The important and difficult work of helping people to lead dignified and independent lives, regardless of age or ability, is deeply undervalued. The 2021 Raise the Wage Act would increase the federal minimum wage from its current level of $7.25 per hour to $15 in 2025 and would disproportionately benefit direct care workers who provide long-term health and personal care services and supports to the elderly and people with disabilities.
By the numbers
- 1.9 million (49.9% of) long-term services and supports (LTSS) direct care workers nationwide would get a raise if the minimum wage is $15 in 2025.
- Nine in 10 of those getting a raise are women.
- One-half are Black, Hispanic, or Asian American/Pacific Islander.
- $3,200 – average annual pay increase for a year-round worker.
- $3,500 – average annual pay increase for a Black year-round worker.
- $3,700 – average annual pay increase for a Hispanic year-round worker.
- In 23 states, 75% or more of LTSS direct care workers would have higher pay.
Previous research has estimated that for the workforce as a whole, the Raise the Wage Act would increase the pay of 32 million workers; these “affected” workers make up 21.2% of all wage and salary workers (Cooper, Mokhiber, and Zipperer 2021). Table 1 provides the analogous estimates for the direct care workforce, who are much more likely to be affected by the policy because they are paid particularly low wages.
The first row of Table 1 shows that a $15 minimum wage in 2025 would increase the wages of 2.2 million, or 46.6%, of the 4.7 million nursing assistants, home health aides, and personal care aides working in the United States. In this report, we focus in on the subset of these direct care workers who provide long-term services and supports (LTSS). We define LTSS direct care workers as those employed as nursing assistants and home health and personal care aides in the following industries: nursing care facilities, residential care facilities, home health care services, and individual/family services. We exclude care workers in industries in which they are less likely to be providing LTSS, such as in hospitals (see the methodology for more details).
Of the 3.7 million direct care workers providing LTSS, about half (49.9%), or 1.9 million, would receive higher pay with a $15 minimum wage in 2025. About 1.1 million of these affected direct care employees work in home care, and about 760,000 work in nursing or residential care homes.
Nearly 2 million LTSS direct care workers would get a raise if the minimum wage is $15 in 2025: Direct care workers affected by the Raise the Wage Act in 2025
| Group | Total workforce (thousands) | Number affected (thousands) | Share of group affected |
|---|---|---|---|
| All direct care workers: Nursing assistants, home health aides, and personal care aides | 4,649 | 2,166 | 46.6% |
| Direct care workers who provide long-term services and supports | 3,711 | 1,852 | 49.9% |
| …in home care | 2,355 | 1,093 | 46.4% |
| …in nursing and residential care homes | 1,357 | 759 | 55.9% |
Notes: Long-term services and supports (LTSS) are health and social services provided to individuals who need assistance with daily living activities such as bathing, dressing, toilet care, shopping, preparing meals, housekeeping, and managing medications. “Home care” includes care workers who work in the “Home health services” or “Individual family services” industries. The affected shares in the “LTSS direct care workers in home care” and “LTSS direct care workers in nursing and residential care homes” subcategories have been scaled for consistency with the broader category “LTSS direct care workers.” See methodology for details.
Sources: Campbell et al. 2021 and Economic Policy Institute Minimum Wage Simulation Model; see Technical Methodology by Cooper, Mokhiber, and Zipperer (2019).
Most of the LTSS direct care workers who would benefit from the Raise the Wage Act are women and people of color. Table 2 shows that, among direct care workers in LTSS, women are particularly likely to have their pay rise (51.2% would see a raise compared with 40.5% of men in this profession).
Since women make up the vast majority of LTSS direct care workers, 90.7% of those who would benefit from the Raise the Wage Act are women. One-half of those who would benefit are Black, Hispanic, or Asian American/Pacific Islander.
Half of LTSS direct care workers who would get a raise from a $15 minimum wage are Black, Hispanic, or AAPI: Numbers and shares of LTSS direct care workers affected by the Raise the Wage Act in 2025, by race/ethnicity and gender
| Group | Total LTSS direct care workforce (thousands) | Number affected (thousands) | Share of group affected | Share of affected who are in each group |
|---|---|---|---|---|
| Overall | 3,711 | 1,852 | 49.9% | 100.0% |
| Gender | ||||
| Women | 3,279 | 1,679 | 51.2% | 90.7% |
| Men | 431 | 174 | 40.5% | 9.4% |
| Race/ethnicity | ||||
| White | 1,428 | 860 | 60.2% | 46.4% |
| Black | 1,145 | 590 | 51.5% | 31.9% |
| Hispanic | 747 | 296 | 39.7% | 16.0% |
| AAPI | 263 | 40 | 15.4% | 2.2% |
Notes: Long-term services and supports (LTSS) are health and social services provided to individuals who need assistance with daily living activities such as bathing, dressing, toilet care, shopping, preparing meals, housekeeping, and managing medications. AAPI stands for Asian American/Pacific Islander.
