Direct Care Workforce: An Integral Part of Long-Term Services and Supports

This Issue Brief highlights basic facts about direct care workers.

This Brief was prepared through intramural research by the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy. For additional information about this subject, visit the DALTCP home page at http://aspe.hhs.gov/office_specific/daltcp.cfm or contact Ruth Katz at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201, Ruth.Katz@hhs.gov.

Millions of people with disabilities rely on long-term services and supports to assist them with activities of daily living such as bathing, toileting, and dressing. Most of this support is provided by family members and friends, often in informal arrangements. In addition to the support provided by friends and family members, many people will require the services of paid direct care workers, making these workers an integral component of the long-term services and supports delivery system in the United States.

There are 1.9 million direct care workers--nurse aides and home health aides--in the United States workforce.¹ These professionals are the primary providers of paid hands-on care for more than 13 million people with disabilities in the United States. They assist individuals with a broad range of support, including meal preparation, medication assistance, bathing, dressing, mobility and getting to planned activities on a daily basis. Direct care workers are essential to the delivery of long-term services and supports. The American Taxpayer Relief Act of 2012 (the “fiscal cliff” legislation) established a new commission to come up with new long-term care reform options. One of the issues the legislation specifically charged the commission with was examining issues related to workers who provide long-term services and supports, including whether the number of such workers is adequate to provide long-term services and supports to individuals who need them; and workforce development necessary to deliver high-quality services to such individuals.²

The purpose of this Issue Brief is to highlight basic facts about these workers, summarizing key findings from two surveys of the direct care workforce. The National Home Health Aide Survey is a national probability survey of home health aides designed to provide national estimates of home health aides employed by agencies that provide home health and/or hospice care.³ The National Nursing Assistant Survey is a parallel national survey of nursing assistants working in nursing facilities in the United States.⁴ Neither of these surveys includes personal care aides working outside of a home health or hospice agency or a nursing home.