Workers in residential long-term care facilities face low pay and poor working conditions, according to a new EPI report examining employment levels, demographics, compensation, poverty rates, and unionization rates of these workers.

Among residential long-term care workers—which consist of workers in nursing homes and residential care facility industries—the report finds:

• A vast majority (80.9%) are women.
• A disproportionate number are Black women (22.4%) and immigrant women (12.8%).
• $15.22 is the median hourly pay—below the U.S. median hourly wage of $20.07.
• 7.2% live in poverty—higher than the poverty rate for all workers (5.3%).
• 6.9% are covered by a union contract—a lower rate than the overall workforce (11.9%).

In addition to facing low wages, residential long-term care workers are less likely than workers in general to be covered by employer-provided retirement and health insurance benefits.

“For too long, our society has devalued the elderly and people with disabilities as well as the workers who help them lead more enriched and independent lives. It is no coincidence that women—particularly women of color and immigrants—perform much of this hands-on care work, both paid and unpaid, in homes and in residential long-term care settings,” said Julia Wolfe, former EPI state economic analyst and co-author of the report.

Prior to the pandemic, employment in the residential long-term care industry was increasing rapidly but failing to meet demand. During the pandemic, this industry experienced sharp job losses and employment is still nearly 400,000 below pre-pandemic levels, which accounts for about one-third (34.8%) of the private-sector jobs lost over that period. In almost every state, residential long-term care employment has not recovered to pre-pandemic levels, according to the report.

The report calls for expanding public funding to ensure higher pay and improved working conditions for care workers, which will also attract and retain an experienced and committed workforce. In addition, policymakers can pass legislation to raise the minimum wage and strengthen protections for workers seeking to organize a union. States and localities can establish industry-specific worker standards boards to recommend changes to industry minimum wages and working conditions.

“Employment levels in the long-term care industry have failed to meet demand, and the shortfall is expected to grow. Yet long-term care workers do not receive adequate pay for their work, and many live in poverty,” said Sebastian Martinez Hickey, EPI research assistant and co-author of the report. “If we are to ensure that those who need care receive quality care, we must be able to attract more workers to this profession and ensure that those workers have the pay, benefits, and supports they need.”

“The deficiencies in access, quality of care, and quality of life for residents and their families are inseparable from the struggles and deficiencies in job quality, societal recognition, public funding, and voice on the job for long-term care workers,” said Marokey Sawo, EPI state economic analyst and co-author of the report. “Only when workers, care recipients, and their families stand together in solidarity can the U.S. overcome its short-sightedness to secure the services and job quality necessary for a dignified collective future. Such a future can be achieved only with adequate public funding that simultaneously improves conditions for care workers and ensures adequate care access and quality for those in need, regardless of their income or wealth level.”