Caring in America: A Guide to America’s Home Care Workforce
Numbering on the order of 2.5 million workers, the home care and personal assistance workforce in the United States has reached historic proportions and is expected to increase at rates four to five times that of jobs overall in the economy. The tremendous growth of this workforce is being fueled by profound structural changes in our society that are fundamentally reshaping long term services and supports.
Chief among these changes is the aging of our population and significant increases in life expectancy due to medical advances that allow individuals with chronic conditions and severe disabilities to live longer. People’s preference for receiving supports and services in their own homes as opposed to institutional settings is also amplifying demand for home care and personal assistance workers, bolstered by various legal decisions supporting the right to receive care in the least restrictive settings possible. State and federal policies show a similar trend, increasingly supporting home and community based services as alternatives to traditional, more costly institutional care.
Using the best data and research evidence available, this national report presents the most complete picture possible of America’s home care and personal assistance workforce, with the hope that this material will support a more informed public discussion of the key policy issues shaping the future of in-home services and supports upon which families, communities, and businesses increasingly depend.
The report begins by presenting basic facts on the size of the home care and personal assistance workforce and its demographic characteristics along with a description of job titles and tasks performed. It also analyzes the employers in the in home care industry sector as well as the complex of service delivery systems that provide daily services and supports to millions of people living in their homes.
The next sections of the report investigate the state of training for home care and personal assistance workers, and the job hazards that accompany this work. It looks at three closely related topics: workforce compensation, the employment patterns of aides, and evidence of workforce instability.
Finally, the report concludes by addressing the current status of federal and state wage and hour protection for this workforce. Untold numbers of home care and personal assistance workers are excluded from federal minimum wage and hour protection on the grounds that the work they perform is casual and confined to “fellowship and protection.” In light of significant changes that have taken place in the home care industry, the U.S. Department of Labor is currently reviewing the regulations that interpret this statute. We hope the comprehensive data and analysis provided in this report contributes to an informed debate and appropriate regulatory reform.
Click here to read the full report.