Direct Care Workers Grapple With Low Pay, Poor Job Quality, Research Shows

Workforce innovations firm releases new annual data on U.S. direct care workers.

Direct care workers, who are "essential to the lives of millions of older adults and people with disabilities," struggled in poverty-level jobs across all long-term care settings, according to a new report from PHI, a national research, advocacy, and workforce innovations organization.

Direct Care Workers in the United States: Key Facts provides an annual look at the direct care workforce, including its occupational roles, demographics, job quality challenges, and projected job openings. It includes detailed overviews of three segments of this workforce: home care workers, residential care aides, and nursing assistants in nursing homes.

PHI annually releases new data on the direct care workforce, which in 2020 included 4.6 million workers, including 2.4 million home care workers, 675,000 residential care aides, 527,000 nursing assistants in nursing homes, and about 1 million direct care workers employed in other settings.

"Our new report emphasizes how longstanding poor job quality in direct care has prevented our country from effectively responding to the COVID-19 crisis and keeping workers and the people they support healthy and safe," Jodi M. Sturgeon, PHI president, said in a press release. "This data should serve as a call to action to further invest in this essential workforce."

Growing workforce sector

The direct care workforce expanded rapidly over the last decade, growing from 3.1 million workers in 2010 to 4.6 million in 2020, according to PHI. In the next decade, the direct care workforce will add an estimated 1.3 million new jobs to meet rising demand, the report states.

Despite that growth, however, long-term care employers will face difficulty in recruiting and retaining workers, given high turnover in this job sector. When including jobs that must be filled when existing workers transfer to other occupations or exit the labor force, long-term care employers will need to fill 7.4 million job openings in direct care from 2019 to 2029, the report says.

"It's difficult to imagine how the long-term care sector will meet demand for direct care workers without dramatically improving their jobs," said Kezia Scales, director of policy research at PHI. 

The direct care workforce continues to be largely comprised of women, people of color, and immigrants, according to the report. For example, immigrants constitute 31 percent of the home care workforce, compared to 17 percent of the total U.S. labor force.

Workers in these direct care jobs also persistently struggle with poverty; the median wage for direct care workers was $13.56 in 2020, median earnings were $20,200, and 44 percent of these workers relied on some form of public assistance, such as Medicaid, nutrition support, or cash assistance.

Among residential care aides, for example, 32 percent do not have affordable housing and 17 percent lack health insurance.

Direct care workers also face heavy workloads and high injury rates, which have made their jobs even more dangerous during the COVID-19 pandemic, the report says. On average, nursing assistants support 13 residents during a typical shift and are more than three times likelier to experience workplace injuries than the typical U.S. worker.

Looking ahead

While the total number of direct care jobs will increase in the years ahead, this job growth will be concentrated in home and residential care—while the number of nursing assistant jobs in nursing homes will shrink, according to PHI.

Public and private sector leaders must improve these jobs to ensure these jobs get filled, the report notes.

"Direct care workers are essential to the lives of millions of older adults and people with disabilities," said Stephen McCall, data and policy analyst at PHI, "and they deserve high-quality jobs that reflect their enormous value."