The direct care workforce, in numbers

The workforce that delivers care in American homes is large, growing faster than any other occupation, and paid close to the bottom of the wage distribution. Those three facts together explain most of what is difficult about home-based care, and they are all well documented — which is not true of everything in this field.

This page collects the figures we rely on, with sources, and flags the one distinction that most writing about this workforce gets wrong.

Size and growth

PHI, which maintains the standard data series on this workforce, counts roughly 5.4 million direct care workers in 2024, up from about 3.5 million in 2014. Home care workers — home health aides and personal care aides working in private homes rather than facilities — make up 3.2 million of that total, or 59 percent, and have more than doubled over the same decade.

The Bureau of Labor Statistics, using its own broader occupational category, projects home health and personal care aides to grow 17 percent from 2024 to 2034, adding 739,800 jobs against a 2024 base of 4,347,700, with roughly 765,800 openings a year once replacement is included.

What the work pays

Measure	Figure	Basis
Median hourly wage, home care workers	$16.77	PHI analysis of BLS data, Sept 2025
Median annual earnings, home care workers	$22,429	American Community Survey, 2023
Below the federal poverty level	15%	ACS 2023
Below 200% of the federal poverty level	41%	ACS 2023
Receiving some form of public assistance	59%	ACS 2023
Working part-time	46%	ACS 2023

Source: PHI, Direct Care Workers in the United States: Key Facts, September 2025. The gap between the hourly wage and the annual earnings figure is explained by part-time and irregular hours, not by a data error.

The comparable BLS figure for the broader occupational category is a median of $16.78 an hour, or $34,900 a year, across 4,347,700 workers. The difference between BLS’s $34,900 and PHI’s $22,429 is not a contradiction: BLS reports the annual equivalent of a full-time wage, while PHI reports what workers actually earned.

The distinction almost everyone blurs

For completeness, the home care series over recent years: 65 percent in 2021, 77.1 percent in 2022, 79.2 percent in 2023, and 75 percent in 2024 — described by the publisher as the lowest level in five years. The 2018 peak was 81.6 percent.

Home health aide and CNA turnover, from a separate annual compensation survey covering more than 1,100 agencies and 52,200 employees, was 36.3 percent in 2024 and 34.2 percent in 2025.

What is not known

Two things are worth saying plainly, because their absence is often filled in with numbers that will not bear weight.

First, there is no reliable estimate of what turnover costs a home care organization per worker. The figure that circulates — roughly $2,500 per worker — comes from a 2004 report drawing on studies conducted between 1992 and 2004, in unadjusted 2004 dollars. It is twenty-two years old. A peer-reviewed paper published in 2026 states the position directly: cost estimates specific to home care are not yet available. Anyone quoting a precise per-worker figure is extrapolating.

Second, the link between documentation burden and turnover in home-based care specifically is frequently asserted and thinly evidenced. The one peer-reviewed study we could find connecting the two is Dutch, based on 195 community nurses surveyed in 2019, and it found something more interesting than the simple version: time spent on organizational documentation correlated with perceived workload, while time spent on clinical documentation did not. Nurses in the accompanying focus groups described organizational documentation as redundant. If that finding generalizes, the target is not documentation in general but the portion of it that clinicians experience as serving nobody.

Why this matters to what we are building

A workforce with this wage structure and this turnover rate cannot absorb software that adds steps. It also cannot absorb software that requires training. Whatever is built for these workers has to be usable by someone in their first week on the job, on a phone they already own, and it has to be measurably faster than what it replaces — measurably, not assertedly.

That is a demanding standard, and it is the right one. The workforce numbers on this page are the reason.

Common questions

What is the turnover rate for home care workers?

Median annual caregiver turnover in non-medical home care was 75 percent in 2024. Turnover for aides and CNAs at home health agencies was 34.2 percent in 2025. These are two different workforces and the figures are frequently conflated; the 75 percent number is the one that circulates because it is the more arresting of the two.

What do direct care workers earn?

The median home care worker earns $16.77 an hour, per PHI's analysis of federal wage data in its September 2025 Key Facts report. Median annual earnings are $22,429, per the 2023 American Community Survey. The gap between the hourly and annual figures reflects part-time and interrupted work, not a data error.

How many direct care job openings are projected?

6.1 million by 2034, more new jobs than any other occupation in the United States.

Published July 31, 2026. Corrections to rupakshah@pyramid.care.