August 8, 2023
Between 2021 and 2031, the need for home health and personal care aide positions is expected to increase by approximately 25 percent, or 924,000 jobs. This increase—the largest projected across all professions—is driven in part by an aging population. While in 2016, roughly 15 percent of people in the United States were over 65 years old, by 2060, the US Census estimates that over 23 percent of the population will be over 65 years old. That change reflects a shift from roughly 49 million people to about 95 million people.
Despite this growing and projected need for home health and personal care aides, there is a demonstrated lack of workers to fill this need in the workforce. Home health and personal care aides, collectively referred to here as “home care aides” or the “home care workforce,” monitor and provide assistance to people with daily activities. Those receiving assistance include older individuals, people with chronic illnesses, and people with disabilities. The activities may include dressing and bathing, housekeeping tasks, groceries, or appointments outside the home. Such activities not only assist people with day-to-day needs, but more broadly help enable people to stay in their homes and communities rather than move to an assisted care facility. The increasing demand for home care aides is primarily driven by the larger and aging baby boomer generation and people “living longer with complex health needs.” This is furthered by increased preferences and movements toward at home care, which in turn alleviates strain on care facilities. This growing need has also been exacerbated by the COVID-19 pandemic. The pandemic affected all people of all characteristics and needs, but particularly impacted vulnerable populations, including older individuals and those with disabilities, who were at greater risk due to underlying conditions and increased potential exposures in care facilities, which likewise impacted staff.
This report considers existing research on challenges to attracting and retaining the home care workforce and how the five largest states—California, Florida, Texas, New York, and Pennsylvania—have legislatively addressed the growing home health and personal care aide workforce shortage in recent years, from 2019 to 2022. It also considers the demographic characteristics of the home care workforce in each state. Taken together, these states account for 52.4 percent of the home health and personal care aide workforce and 36.4 percent of the population over the age of 65. The report concludes by analyzing how and to what degree states’ legislative proposals and enacted laws align with what research has identified as the key issues related to attracting and retaining a home care workforce.