Report Highlights Challenges, Issues Faced by Direct Care Workers

NEW YORK—PHI National, an organization that works to ensure quality care for older adults and people with disabilities by creating jobs for direct care workers, announced the release of its annual research report, “Direct Care Workers in the United States: Key Facts 2025.” 

This year marks the 20th anniversary of PHI’s Key Facts reports, the goal of which is to provide collected data to shape policy and public understanding of this critical workforce. PHI said the 2025 report highlights the demand for essential workers, the economic challenges they face and the resulting recruitment and retention issues in the current policy environment.

“For two decades, our research has highlighted the chronic challenges facing a direct care workforce comprised largely of women, people of color and immigrants,” said Jodi M. Sturgeon, president and CEO of PHI. “Despite incremental wage growth and the importance of their work, workers still face significant economic instability.”

Key findings from the report include:

• The U.S. population of adults aged 65 and older is projected to increase from 57.8 million in 2022 to 88.8 million by 2060.
• The number of adults 85 and older is expected to nearly triple in that same period, from 6.5 million to 17.5 million. According to the report, this demographic shift is the main factor driving job growth in the direct care workforce.
• Over the past decade, the direct care workforce has grown from nearly 3.5 million workers in 2014 to nearly 5.4 million in 2024, adding almost 1.8 million new jobs.
• The direct care workforce is projected to add more new jobs from 2024 to 2034 than any other single occupation in the country, with over 772,000 new jobs. When accounting for workers leaving the field, there will be an estimated 9.7 million total job openings in direct care from 2024 to 2034.
• The home care workforce more than doubled in size over the past decade, from nearly 1.4 million in 2014 to nearly 3.2 million in 2024. This upward trend is expected to continue, with the homecare workforce alone projected to add over 681,000 new jobs in the next decade.

Wage Challenges & Economic Insecurity:

Despite a median hourly wage increase of $2.98 from 2014 to 2024 (adjusting for inflation), the median hourly wage for all direct care workers was just $17.36 in 2024. Median annual earnings for direct care workers are just under $26,000. Low wages and high rates of part-time work make it difficult for direct care workers to support themselves and their families financially. A total of 36% of direct care workers live in low-income households, and 49% rely on public assistance such as Medicaid or food and nutrition assistance.

The direct care workforce is predominantly women (85% of homecare workers, 84% of residential care aides and 91% of nursing assistants in nursing homes) and people of color (67% of homecare workers, 60% of residential care aides and 61% of nursing assistants in nursing homes).

Black or African American individuals make up 38% of nursing assistants in nursing homes, 35% of residential care aides and 27% of homecare workers, while Hispanic or Latino workers constitute 25% of homecare workers, and 13% of both residential care aides and nursing assistants in nursing homes. Immigrants make up 33% of the homecare workforce, 24% of residential care aides and 21% of nursing assistants in nursing homes.

“As demand for their services skyrockets, a wave of recent policy decisions is threatening the very foundation of our long-term care system,” said Sturgeon. “From increasingly harsh immigration policies and unprecedented federal Medicaid cuts to the reversal of nursing home staffing standards and the proposed rule to strip away minimum wage and overtime protections for home care workers, these actions are actively undermining direct care workers’ livelihoods and destabilizing care for millions of families. We must transform these jobs into sustainable careers, that provide stability for wokers and ensure quality care for those that rely on them. That requires immediate and sustained policy action. It is time for our leaders to act.”

PHI emphasized the need for immediate action from policymakers, long-term care providers and advocates, including:

• Sustained investments in job quality improvements across all direct care settings.
• A focused approach to addressing equity issues within the workforce, particularly for women, people of color and immigrants.
• Thoughtful implementation and robust evaluation of new restrictions to public benefits imposed by the recently enacted budget reconciliation bill, and supportive coaching to help workers maintain current access to current benefits.
• Increased support for workers balancing multiple caregiving roles, both paid and unpaid.
• Improved data collection and reporting on workforce trends.

Read the full report at phinational.org/resource/direct-care-workers-in-the-united-states-key-facts-2025.