OpEd
This fall, PHI released Direct Care Workers in the United States: Key Facts 2025, the 20th anniversary edition of our flagship annual report on this essential workforce. Twenty years on, the Key Facts report shows that poor job quality continues to destabilize this workforce even as demand for long-term care escalates—and foreshadows greater challenges in the years ahead.
Supporting millions of older adults and people with disabilities, the direct care workforce is the largest workforce in the United States—comprising nearly 5.4 million personal care aides, home health aides, and nursing assistants employed across care settings. Reflecting the history and current realities of care work, this workforce predominantly comprises women (85%) and people of color (64%). More than one in four direct care workers are immigrants.
As reported in Key Facts 2025, the direct care workforce added 1.9 million jobs over the past decade (2014 to 2024) and is expected to add 772,000 more new jobs by 2034— more new jobs than any other occupation. Most new direct care jobs will be in home care, given the trend toward (and overwhelming preference for) aging in place. The ever-growing demand for paid caregivers is driven by key demographic trends, including population aging, increased longevity, the rising prevalence of chronic conditions, and evolving family caregiving structures.
More starkly, an additional 8.9 million direct care jobs will become vacant from 2024 to 2034 as current workers leave their occupations or exit the labor force altogether. Yet, despite the imperative to fill these job openings to meet our country’s long-term care needs, persistent job quality concerns threaten to undermine workforce recruitment and retention efforts.
Key Facts 2025 shows that the median wage for direct care workers in 2024 (the most recent year of data available) was $17.36. This dollar amount represents modest inflation-adjusted wage growth over the previous decade but still falls short of a livable or competitive wage. Given high rates of part-time work and unstable schedules among direct care workers, median annual earnings are only $26,000. As a result, more than a third of all direct care workers live in or near poverty, and nearly half (49%) rely on public assistance programs like Medicaid and SNAP. Home-care workers fare the worst, with median annual earnings of less than $23,000 and nearly three in five workers (59%) relying on public assistance to survive.
Incremental wage gains in recent years reflect important federal and state investments in the direct care workforce, most notably through Section 9817 of the American Rescue Plan Act of 2021. However, this fragile progress is now threatened by federal policy developments that directly target this workforce, including unprecedented cuts to Medicaid, increasingly harsh immigration policies, the reversal of the nursing home minimum staffing standards, and the proposal to strip basic employment protections from home-care workers, among others.
What’s more, the availability and reliability of the data that inform our understanding of the direct care workforce are now under threat, given the recent dismissal of the Commissioner of the Bureau of Labor Statistics (BLS), and challenges to the BLS’s trusted methodology. Without those robust and reliable data, our ability to describe the workforce crisis, test solutions, and evaluate progress in the future will be sorely compromised.
The facts are clear—we can’t afford to look away from direct care workforce challenges that are both longstanding and compounded by current political trends. And so, complementing our workforce analyses, PHI has just released a new policy priorities brief—The Path Forward: Preserving, Strengthening, and Reimagining Care in the United States. The brief outlines the proactive steps needed at the state and federal levels to support direct care workers’ lives and livelihoods and safeguard access to the essential services they provide. Going further, it offers a transformative vision of economic stability and career mobility for this essential workforce.
Together, these reports underscore how important it is for all of us to take action to protect our nation’s caregiving infrastructure and strengthen it for the future.
Kezia Scales, PhD, is vice president of Research & Evaluation at PHI.
With thanks to Stephen McCall, director of research, and Sarah Angell, research associate, who led PHI’s Workforce Data Center analyses and produced Direct Care Workers in the United States: Key Facts 2025.
Photo credit: Shutterstock/PeopleImages
