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Not much has changed in a year for the direct care workforce, according to a new PHI research report, released Tuesday

The residential care aide workforce — personal care aides, home health aides and nursing assistants working in assisted living and continuing care retirement communities and other congregate care settings — added 153,980 jobs over the past decade, according to PHI’s annual snapshot of the direct care workforce.

After losing more than 27,000 jobs from 2020 to 2021, the workforce gained back over 71,000 jobs in 2022. But projected employment growth — a 13% increase from 2021 to 2031 — has slowed overall. 

Overall, the residential care aide workforce will have almost 1.2 million job openings from 2021 to 2031 — 88,400 new jobs created by growth, plus 538,100 job openings from workers transferring to other occupations, plus 561,100 workers leaving the workforce altogether.

Barriers to success

Although a growing aging population is fueling demand for the direct care workforce, workers continue to struggle with economic hardship, and long-term care providers struggle to recruit and retain those workers, according to the New York-based research and advocacy organization.

“An increased and strategic investment in direct care workers and the long-term care sector by both government and industry leaders is crucial for meeting the demands of the coming decade,” Kezia Scales, PHI vice president of research and evaluation, said in a statement. “The challenges detailed in this report underscore the imperative to enhance job quality, ensuring that direct care workers are appropriately compensated and supported, both in recognition of their invaluable role and as a critical step to bolster recruitment and retention in an essential and expanding sector of our nation’s workforce.”

State and federal investments in Medicaid funding for long-term care and the workforce led to incremental wage growth over the past decade, according to the report. But almost 40% of workers live in low-income households, and 46% rely on public assistance, PHI said.

With an annual median income of $24,718, 11% of residential care aides live below the federal poverty level, and 40% live in low-income households. Approximately 41% of the workforce receives some form of public assistance. One-third (34%) of residential care aides are housing cost-burdened, and 14% lack health insurance. 

“Considering the prominent role of private payers and providers in determining compensation and other aspects of job quality for residential care aides, transforming these jobs continues to require significant investments through private, as well as public, channels,” the report concluded.

The report also contains information about home health aides and nursing assistants who work in nursing homes.