Home caregiver helping senior woman walking at home
(Credit: FG Trade / Getty Images)

The residential care aide workforce — personal care aides, home health aides and nursing assistants who work in assisted living communities, continuing care retirement / life plan communities and other congregate care settings — added 94,730 jobs over the past 10 years, increasing from 552,770 workers in 2011 to almost 650,000 in 2021, according to PHI National’s annual snapshot of the direct care workforce, released this week.

The number of residential care aides dropped “significantly” during the pandemic, however — by close to 30,000 jobs. And that drop, according to the organization, raises questions about whether the previously steady growth trend in this workforce will continue.

That being said, the residential care aide workforce is projected to add 145,500 new jobs by 2030, PHI said. This workforce will have more than one million total job openings by 2030, including the new jobs created by growth in demand, along with 416,000 openings caused by workers moving into other fields and 470,500 openings due to workers leaving the labor force. In fact, PHI anticipates that 56% of all job openings across residential care settings in this timeframe will be for residential care aides. 

Residential care aides currently make up 14% of the direct care workforce and support more than 1.1 million older adults and individuals with disabilities, according to the report.

Transforming residential care aide jobs will require significant investments through private and public channels, PHI said. 

The annual report shows that the growing population of older adults continues to drive up demand for direct care workers of all kinds. Over the past decade, the direct care workforce added 1.5 million new jobs, growing from 3.2 million workers to 4.7 million — 647,000 residential care aides, 471,000 nursing assistants in nursing homes, 2.6 million home care workers and 1 million direct care workers employed in other settings.

The overall direct care workforce is projected to add another 1.2 million new jobs by 2030, with an estimated 7.9 million job openings in direct care from 2020 to 2030.

Wages rise slightly

Residential care aides’ wages have risen slightly over the past 10 years, from $12.51 in 2011 to $14.11 in 2021, with a median annual income of $23,100. Low wages lead to high poverty rates in this workforce, according to the report, with 11% living in  households below the federal poverty level and two in five workers living in low-income households. Due to high poverty rates, 38% of residential care aides receive some form of public assistance.

The overall direct care workforce, despite being larger than any single occupation, also continues to struggle with low wages and other barriers that hinder recruitment and retention, according to PHI.

“Year after year, our annual research on direct care workers has revealed the continual growth of this workforce, the increased demand for their services and the profound economic hardships they face,” PHI President and CEO Jodi M. Sturgeon said. “It is long overdue for this country to transform the direct care workforce, improving their financial security and long-term services and supports for everyone.”

Job growth is occurring mostly in the home- and community-based services sector, with the overall number of residential care aides projected to increase by 22%. By contrast, the nursing assistant workforce is expected to continue steadily declining due to consumer preferences and public policies expanding HCBS funding and access.

Although direct care worker wages have grown incrementally — mostly due to state and federal investments in Medicaid programs and the workforce in response to the COVID-19 pandemic — those wages continue to be lower than other industries, the organization said. 

The demographics, occupational roles, job quality challenges, projected job openings, and the continuing effects of the pandemic on the long-term care industry underscore the “pressing need for job quality interventions” to improve the lives of workers and older adults, PHI said.

A growing population

The need for those interventions is pressing, according to the report, as the number of adults aged 65 or more years in the nation is projected to almost double by 2060, going from 49.2 million to 94.7 million, from 2016 to 2060. The number of adults aged 85 or more years in that time is expected to almost triple, going from 6.4 million to 19 million.

Older adults also are living longer and with complex chronic conditions, the report noted. Approximately one in nine older adults are living with Alzheimer’s disease today. That number is expected to more than double by 2030, going from 6.5 million in 2020 to 13.8 million in 2060.

“This trend will drive up demand for direct care workers since more than a third of individuals across all long-term care settings are living with Alzheimer’s disease or another form of dementia,” the report reads.