PHI Releases New Analysis on the Direct-Care Workforce

A new PHI analysis (pdf) of the direct-care workforce shows that the wages and benefits for these frontline health care workers continue to be woefully inadequate.

“The problematic quality of direct-care jobs continues to undermine America’s capacity to produce a caregiving workforce that can deliver the basic hands-on services and supports demanded by millions of elders and persons with disabilities needing assistance with basic daily activities and tasks,” said PHI Director of Policy Research Dorie Seavey, Ph.D.

In 2008, there were more than 3.2 million direct-care workers. By 2018, this workforce is projected to increase to over 4.3 million, making direct-care workers the nation’s second largest occupational grouping.

Demographic and Economic Profile

Facts 3: Who Are Direct-Care Workers? (pdf) presents the most up-to-date demographic and economic profile of the nation’s direct-care workforce. Among the findings highlighted in this year’s Direct-Care Worker at a Glance snapshot are:

• The majority of the workforce is female (89 percent), over half (53 percent) is non-White, and nearly a quarter (23 percent) is foreign born. The average age of direct-care workers is 42 years old.
• Almost half (45 percent) of direct-care workers live in households earning below 200 percent of the federal poverty income level.
• Nearly half (46 percent) of direct-care workers depend on public assistance, such as food stamps; Medicaid; or housing, child care, or energy assistance — up from 41 percent the year before.
• In 2009, an estimated 900,000 direct-care workers did not have any health coverage.
• The median hourly wages for home health aides have declined over the past nine years to under $8, while personal care aides’ hourly wages have remained stagnant at $7.50 (both adjusted for inflation).

Shift Toward Home- and Community-Based Settings

Facts 3: Who Are Direct-Care Workers? (pdf) also presents the most recent employment estimates and projections for the direct-care workforce, clearly identifying rapid growth among home- and community-based occupations:

• Home health aides and personal care aides are projected to be the third and fourth fastest-growing occupations in the nation — with projected increases of 50 and 46 percent, respectively, between 2008 and 2018.
• A growing number of direct-care workers are independent providers — employed directly by consumers and their families instead of an agency through a model known as “consumer-directed care.”
• By 2018, home- and community-based direct-care workers will outnumber facility workers by nearly two to one.

Workforce Reaches Historic Proportions

“The historic proportions of this workforce are truly astounding,” Seavey said. “With demand for over a million new positions expected in the next few years, policymakers and providers have an unprecedented opportunity to improve the quality of these jobs. The fabric of our country’s caregiving infrastructure depends on it.”

The new PHI analysis is based on the most recent data from the March Supplement of the Current Population Survey, a nationally representative sample.

Facts 3: Who Are Direct-Care Workers? (pdf) was made possible with support from The SCAN Foundation.

For more information on the direct-care workforce, see PHI’s Workforce Facts, and visit the PHI Chart Gallery for downloadable charts.

– by Deane Beebe