PHI is a not-for-profit research organization dedicated to improving care delivery and maximizing the contributions of direct care workers. In the Bronx-based group's latest publication, "New Research: High Demand Yet Low Wages for Direct Care Workers," they have shared research that shows the direct care workforce now outnumbers every occupation in the country.
PHI's summary of its research is available on its web site, phinational.org. Some of the highlights are a little surprising.
The report also revealed that the growing need for direct care workers has not had the expected influence on wages. From the report's executive summary:
"[These workers] remain poorly compensated. In the past 10 years, inflation-adjusted median hourly wages increased only marginally for this workforce — from $12.61 in 2009 to $12.80 in 2019. Home care workers earned the least in 2019, with a median hourly wage
of $12.12, up from $11.21 in 2009, while median wages were $12.69 for residential care aides and $13.90 for nursing assistants in nursing homes.
"These low wages, combined with a high rate of part-time hours in this workforce, make it challenging for direct care workers to financially support themselves and their families. Home care workers have the lowest median annual earnings, at $17,200, followed by residential care aides at $21,100 and nursing assistants in nursing homes at $23,300. Because home care workers' earnings are particularly low, nearly half (47 percent) live in low-income households and over half (54 percent) rely on some form of public assistance.
"Two in five residential care aides and nursing assistants in nursing homes also live in low-income households, and over a third rely on public assistance. Inadequate compensation and other job quality concerns both reflect and perpetuate the racial and gender disparities faced by direct care workers. Nearly 90 percent of these workers are women, three in five are people of color, and one in four are immigrants to the U.S."
The report also explains the industry's well-documented caregiver turnover problem, blaming it primarily on poor job quality. Widespread vacancies are also seen across long-term care, undermining care quality and continuity. "Without intervention," the report predicts, "current direct care workforce shortages will continue to worsen."
The right way to look at the problem to fully grasp its scope is to combine the naturally growing demand for caregivers that stems from demographics with the related, extraordinary demand from vacancies created when existing workers transfer to other occupations or exit the labor force altogether. Home and residential care will need 1.3 million new workers by 2028 just to meet rising demand from an aging population, but another 6.9 million will be needed to fill jobs that will be abandoned during that time, for a total of 8.2 million job openings in direct care by 2028.
Looking at U.S. demographics across generations rather than year by year, the need for caregivers appears stark. Between now and 2060, the report predicts, the bulk of the population, 18 to 64 year olds, will increase 15 percent. The over-65 group will grow by 92 percent and the so-called "oldest old," those 85 and older, will increase 198 percent.
Drilling down into the data, persons of color over 65 will increase from 23 percent to 45 percent, and the proportion of older adults who are immigrants will increase from 14 percent to 23 percent.
The report also finds that Americans are living longer with complex chronic conditions, such as Alzheimer's disease and other forms of dementia (among other conditions). "There are 5.8 million people aged 65 and older currently living with Alzheimer's disease," the report says, "and this population is projected to more than double to 13.8 million by 2050. This trend is expected to drive up demand for direct care workers since, across all long-term care settings, more than a third of consumers have Alzheimer's disease or another form of dementia."
Without quoting the entire report, available at phinational.org, here are a handful of other insights, few of which will sound unfamiliar:
Qualifying for public assistance:
The report draws the conclusions that, although wages have increased incrementally for home care workers, these raises have not translated into widespread improvements to their financial wellbeing. A large proportion of home care workers still live in low-income households and relies on public assistance. Low compensation and other job quality concerns drive high turnover and widespread vacancies in the field, which in turn threaten care quality and continuity now and into the future.
PHI works to transform eldercare and disability services. We foster dignity, respect, and independence for all who receive care, and all who provide it. As the nation's leading authority on the direct care workforce, PHI promotes quality direct care jobs as the foundation for quality care.
Drawing on 25 years of experience working side-by-side with direct care workers and their clients in cities, suburbs, and small towns across America, PHI offers all the tools necessary to create quality jobs and provide quality care. PHI's trainers, researchers, and policy experts work together to:
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