Home care workforce report: nearly 3.5 million workers, fast growth ahead, and pay that still lags

The aides who help older adults and people with disabilities at home now make up the biggest share of the country's direct care workforce, and demand is still climbing. That's according to PHI's annual report, Direct Care Workers in the United States: Key Facts 2026, released Sept. 15. PHI is a national nonprofit that researches and advocates for direct care workers, and the report draws on federal labor, census and CMS data.

The numbers

From the full report:

• Size: The direct care workforce grew from about 3.6 million workers in 2015 to nearly 5.8 million in 2025. PHI says that makes it the largest workforce in the United States.
• Home care: Home care workers (personal care aides and home health aides) more than doubled, from nearly 1.5 million in 2015 to nearly 3.5 million in 2025.
• Growth ahead: PHI projects home care will add nearly 773,000 new jobs from 2025 to 2035, an increase of 21% and more than any other occupation. Counting workers who leave or change fields, it expects nearly 6.2 million home care job openings over that period.
• Pay: The median home care wage rose from $13.74 an hour in 2015 to $16.98 in 2025, adjusted for inflation. That is $3.57 below the median for similar occupations ($20.54).
• Hours: 46% of home care workers work part-time (under 35 hours a week), and 18% work only part of the year.
• Financial strain: 54% of home care workers receive some form of public assistance, and 12% lack health insurance.
• Who pays: Medicaid accounts for 66% of the $360 billion a year spent on home and community-based services, by PHI's estimate.

PHI notes that the 2025 federal reconciliation law "is expected to curtail HCBS funding and access in the years ahead." It also says low pay is a key driver of recruitment and retention problems in home care.

What it means for families

A tight workforce can show up as waitlists, missed shifts or frequent caregiver changes. When you talk to agencies:

• Ask about staffing directly. How soon could care start? How many hours can they reliably cover?
• Ask about backup. What happens if your regular caregiver is sick or quits? Who covers, and how will you be told?
• Ask about consistency. Can you expect the same caregiver or a small team?
• Ask how caregivers are trained and supported. Our list of questions to ask a home care agency covers this.

What it means for agencies

PHI's findings point to wages, hours and job stability as the main levers for keeping staff. Its numbers can be useful context when you explain rates to families or plan recruiting for the years ahead.