The direct care workforce serving residents in assisted living communities and other residential care settings has fluctuated in the past several years, struggling not only to return to pre-pandemic levels but also facing shortages as demand from a rapidly aging population necessitates even more jobs, according to a new report from PHI.
The national organization committed to strengthening the direct care workforce released its annual snapshot of that workforce on Tuesday, examining demographics, occupational roles, job quality challenges and projected job openings among residential care aides, nursing assistants in nursing homes and homecare workers.
According to the report, there are 655,950 residential care aides — also known as personal care aides, home health aides and nursing assistants — who work in assisted living communities, group homes and other residential care settings.
The number of residential care aides has fluctuated somewhat in recent years, adding 48,070 jobs over the past 10 years. After losing more than 38,000 jobs from 2020 to 2022, the residential care aide workforce showed signs of recovery in gaining back more than 20,000 jobs in 2023.
As the nation’s population of older adults grows dramatically, demand for direct care workers is escalating — the number of older adults is projected to increase to 88.8 million by 2060, and the industry will see a “staggering” 8.9 million job openings from 2022 to 2032 for all types of direct care workers, according to PHI.
In an update to its 2023 “The Value of Assisted Living in America” white paper, Argentum reported that the senior living industry will need more than 3 million caregivers and other workers by 2040, with more than 20 million workers needed across all long-term care settings.
The residential care aide workforce — the largest occupational group within residential care settings and 13% of the total direct care workforce — is projected to have 1.1 million total job openings by 2032, according to PHI. This includes the addition of 78,900 new jobs from 2022 to 2032, 474,800 job openings caused by workers moving into other occupations, and 520,800 job openings due to workers leaving the labor force altogether.
Wage challenges and economic insecurity
Despite the demand and “critical importance” of their work, direct care workers continue to face “significant” economic challenges, PHI noted.
Wages for residential care aides have risen “somewhat” over the past 10 years, with median hourly wages increasing from $13.69 in 2014 to $17.15 in 2023, compared with the median hourly wage for all direct care workers at $16.72.
Due to low wages, 11% of residential care aides live in households below the federal poverty level, and 34% live in low-income households, with 45% receiving some form of public assistance, according to the report. In addition, 35% are housing cost-burdened, and 11% lack health insurance.
More than one in four residential care aides works part time, compared with 15% who work more than 40 hours weekly, and 19% reported being employed for only part of the year rather than year-round.
The report also highlights a concern regarding “benefits cliffs,” where small wage increases can lead to a loss of public benefits, potentially resulting in net income losses for workers.
“This report underscores the critical importance of direct care workers for the future of care in the United States, while also highlighting the significant challenges they face,” PHI President and CEO Jodi M. Sturgeon said in a statement. “As demand grows, it’s crucial that we address issues of low ages, limited benefits and lack of career advancement opportunities to ensure a stable and qualified workforce.”
Policy implications
Policymakers, healthcare providers and advocates can use the research results to make sustained investments in job quality, address equity issues with the workforce, and improve data collection and reporting on workforce trends, PHI said.
“The challenges they face are significant, but recognition is growing of the need to invest in direct care workers as a lifeline to older adults, people with disabilities and family caregivers,” Sturgeon said. “By transforming direct care jobs into quality careers, we can ensure economic stability for the people who care for us every day and ensure high quality care and support for all who need it, in the settings of their choice.”
