Direct care workers, including residential care aides who work in assisted living communities, have been elevated to “hero” status during the COVID-19 public health crisis. New research, however, indicates that these workers’ economic security and job stability is threatened by low wages and other economic barriers.

“Direct Care Workers in the United States: Key Facts” from PHI, a New York-based research organization, predicts that the challenges residential care aides face due to low wages and other job quality limitations will intensify as demand increases for community-based residential care services. 

This is the first year PHI’s data have included residential care aides, who support at least 1.1 million older adults in assisted living communities, small group homes and other residential care settings, according to the organization. The report also discusses home care workers and nursing assistants who work in nursing homes.

According to PHI data, the nation’s 735,000 residential care aides earn a median hourly wage of $12.69 — or median annual earnings of $21,100 — meaning that almost 40% live in low-income households. 

The report said that 85% of residential care aides are women, 31% are Black or African American and 21% are immigrants. Also, almost half of those in this workforce have completed no formal education beyond high school. 

With 28% of residential care aides having a child under the age of 18 and 14% raising a child under the age of five, residential care aides face several challenges, PHI said. 

Twenty-five percent work part-time or fewer than 35 hours per week, according to the report. Of those, 20% work part-time for non-economic reasons, including personal or family obligations or health issues, and 4% are not able to find full-time work due to business conditions at their workplaces or economic pressures in the labor market. About 13% of residential care aides typically work overtime.

Due to low wages and the inability to find full-time work, one in seven residential care aides lives in a household below the federal poverty line, PHI said. Due to high poverty rates among workers, 38% receive some form of public assistance, according to the report. 

In addition, 13% do not have health insurance. Although 56% receive insurance through an employer or union (including insurance through a spouse or another job), more than 25% rely on public health insurance coverage, most commonly Medicaid, PHI said.

Of the senior living industry’s $112.2 billion in annual revenue, 41% comes from private sources, including long-term care insurance and out-of-pocket payments, with 37% coming from public programs (primarily Medicare and Medicaid), according to the report. Public revenue sources make up 16% of revenue in senior living and continuing care retirement communities, PHI said.

“Particularly given the prominent role of private payers and providers in determining compensation and other aspects of job quality for residential care aides, transforming these jobs will require a significant investment through public and private channels alike,” the study authors wrote.

The growing older adult populations is driving up demand for direct care workers, particularly residential care aides, PHI said. The population of adults aged 65 or more years will almost double from 49.2 million in 2015 to 94.7 million in 2060, according to the U.S. Census Bureau. As people live longer, direct care workers are supporting more people with complex chronic conditions — the number of people with Alzheimer’s disease is expected to jump from 5.8 million to 13.8 million by 2050, the authors said. 

The residential care aide workforce, which makes up 16% of the total direct care workforce, added 164,000 jobs over the past 10 years, increasing in size from 570,600 workers in 2009 to almost 734,000 in 2019, according to the report. The field is projected to add another 168,400 new jobs between 2018 and 2028, more new jobs than any other occupational group in residential care. PHI projected that 59% of all job openings across residential care settings will be residential care aide jobs.

“It has taken a significant health crisis for our country to begin seeing the value of our long-term care system and its workforce, but this research shows how much work is needed to address the many barriers facing direct care workers,” PHI President Jodi M. Sturgeon said. “The direct care workforce is on the frontline of this crisis, as essential as ever, and they deserve a significant investment in their jobs.”