Care work is vital to a functioning society and a crucial activity in many of our most intimate relationships and communities. Yet we, as a society, underinvest in care workers. On average, care workers, especially home care workers and personal aides, are about three times more likely to live in poverty. This is in part because of the history of care work and the association of caregiving to women and women of color. Care work is hard and viewed as less prestigious than other professions, even though it is essential. We expect our loved ones to be cared for, but we do not put adequate attention or prioritization into the human capital and well-being of those who do this work. 

According to the Bureau of Labor Statistics, home health and personal care aides held around 4 million jobs in 2023, with over half employed by individual and family services. Between 2022 and 2032, the direct care industry [1] is anticipated to experience the largest job growth of any sector in the nation, adding more than 860,000 new positions. Over the next decade, approximately 8.9 million direct care jobs will need to be filled, including both new roles and openings created as workers leave the profession, switch careers, or exit the workforce altogether. 

Less than a Livable Wage: Pay for Care Workers 

Despite high demand, wages for home health and personal care aides fail to reflect their essential role in society. In all states, the median wage reported for these occupations falls below a “livable wage,” according to the Massachusetts Institute of Technology’s Living Wage Calculator. A living wage is defined as the amount of income needed to cover essential expenses such as food, housing, healthcare, transportation, and other basic needs without the need for government assistance. A living wage considers the local cost of living, which can vary by location, as well as inflation and other economic factors. 

Even in the states where home health and personal care aides earn the highest median wage—Washington, Oregon, Rhode Island, and Massachusetts—it is still not enough to cover daily living expenses. For Washington, the highest paid state, the living wage for an adult with no children is set at $26.36, and home health care workers make an average [2] of $20.19 an hour, which translates to an annual mean wage of $42,000. The gap between the recommended living wage and the average hourly wage for home health and personal care aides in the highest-earning states ranges from $5.73 in Rhode Island to $10.34 in Massachusetts.  

Across the country, personal health and care aides make anywhere from $11.49 an hour (the bottom 10th percentile) to $20.41 an hour (the top 90th percentile).  This results in annual earnings ranging from $23,910 to $42,450 respectively, a yearly take-home much lower than an average annual salary of $58,084 for all American workers in 2023. The median wage for home health workers was around $16.12 an hour, translating to around $33,530 annually for full-time, year-round workers in 2023. 

Difficult Working Conditions for Care Workers 

While low wages limit the economic agency of home care workers, the nature of care work—intimate, isolated, and often performed inside clients’ private homes—creates additional barriers to financial stability and worker safety. Because these jobs are typically performed outside of traditional workplace settings, care workers often face unpredictable hours, limited oversight or protections, and reduced access to benefits, unionization, or career advancement. 

• Lack of benefits: Many care workers lack access to critical benefits such as health insurance, retirement savings plans, paid sick leave, and paid family leave. This often goes hand-in-hand with the fact that domestic workers operate within individuals’ homes, or within small, private facilities. Direct care workers are less likely to have employer-provided benefits than other workers (53% vs. 32% for health insurance). Due to the financial precarity of these positions, care workers more frequently rely on government assistance programs. 
• Precarious work and job insecurity: Care workers are frequently employed on a part-time or temporary basis, often through staffing agencies, which can lead to inconsistent hours, job insecurity, and a lack of stable income. This instability can also make it harder to budget or plan for the future. 
• Gender and racial disparities: More than 90% of domestic workers are women and over half are women of color. Care work has long been considered ‘women’s work,’ a perception that has contributed to the devaluation of care jobs. This work has thus garnered a connotation of being for people in marginalized communities, resulting in many immigrants and women of color pushed into these sectors for little pay. Given the fact that care jobs are disproportionately held by women of color, racial and gendered pay gaps are very much at play.  
• Limited opportunities for career advancement: Even with opportunities for specialization and certification, the pay doesn’t go up that much, and there is not an explicit route for advancement. 
• Hard to unionize: Given the siloed nature of work for home healthcare workers, it is difficult for workers to organize collectively and unite as a way to demand better conditions, higher pay, and other advancement opportunities. This segmentation of workers can also mean that there is less employer accountability for fair work conditions and fewer policies around building fair working conditions. Additionally, domestic workers were left out of the National Labor Relations Act of 1935, which was designed to grant employees the right to form labor unions and take part in other collective actions to advocate for improved working conditions.  
• Lack of public investment in care work: In the United States, care is often considered personal and private, which leads to a lack of public investment in families and care infrastructure. Given the lack of public support to help finance families’ needs for care, many turn to private companies, which are typically focused on garnering a profit. This focus on economic output can frequently result in lower wages for workers. 

Key Takeaways: The Future of Care Work 

Care work, specifically home health and personal care aides, is expected to rise by 21% between 2023 and 2033.  With an aging population, the need for direct care workers is becoming progressively urgent. Nearly all 50 states reported experiencing shortages of care workers, according to a survey done by administrators of Medicaid Home- and Community-Based Services (HCBS) programs. Without access to care workers, those in need of support, including older adults and individuals with disabilities, can face life-threatening consequences, such as an increase in hospitalizations. To address this reality, policies should focus on making care work a more desirable and livable career.  

[1] The “direct care industry” refers to the sector of the healthcare industry that provides hands-on support for individuals experiencing aging, illness, or disability. This includes personnel who provide home health care services, work in palliative care, nursing homes, assisted living facilities, and personal care assistants. 

[2] Hourly mean wage.