October 27, 2021
The need for long-term care has grown continuously as the US population has aged. By 2050, the number of persons who may require some type of long-term care is expected to nearly double from over 10 million in 2000. Although family members and neighbors often provide unpaid care, formal paid home health aides are increasingly becoming a reliable source of care for many. As such, home health aides are among a small number of occupations in which jobs are projected to grow the most over the next few years.
The impending increase in this low-wage occupation raises concerns about the economic well-being of home health aides and their families. In the absence of policy interventions to raise pay, its growth signals an expansion of the low wage labor market. We use the American Community Survey to examine the gendered, racial, ethnic composition, and some economic outcomes of employment in this occupation.
Women of Color are Overrepresented
Table 1 shows the gendered racial and ethnic composition breakdown of the home health aide occupation, compared to their share of the entire labor force. Home health aide demographics do not reflect those of the overall US workforce. Home health aide jobs are held primarily by female workers, particularly female workers of color. White women are not overrepresented in these jobs, but Asian, Latinx, and Black women are. Of these groups, Black women are most overrepresented, making up nearly 30 percent of all home health care workers but constituting only about 6 percent of the labor force. Latinx women are the second most overrepresented, making up slightly more than 23 percent of home health aides — nearly triple their representation in the US workforce.
| Race and Gender Breakdown Among Home Health Aides | Percent of US Labor Force | |
|---|---|---|
| White Men | 3.76 | 32.51 |
| White Women | 27.44 | 28.76 |
| Black Men | 3.15 | 5.62 |
| Black Women | 29.87 | 6.36 |
| Hispanic Men | 1.99 | 9.88 |
| Hispanic Women | 23.35 | 7.85 |
| Asian Men | 1.28 | 3.19 |
| Asian Women | 6.12 | 2.99 |
| Others | 3.05 | 2.84 |
Note: Racial and ethnic categories are mutually exclusive. Latinx refers to Hispanic/Latinx of any race while white, Black, and Asian refer to non-Hispanic whites, non-Hispanic Blacks, and non-Hispanic Asian Americans, respectively.
Source: Authors’ analysis from the American Community Survey 2018–2019.
Many Women Working as Home Health Aides Remain Impoverished
Figure 1 indicates the percentage of home health aides who live in households whose income falls under the official poverty line by gendered racial and/or ethnic group. It highlights the detrimental economic effects of women being generally overrepresented in home health care occupations.
Figure 1
About one-fifth of Latinx women (21.4 percent) employed as home health aides live in poverty, compared to 12.7 percent of white men with the same occupation. Similarly, a nontrivial portion of both Black and white women in this occupation (19 percent and 16.6 percent, respectively) live in households with income below the federal poverty line. This pattern continues to hold when we adjust for a worker’s education, age, household size, and whether they have children (results available upon request).
A Greater Share of Female Home Health Aides Live in Poverty
An evaluation of median earnings helps explain why female home health aides are more susceptible to poverty than men, regardless of race or ethnicity. Table 2 shows the yearly median earnings of each gendered racial or ethnic group in this occupation (restricting the sample to full-time, full-year workers), and the difference between their earnings and the median earnings for all full-time workers nationwide.
| Median earnings of home health aides ($) | Gap to median earnings for full-time workers ($42,500) | |
|---|---|---|
| White Men | 25,498 | -17,002 |
| White Women | 24,000 | -18,500 |
| Black Men | 27,300 | -15,200 |
| Black Women | 25,000 | -17,500 |
| Latinx Men | 25,498 | -17,002 |
| Latinx Women | 23,458 | -19,042 |
| Asian Men | 30,000 | -12,500 |
| Asian Women | 24,478 | -18,022 |
| Others | 24,478 | -18,022 |
Note: Racial and ethnic categories are mutually exclusive. Latinx refers to Hispanic/Latinx of any race while white, Black, and Asian refer to non-Hispanic whites, non-Hispanic Blacks, and non-Hispanic Asian Americans, respectively.
Source: Authors’ analysis from the American Community Survey 2018–2019. Dollar amount is constant in 2019 dollars.
Across the board, Latinx women earn the least overall among home health aides at around $23,500 per year, followed by white women at $24,000. Although Black women appear to earn more than both of these groups at $25,000, these differences are not statistically significant. All of these home health aide workers suffer from low earnings.
When considering gender differences in median earnings, women employed as home health aides earn less than their male counterparts, regardless of race or ethnicity. The median earnings of white women are approximately $1,500 lower than those of white men, and the gender gap among Latinx and Black home health aides is larger at $2,040 and $2,300, respectively. The largest gender pay gap in this occupation is observed between Asian men and women at nearly $5,522.
Educational Attainment Does Not Explain Low Earnings of Female Home Health Aides
We note that all groups of female home health aides appear more likely to be high school graduates, except for white women who overwhelmingly have some college or above. Nearly all groups of male home health aides are more likely to have at least some college experience, while Latinx men tend to have a high school diploma or less. These differences in educational attainment do not appear large enough to account for the differences in median earnings across groups. White women working as home health aides, whose educational attainment is close to the same as that of men, have the second lowest wages of any group.
Conclusion
The yearly median earnings for a full-time, full-year home health aide is only about $24,500, compared to $42,500 yearly median earnings among all full-time, full-year workers in the US. This essential but underpaid industry is predominantly composed of women, with women representing nearly 90 percent of all home health aides. As a result, these women regardless of their ethnic and racial background, may be more susceptible to poverty. Given the momentum of shifting to home-based, noninstitutional long-term care for the majority of aging adults, it is vital to raise wages and ensure sufficient hours, as well as to enhance the training opportunities and earnings associated with jobs in this industry.
