There are 4.6 million direct care workers in the United States. This includes 2.4 million home care workers, 675,000 residential personal care aides, 527,000 nursing assistants in nursing homes and approximately one million direct care workers employed in other settings. Statutory and regulatory definitions of the roles and titles of direct care workers can vary from state to state, and overall, each job has a slightly different scope of practice depending on the number of hours of required training and other criteria, according to a 2021 PHI report.

Additionally, an estimated 53 million Americans — often adult children, spouses or friends — served as informal caregivers to an older adult or individual with disabilities in 2020, up from 43.5 million in 2015. Of those, 24% were caring for more than one person and 26% were caring for someone with Alzheimer’s disease or dementia. These caregivers often experience burnout, adverse health conditions and other challenges as a result of their duties, according to the National Alliance for Caregiving.

Among the challenges facing the direct care and family caregiving workforces are insufficient compensation, inadequate training, limited career advancement opportunities, imbalanced worker supply and demand, a lack of reliable workforce data and a variety of structural and societal inequities among those who work in the direct care field. But some states are exploring strategies to increase compensation, offer employment supports, enhance training and education, facilitate career advancement, expand the direct care employee pipeline, improve workforce data collection and monitoring, and support family caregivers.

This website highlights state policy activities to improve opportunities for all Americans who are part of the long-term care workforce, including direct care workers across a variety of settings, family caregivers, specialized care providers and administrative support staff of all stripes.