The fastest-growing U.S. jobs are no longer concentrated in corporate offices or on factory floors. They are increasingly found “in homes and nursing facilities, caring for an aging population,” even as “worker shortages and policy threaten the pipeline.”
Grouped under the formal categories of “social assistance” and “healthcare,” at-home care services, hospitals and long-term care facilities “added 124,000 positions.” Much of that expansion came from “the tens of thousands of aides and assistants who help elderly and disabled people bathe, dress, eat and manage their daily lives.”
Their work is described as “essential — and booming — but it is also physically demanding and often modestly paid.”
A Broader Shift in the Labor Market
The rise in care jobs “underscores a broader shift underway in the American labor market.” Although “recent headlines suggest that employment in the U.S. is resilient,” much of today’s job growth “is not in the corporate offices or on the factory floors that have traditionally powered economic expansion.” Instead, it “is concentrated in labor-intensive care and service-based roles.”
As the country ages, “demand for long-term care is projected to keep rising.” At the same time, “immigration restrictions, falling birth rates and sweeping Medicaid funding cuts are narrowing the pipeline of workers willing, or able, to fill these roles.”
High Demand, Modest Pay
Health care includes “some of the highest-paid professions in the country.” Surgeons, for example, “can earn more than $450,000 annually, data from the federal Bureau of Labor Statistics shows.” But it is emphasized that “physicians are not the people driving the surge in health care work that amounted to more than 700,000 new jobs last year.”
Instead, “nearly 4 million people, most of them women, work as home health or personal care aides,” according to the Bureau of Labor Statistics. “Another roughly 1.5 million work as nursing assistants.”
For many of these roles, “pay remains modest.” Home health and personal care aides “earn a median of about $16.82 an hour, or roughly $35,000 a year.” By comparison, “the federal poverty level for a family of four is $32,150.”
Nursing assistants “earn a median of about $19.84 an hour, or roughly $41,000 annually.” Both figures “sit well below the national annual median wage of $49,500.”
“When we talk about the direct care workforce, we’re talking about people who are providing typically long-term care services to older adults and younger people with disabilities,” Priya Chidambaram, senior policy manager at KFF, a nonpartisan health policy research organization, said in an interview.
A Workforce Shaped by Women, Immigrants and Older Workers
The direct care workforce is described as “overwhelmingly female, about 87%,” and “more than a quarter are immigrants.” Approximately “11% are noncitizen immigrants and 17% are naturalized citizens,” according to KFF’s analysis of federal data. “About 40% of workers are at least 50 years old.”
Care delivered at home “is even more dependent upon immigrants, with around 1 in 3 home health workers foreign-born.”
Many workers enter the field after first caring for a family member. “We see some people entering the workforce just from their own personal experience,” Chidambaram said. Others “want to work in health care, but encounter financial or educational hurdles that make a shorter certification program for a direct care role more attainable than a nursing degree.”
Training Pathways and Demands of the Job
Training requirements “vary by state.” Nursing assistants “typically complete certified nurse aide training,” while home health and personal care aides “often take short certification courses.” Roughly “half of direct care workers have a high school education or less.”
Despite the relatively low educational barriers, “the work itself is anything but easy.”
“It’s emotionally and mentally and physically demanding work,” Chidambaram said. “The financial benefits associated with the work don’t meet up with the demands of the work itself.”
As job growth continues to concentrate in long-term care and service-based roles, the expanding workforce of aides and assistants remains central to supporting an aging population, even as pay levels and policy pressures raise questions about the sustainability of the pipeline.