Sources: Campbell et al. 2021 and Economic Policy Institute Minimum Wage Simulation Model; see Technical Methodology by Cooper, Mokhiber, and Zipperer (2019).
Table 3 shows that the average LTSS direct care worker affected by the Raise the Wage Act would receive an annual pay increase of $3,200 (in 2021 dollars) if they work year round (52 weeks per year). Black or Hispanic LTSS direct care workers would see slightly larger pay increases: The average annual earnings for these workers would rise by $3,500 and $3,700, respectively, if they work year round.
Black and Hispanic LTSS direct care workers would see larger-than-average annual pay gains from a $15 minimum wage: Pay increases for LTSS direct care workers affected by the Raise the Wage Act in 2025, by race/ethnicity and gender
| Group | Average hourly increase | Average annual increase for year-round workers |
|---|---|---|
| Overall | $1.83 | $3,200 |
| Gender | ||
| Women | $1.85 | $3,300 |
| Men | $1.72 | $3,000 |
| Race/ethnicity | ||
| White | $1.67 | $2,900 |
| Black | $1.92 | $3,500 |
| Hispanic | $2.24 | $3,700 |
| AAPI | $1.39 | $2,300 |
Notes: Long-term services and supports (LTSS) are health and social services provided to individuals who need assistance with daily living activities such as bathing, dressing, toilet care, shopping, preparing meals, housekeeping, and managing medications. AAPI stands for Asian American/Pacific Islander. Year-round workers work 52 weeks per year. All estimates are in 2021 dollars.
Source: Economic Policy Institute Minimum Wage Simulation Model; see Technical Methodology by Cooper, Mokhiber, and Zipperer (2019).
Figure A shows that pay increases for LTSS direct care workers are concentrated in the bottom half of their occupations’ hourly wage distributions and would significantly reduce inequality in this profession. For instance, without the Raise the Wage Act, the 10th percentile of the LTSS direct care worker wage distribution would be just $11.10 in 2025. However, with the Act it would be 35.1% higher, at $15. The 20th-percentile wage would be 19.0% higher in 2025 under the Raise the Wage Act.
LTSS direct care worker pay increases from a $15 minimum wage would be concentrated at the bottom of the wage distribution: Wage distribution of LTSS direct care workers in 2025, with and without the Raise the Wage Act (RTWA)
| Percentile | Wage in 2025 with RTWA | Wage in 2025 without RTWA |
|---|---|---|
| 10th | $15.00 | $11.10 |
| 20th | $15.00 | $12.60 |
| 30th | $15.00 | $13.77 |
| 40th | $15.31 | $14.84 |
| 50th | $15.96 | $15.70 |
| 60th | $16.43 | $16.35 |
| 70th | $16.85 | $16.79 |
| 80th | $18.35 | $18.35 |
| 90th | $21.44 | $21.44 |
Notes: Long-term services and supports (LTSS) are health and social services provided to individuals who need assistance with daily living activities such as bathing, dressing, toilet care, shopping, preparing meals, housekeeping, and managing medications. All estimates are in 2021 dollars.
Sources: Economic Policy Institute Minimum Wage Simulation Model; see Technical Methodology by Cooper, Mokhiber, and Zipperer (2019).
Nationally, 49.9% of LTSS direct care workers would benefit from the Raise the Wage Act. However, since some states already have higher minimum wage standards, this overall share understates the benefits of the Raise the Wage Act in low-minimum-wage states.
Figure B and Appendix Table 1 show state-specific totals and shares of LTSS direct care workers who would have higher pay as a result of the policy. In nine states, more than five out of every six direct care workers in LTSS would have higher take-home pay: Mississippi (90.7%), Louisiana (89.3%), Arkansas (87.4%), Oklahoma (85.9%), West Virginia (85.3%), Alabama (84.8%), New Mexico (84.8%), Missouri (84.4%), and Kansas (83.5%). In 23 states, 75% or more of LTSS direct care workers would have higher pay. Southern states tend to have particularly high shares of direct care workers who would benefit from the RTWA, since many of these states have low minimum wages (EPI 2021). In fact, the five states that would not have a minimum wage at all if it were not for the federal minimum wage are all in the South.
