Direct Care Workforce: An Integral Part of Long-Term Services and Supports. Who Are Direct Care Workers?

04/01/2013

Direct care workers are disproportionately female; over 90% are women. Home Health Aides (HHAs) tend to be older than Certified Nursing Assistants (CNAs)--the average age of CNAs is 39 years old and the average age of HHAs is 46 (Figure 1). About half of all direct care workers are married or live with a partner (Figure 2). A minority are immigrants (22% of CNAs and 14% of HHAs).5 Direct care is a demanding profession, with low wages and limited fringe benefits. In 2007, the average hourly wage for direct care workers was between $11 and $12 per hour (Figure 3). Many CNAs and HHAs do not have access to health insurance through their employer, and about 23% of CNAs and 13% of HHAs participate in Medicaid or other government programs that pay for medical care (Figure 4). This number may increase when the Medicaid expansions in the Affordable Care Act (ACA) are implemented. The ACA permits states to expand Medicaid eligibility to all persons with incomes lower than 133% of the federal poverty level. Given their low incomes, more CNAs and HHAs are likely to become eligible when the expansion goes into effect.

FIGURE 1. Age/Gender
Age Bar Chart: Under 30 -- CNAs (29.8%), HHAs (13.2%); 30-44 -- CNAs (35.9%), HHAs (30.3%); 45+ -- CNAs (34.3%), HHAs (56.5%). Gender Bar Chart: Male -- CNAs (8.0%), HHAs (5.0%); Female -- CNAs (92.0%), HHAs (95.0%).
SOURCE: RTI analysis of the 2007 National Home Health Aide Survey and the 2004 National Nursing Assistant Survey, 2009. [Available at http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.]
CNAs = certified nursing assistants; HHAs = home health aides.

Direct care workers have low incomes. Almost two-thirds of CNAs report household incomes of less than $30,000 per year. HHAs have slightly higher household incomes, with nearly 50% reporting incomes of less than $30,000 per year (Figure 5). Additionally, many direct care workers rely on public assistance at some point, to supplement their low incomes. Almost 25% received cash welfare for families and children presently or at some point in the past, and more than 40% have received food stamps.6

FIGURE 2. Marital Status
Bar Chart: Married/living with partner -- CNAs (51.1%), HHAs (51.0%); Widowed/divorced/separated -- CNAs (22.3%), HHAs (32.4%); Never married -- CNAs (26.6%), HHAs (16.6%).
SOURCE: RTI analysis of the 2007 National Home Health Aide Survey and the 2004 National Nursing Assistant Survey, 2009. [Available at http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.]
CNAs = certified nursing assistants; HHAs = home health aides.

 

FIGURE 3. Compensation
Bar Chart: Hourly rate of pay -- CNAs ($11.20), HHAs ($11.57); Workers reporting a pay increase in the last 12 months -- CNAs (63.2%), HHAs (57.0%).
SOURCE: RTI analysis of the 2007 National Home Health Aide Survey and the 2004 National Nursing Assistant Survey, 2009. [Available at http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.]
NOTE: Wage data are in 2007 dollars. Wage data from the 2004 NNAS were adjusted to 2007 using U.S. Bureau of Labor Statistics data on percentage increase in CNA wages over the time period.
CNAs = certified nursing assistants; HHAs = home health aides.

 

FIGURE 4. Health Coverage Choices
Bar Chart: Uninsured -- CNAs (16.5%), HHAs (18.8%); Spouse/partner's insurance or purchased on their own -- CNAs (27.7%), HHAs (26.0%); Medicaid or other government program -- CNAs (23.3%), HHAs (13.1%).
SOURCE: RTI analysis of the 2007 National Home Health Aide Survey and the 2004 National Nursing Assistant Survey, 2009. [Available at http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.]
CNAs = certified nursing assistants; HHAs = home health aides.
* Respondents reporting no health insurance coverage purchased privately or provided by employers, government, or other family members. Employees had to work at least 16 hrs/week to be eligible to participate in this survey. Thus, findings may underestimate the percentage of part-time workers and, subsequently, the total number of uninsured workers.

 

FIGURE 5. Household Income
Bar Chart: Less than $20,000 -- CNAs (38.2%), HHAs (22.7%); $20,000-under $30,000 -- CNAs (27.9%), HHAs (26.8%); $30,000-under $40,000 -- CNAs (14.2%), HHAs (21.6%); $40,000-under $50,000 -- CNAs (9.7%), HHAs (11.4%); $50,000 or more -- CNAs (10.0%), HHAs (17.5%).
SOURCE: RTI analysis of the 2007 National Home Health Aide Survey and the 2004 National Nursing Assistant Survey, 2009. [Available at http://aspe.hhs.gov/daltcp/reports/2011/CNAchart.htm.]
CNAs = certified nursing assistants; HHAs = home health aides.

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