They help with dressing, bathing and eating, assisting older people and people with disabilities in their homes and in nursing homes—yet many live in poverty and without health insurance.
Who is this population? What are their economic realities? And will the supply of these workers meet growing demand as millions of Americans grow older in the decades that follow?
New research from PHI, the nation’s authority on the direct-care workforce, sheds light on this critical segment of the U.S. workforce. Released in conjunction with Labor Day, which commemorates the contributions of the American worker, this new data illuminates the realities of direct-care workers.
According to PHI, home care workers and nursing assistants in nursing homes fit a profile: the typical worker in these sectors is a woman, a person of color, and in her late 30s to mid-40s. Roughly a quarter of these workers are born outside of the United States and half lack formal education beyond high school.
While the number of nursing assistants has remained intact over the past 10 years, at a little over 600,000, the home care workforce has more than doubled to 2.2 million people in that time period, reflective of the demand spurred by the “greying of America” and the current older generation’s desire to age at home.
With growth comes profits. Home health care reaps $71 billion a year, while nursing homes generate $116 billion in annual revenue, most of which is covered by programs such as Medicare and Medicaid.
Unfortunately, these industries’ profits don’t trickle down. Twenty-four percent of home care workers and 17 percent of nursing assistants live in poverty. To survive, more than half of home care workers and nearly 40 percent of nursing assistants rely on some form of public assistance.
Wages are a major contributing factor to poverty: home care workers earned $10.11 an hour in 2015 and about $13,400 a year, as a result of working part-time hours and in some cases only part of the year. Similarly, nursing assistants earned $11.46 an hour and brought home an annual income of $19,000 in 2015.
Are these wages enough? Probably not. A housing report from May of this year found that a worker would need to earn $20.30 an hour to afford a decent two-bedroom apartment and not devote more than 30 percent of their income on housing costs.
In addition to low wages, about one in four home care workers and one in five nursing assistants are uninsured, though the Affordable Care Act (ACA) improved health coverage for many of these workers. (Among nursing assistants, health insurance rates increased by 11 percent between 2010 and 2014, largely as a result of expanded coverage made possible by the ACA. Similarly, health insurance rates went up 14 percent for home care workers.)
These job characteristics have repercussions for all of us: poor job quality turns away workers when we need it most. From 2014 to 2024, home care will add 633,000 new jobs, more than any other occupation. Unfortunately, labor force participation among women ages 25 to 64, who make up 73 percent of the home care workforce, will increase by only 2 million—a much smaller pool than the previous decade. Most alarming is that industry reports continually show high turnover rates among direct-care workers, often within a year, leaving for jobs with higher pay and better benefits.
We’re getting older as a country; people age 65 and older are expected to double from 48 million to 88 million between now and 2050. But who will care for us as we age? Where are all the workers going? These are the questions this new research raises. We need answers now.