The need for direct care workers in long-term care settings has grown in the last 10 years, and with staff expected to transfer to other occupations or exit the workforce altogether, alongside a growing elderly population, such job openings will nearly double in the next decade.
From 2019 to 2029, there will be an estimated 7.4 million direct care openings, according to a report released by PHI National, a New York City-based policy research and advocacy organization.
The expectation mirrors U.S. population projections, PHI said. Adults aged 65 and older will balloon from 49.2 million to 94.7 million between 2016 and 2060.
The long-term care workforce added about 1.5 million new jobs from 2010 to 2020, jumping from 3.1 million to 4.6 million.
Demand will fall heavily on home care and residential aides, the report indicated, explaining the public’s preference for home or community-based care services (HCBS) rather than a nursing home.
“Nearly all of the job growth that we’re seeing in this field is going to occur in home care, the total job growth for the direct care workforce is actually offset slightly by projected falling demand for nursing assistants,” said Stephen McCall, data and policy analyst for PHI.
PHI broke down direct care workers into three categories in its study: nursing assistants, residential care aides and home care workers. Nursing assistants were further classified into the following categories: certified nursing assistants (CNAs), certified nursing aides, nursing attendants, nursing aides, nursing care attendants and medication aides.
PHI pointed to the Biden administration’s $400 billion funding of HCBS to explain a falling demand for nursing assistants, running parallel with public preference.
“This growing population of older adults, their preferences for care are different today than they were in the past. They really prefer to live at home and receive services at home,” explained McCall. “That was actually probably always the case, the difference is that policies and programs have caught up to that preference to make home and community based services more available to folks.”
Regardless of the shift to HCBS, the nursing assistant workforce is expected to have 561,800 total job openings between 2019 and 2029, the report said, regardless of the shift to HCBS. PHI factored in 272,000 of this figure from workers moving into other occupations and 299,900 openings caused by workers exiting the labor force altogether.
Nursing assistant job openings will be offset by 10,100 positions cut due to falling demand.
“That’s not to say that we should neglect the nursing assistant workforce, since demand for these workers is falling,” noted McCall. “Yes, there will be just astounding growth in the homecare workforce, but we absolutely have to attend to the needs of nursing assistants as well and make sure that those are good quality jobs as well.”
Direct care will add “more new jobs than any other single occupation,” the report said. Despite demand, the median hourly wage in 2020 was $13.56, data say.
“We know that wages for nursing assistants have been stagnant, and the reports shows that the median hourly wage for these professionals has only gone up about $1 in 10 years,” said Lori Porter, co-founder and CEO of the National Association of Health Care Assistants (CNAs). “It reaffirms much of what we either knew or suspected previously.”
Median annual earnings for direct care workers was just $20,200; 44% of this workforce lives in low-income households and 45% rely on public assistance like Medicaid, nutrition or cash assistance.
“These trends both reflect and perpetuate the racial and gender inequalities faced by direct care workers, who are largely women and people of color,” the report said.
About 41% of nursing assistants live in low-income households, the report said, and 12% live in households below the federal poverty line. Roughly 34% of nursing assistants rely on public assistance.
“It is past time for CNAs to be paid a living wage, receive adequate benefits, and be able to do the work they are trained for and that they love without have to maintain two or more jobs and worry constantly about getting sick or injured,” Porter told SNN. “This last part is of particular concern, as the report noted 1,700 staff, including many CNAs, have died from COVID-19. At the same time, these individuals are three times more likely to experience workplace injuries that the average U.S. worker. Yet 13% of CNAs lack health insurance.”
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