Sec. 2. Findings
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Congress finds the following: Nearly 20,000,000 adults in the United States require assistance completing self-care and other daily tasks due to physical, cognitive, developmental, or behavioral conditions. This number includes about 17,000,000 individuals living in the community, 1,500,000 residing in nursing homes, and nearly 1,000,000 in residential care. The number of people needing this type of assistance is expected to rise as the percentage of the population that is over age 65 increases dramatically in the coming decades.
The assistance of direct care workers allows older individuals and individuals with disabilities to live with dignity and safety, and to exercise their right to live independently in their own homes and communities, in keeping with what is most appropriate for their needs and preferences. Older individuals and individuals with disabilities may also participate in the direct care workforce, further supporting their ability to live independently. According to PHI, direct care workers provide most of the paid, hands-on care for older individuals and individuals with disabilities.
From 2014 to 2024, home care occupations are projected to add more jobs than any other single occupation, with an additional 633,100 new jobs. Home care is also among the top 10 fastest-growing occupations, and with the projected growth in the population over age 65, this may underestimate the number of home care workers that will be needed to provide care for this growing population. Many direct care workers lack access to a career pathway or advanced training opportunities.
This limits their ability to build competency and expertise in their field that, when gained, may lead to an increase in their earning capacity. According to PHI, more than half of home care workers have completed no formal education beyond high school, making high-quality, transferable training essential to success on the job. As of 2018, the median wage for direct care workers is $12.27 per hour and wages and earnings for home care workers are even lower in rural areas. Because of low wages, variable work hours, and the inability to access workplace-based benefits, 44 percent of such workers live in low-income households, and 15 percent of the workers from such households live below the poverty line.
Nearly half of direct care workers rely on some form of public assistance to support themselves and their families. According to PHI, the direct care workforce is primarily comprised of low income women and people of color. Approximately 9 in 10 direct care workers are women, more than half are women of color, and one quarter of direct care workers are immigrants. The direct care workforce is plagued with high turnover, low job satisfaction, and workforce shortages. These conditions can contribute to reduced quality of care and threaten the availability of supports for older individuals and individuals with disabilities.
Because of the nature of the work, direct care workers suffer from disproportionately high rates of injury. In 2016, the injury rate for nursing assistants was 337 per 10,000 as compared to 100 per 10,000 for other occupations. Training has been shown to reduce worker turnover, reduce rates of injury, and lead to increased job satisfaction. The Institute of Medicine found that to ensure that the United States is prepared to meet the health care needs of older individuals during the 21st century, it is essential that the capacity of the direct care workforce be enhanced in both the number of workers available and their ability to meet their own health care and quality of life needs.