing population of older adults. We’ve seen this workforce add millions of jobs over the past decade, and we can expect a million more in the next decade — more new jobs than any other occupation.”

PHI’s annual snapshot of the direct care workforce came out on Tuesday. Similar to past years, the report provides demographic and economic information on direct care workers and the people they serve.

Broadly, “direct care worker” refers to caregivers who assist older adults and people with disabilities with essential daily tasks and activities across a variety of settings. In addition to home care, for example, there are residential care aides who work in assisted living facilities and similar communities, plus the nursing assistants who work in nursing homes.


With more than 2.4 million caregivers, the home care subsector is the largest chunk of the direct care workforce. PHI also estimates that at least 1.2 million independent caregivers are employed through Medicaid-funded consumer-directed programs, which effectively makes this workforce even larger than it appears.

“‘Direct care workers,’ as we use the term, refer to personal care aides, home health aides and nursing assistants who provide daily assistance to older adults and people with disabilities, with activities of daily living like eating, bathing and getting dressed,” McCall said. “Within the workforce, there’s some variation of responsibilities across job titles. Personal care aides are more likely to provide sort of socially oriented services, helping people stay connected to their communities. Home health aides and personal assistants can provide health monitoring and maintenance services under supervision, either remote or on site.”

As has long been the case, the home care workforce is primarily made up of women, people of color and immigrants. The median age of the home care direct care worker is 47, with nearly one in four having at least one child under the age of 18 at home.

About two in five home care workers work part time, often due to non-economic reasons, such as family obligations or health issues. Roughly 14% work more than 40 hours per week.

“This is gendered work. It’s typically sort of on the shoulders of women to provide care, either on a compensated or uncompensated basis,” McCall said. “I think that also is inextricably linked to their job quality because, in general, we as a society undervalue women’s labor, particularly [as it relates to] domestic labor.”

While the population of adults 65 and older is projected to double by 2060, the number of people 85 and older in the U.S. is expected to nearly triple.

The group of older adults isn’t just growing either; it’s also becoming more diverse, with more individuals coming from immigrant backgrounds, according to PHI. The number of older adults living with Alzheimer’s disease or another form of dementia is likewise on the rise.

“While an economist might expect that, with that rising demand comes rising wages, we’re really not seeing that for this workforce,” McCall said. “These workers still face immense economic instability.”

The 2020 median hourly wage for all direct care workers was $13.56, with median annual earnings of $20,200.

For home care workers specifically, inflation-adjusted median hourly wages were $12.98 in 2020, a slight increase from $11.23 in 2010. The median annual earnings for home care workers is about $18,100, according to PHI.

“In the past decade, we’ve seen wages adjusted for inflation kick up a little bit,” McCall said. “But those wage increases really haven’t translated into widespread economic stability for these workers. This is particularly troubling given everything that they’ve faced during the COVID-19 pandemic, where they were literally laying their lives on the line … and are still providing critical services to older adults and people with disabilities.”

Compensation has been a pervasive challenge, but conditions appear to be improving as home-based care receives more attention from the Biden administration and Congress.

Introduced in June, for instance, the Better Care Better Jobs Act seeks to invest hundreds of billions of dollars into the U.S. caregiving economy, partly by strengthening state Medicaid programs around home- and community-based services (HCBS).

“I remain optimistic that we’re on the precipice of the real transformative change that we know is so needed,” McCall added. “While the data are similar to previous years, the context is entirely new. First off, the longstanding job-quality challenges we’ve studied in the past have been receiving unprecedented attention among policymakers. … Then, the COVID-19 pandemic has brought even more attention to the critical nature of this work..”

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