The U.S. labor market added 130,000 jobs in January, but a closer look reveals a clear driver: elder-care services. Positions in at-home care, hospitals, and long-term care facilities accounted for 124,000 of those new roles, highlighting the growing reliance on workers who support older and disabled Americans in their daily lives.
These jobs are essential. Aides and assistants help with bathing, dressing, eating, and managing everyday tasks. Yet, despite their importance, the roles are physically demanding and often offer modest pay. This pattern points to a broader shift in the labor market.
Unlike the traditional engines of employment growth—corporate offices and manufacturing floors—today’s expansion is concentrated in labor-intensive care and service roles.
Low Pay, High Demand
While the healthcare sector includes some of the highest-paid careers, such as surgeons earning over $450,000 annually, the surge in employment comes primarily from direct care roles. Home health and personal care aides represent nearly 4 million workers, and about 1.5 million are nursing assistants, according to the Bureau of Labor Statistics.
Median pay for home health and personal care aides sits at approximately $16.82 per hour, or $35,000 per year—barely above the federal poverty level for a family of four, which is $32,150. Nursing assistants earn a median of $19.84 per hour, roughly $41,000 annually, both below the national median wage of $49,500.
Priya Chidambaram, senior policy manager at KFF, notes, “When we talk about the direct care workforce, we’re talking about people who are providing typically long-term care services to older adults and younger people with disabilities.”
Workforce Composition and Challenges
The direct care workforce is overwhelmingly female, making up 87% of workers, with immigrants representing over a quarter. About 11% are noncitizen immigrants and 17% are naturalized citizens. Nearly 40% of workers are at least 50 years old.
Home-based care is even more dependent on foreign-born workers, with one in three home health aides being immigrants. Many enter the field after caring for family members, while others choose the role as a practical entry into healthcare due to financial or educational barriers.
Training requirements vary. Nursing assistants complete certified nurse aide programs, while home health and personal care aides often finish shorter certification courses. Roughly half of direct care workers have a high school education or less. Despite these lower educational barriers, the work is physically, mentally, and emotionally taxing.
Alyssa Crockett, a licensed practical nurse in long-term care, described her experience: “We cannot do everything. It’s so messed up. My 12-hour shift? I get 25 minutes per person. … How is this possible? I’m truly at the point of realizing that I’m going to lose my nursing license working in long-term care, which sucks, because it’s my entire heart. We need to do better.”
High turnover reflects these challenges. Nursing assistants can see annual turnover near 100%, while home health roles experience rates around 75%, driven by burnout and unstable hours.
Growing Demand With an Aging Population
The demand for elder-care services is rising sharply. Americans aged 65 and older are expected to make up more than 20% of the population by 2035, meaning one in five may require some form of care. Baby boomers are entering their 70s and 80s, and more older adults prefer aging at home rather than in institutional settings.
Chidambaram warns, “All these things are combining to create this inevitability that there will not be enough of a workforce to meet the demands of an aging population.”
Immigration policy further complicates staffing. Direct care roles rarely use H-1B visas, relying instead on employment-based visas and temporary protected status (TPS). Restrictions implemented under the Trump administration, including pauses on employment visas and ending TPS for some countries, have reduced the pool of available workers.
Medicaid, the primary funder of long-term care, also impacts the workforce. Recent legislation cut roughly $1 trillion from the program, potentially lowering wages and straining agencies that employ aides and nursing assistants.
Preparing for the Future
Economists question whether the sector could face a demographic decline after the baby boomers pass. For now, the more pressing issue is insufficient staffing to meet demand. The workforce not only supports aging Americans but also younger individuals with disabilities who rely on long-term care.
Chidambaram emphasizes, “We have this growing demand, and it sounds like the supply is going to reduce pretty significantly over the next few years. It’s going to impact us for the next 30 years.”
The elder-care workforce remains the backbone of U.S. job growth, yet its members face low pay, high turnover, and mounting pressure. Addressing these challenges is essential to sustain a system millions of Americans will increasingly rely on.
