Caregiver feeding an older adult
(Credit: Jasmin Merdan/Getty Images)

Demand for direct care workers — home care workers; residential care aides in assisted living communities, residential group homes and other residential care settings; and nursing assistants in skilled nursing facilities — is on the rise. The need is projected to outpace the number of available workers, however. That’s according to a new report from direct care workforce specialty group PHI.

“Between 2021 and 2031, the direct care workforce is projected to add more than 1 million new jobs, which represents the largest growth of any job sector in the country,” according to PHI. “During the same timeframe, nearly 9.3 million total direct care jobs will need to be filled, including new jobs and job vacancies that are created as existing workers leave the field or exit the labor force.”

Turnover is a large concern. PHI noted that the median annual turnover for nursing assistants in nursing homes was almost 100% in 2017 and 2018, and turnover in home care was approximately 64% in 2021, according to the data.

Nursing homes

Nursing assistants in nursing homes make up 9% of the total direct care workforce, PHI said. Their numbers have declined in recent years. Low wages are one culprit, according to the experts. Although wages for nursing assistants have increased over time — from $14.51 an hour in 2012 to $17.06 in 2022 — PHI noted that the increases barely kept pace with the cost of living.

Additionally, more than a fourth of nursing assistants work only part-time in nursing homes, making them unable to earn a living wage, PHI said, adding that it works out to a 21% year-over year decrease in pay from 2021 to 2022.

“Due to low wages and a prevalence of part-time hours, nursing assistants earn a median annual income of $25,748,” the organization noted.

Nursing assistants are more prone to workplace accidents than workers in other occupations, according to the report. They are up to eight times more likely to have workplace accidents, as work-related illnesses are taken into consideration.

COVID-related absences caused the rate of workplace accidents to increase by more than 300% from 2019 to 2020., PHI said. The numbers have come down some since 2020, but the group said that “overall injury and illness incidence rates in nursing homes remain some of the highest in any industry.”

Home care

Home care is anticipated to add 900,000 new jobs by 2031, PHI said. That’s more than any new jobs in any other industry in the United States.

Most home care workers are living in poverty-level households, according to the report, mostly due to low wages and part-time roles. 

“While minimum wage increases, Medicaid policy changes and COVID-related funding helped boost wages for home care workers in recent years, this wage growth reversed in 2022,” the authors wrote. 

Wage concerns and job quality concerns are driving turnover within home care, PHI said.

Residential care aides

Residential care aides work in a variety of settings, including assisted living communities, group homes and continuing care retirement communities. Those workers are predominantly women, people of color and a disproportionate number of immigrants, PHI said. Immigrants comprise 21% of the direct care workforce, compared with 17% of the total US workforce.

The number of residential care aides dropped some in 2021 but recovered in 2022, according to the data. Overall, the subsector has added 153,990 jobs over the past decade.

Residential care lost 27,000 jobs from 2020 to 2021 due to pandemic-related concerns, PHI said, but this workforce gained back more than 71,000 jobs in 2022.

Residential care aides have gained some momentum in wage growth, according to the report. Wages have increased slightly more than the rate of goods and services over the past decade. 

Approximately 25% of residential care aides work less than 40 hours per week, the report authors said. Because of the part-time status of so many of the workers, the median annual income for residential care aides is $24,718.

“As in home care, recruitment and retention in the residential care sector have been acutely challenging in recent years due to rising demand coupled with poor job quality for residential care aides,” according to the report.

Read more about the residential care aide research in the report in McKnight’s Senior Living.