In 23 states, 75% or more of LTSS direct care workers would have higher pay if the minimum wage is raised to $15 an hour: Number and share of direct care workers in long-term services and supports who would benefit from the Raise the Wage Act of 2021, by state
| State | Share of LTSS direct care workers affected | Total LTSS direct care workforce | Total number of affected LTSS direct care workers |
|---|---|---|---|
| Alabama | 84.8% | 37,000 | 31,000 |
| Alaska | NA | NA | NA |
| Arizona | 66.3% | 59,000 | 39,000 |
| Arkansas | 87.4% | 36,000 | 32,000 |
| California | NA | 471,000 | NA |
| Colorado | 55.1% | 44,000 | 24,000 |
| Connecticut | NA | 54,000 | NA |
| Delaware | NA | NA | NA |
| Washington D.C. | NA | NA | NA |
| Florida | 75.7% | 152,000 | 115,000 |
| Georgia | 80.7% | 61,000 | 49,000 |
| Hawaii | NA | NA | NA |
| Idaho | 78.2% | 19,000 | 15,000 |
| Illinois | 1.4% | 145,000 | 2,000 |
| Indiana | 79.6% | 66,000 | 52,000 |
| Iowa | 75.0% | 41,000 | 31,000 |
| Kansas | 83.5% | 34,000 | 29,000 |
| Kentucky | 80.4% | 32,000 | 26,000 |
| Louisiana | 89.3% | 54,000 | 48,000 |
| Maine | 67.6% | 22,000 | 15,000 |
| Maryland | NA | 53,000 | NA |
| Massachusetts | NA | 96,000 | NA |
| Michigan | 73.2% | 115,000 | 84,000 |
| Minnesota | 42.3% | 97,000 | 41,000 |
| Mississippi | 90.7% | 26,000 | 23,000 |
| Missouri | 84.4% | 77,000 | 65,000 |
| Montana | NA | NA | NA |
| Nebraska | 75.6% | 23,000 | 17,000 |
| Nevada | NA | NA | NA |
| New Hampshire | NA | NA | NA |
| New Jersey | NA | 90,000 | NA |
| New Mexico | 84.8% | 34,000 | 29,000 |
| New York | 16.1% | 423,000 | 68,000 |
| North Carolina | 83.3% | 98,000 | 82,000 |
| North Dakota | NA | NA | NA |
| Ohio | 82.1% | 146,000 | 120,000 |
| Oklahoma | 85.9% | 35,000 | 30,000 |
| Oregon | 44.4% | 54,000 | 24,000 |
| Pennsylvania | 78.1% | 187,000 | 146,000 |
| Rhode Island | NA | NA | NA |
| South Carolina | 82.3% | 43,000 | 36,000 |
| South Dakota | NA | NA | NA |
| Tennessee | 78.2% | 58,000 | 45,000 |
| Texas | 83.2% | 324,000 | 270,000 |
| Utah | NA | NA | NA |
| Vermont | NA | NA | NA |
| Virginia | 71.1% | 74,000 | 52,000 |
| Washington | 42.0% | 77,000 | 32,000 |
| West Virginia | 85.3% | 25,000 | 22,000 |
| Wisconsin | 77.5% | 87,000 | 67,000 |
| Wyoming | NA | NA | NA |
Notes: Long-term services and supports (LTSS) are health and social services provided to individuals who need assistance with daily living activities such as bathing, dressing, toilet care, shopping, preparing meals, housekeeping, and managing medications. We do not report data for states in which the total direct care workforce sample size is less than 250. We also do not report counts and shares of affected workers for states in which fewer than 1,000 workers are affected; this is the case for states in which the state minimum wage is already scheduled to reach $15 by 2025.
Sources: Campbell et al. 2021 and Economic Policy Institute Minimum Wage Simulation Model; see Technical Methodology by Cooper, Mokhiber, and Zipperer (2019).
Direct care workers are on the front lines of meeting a large and growing need for support with daily activities (Campbell et al. 2021). Yet their work is deeply undervalued, reflecting the racism, sexism, and xenophobia these workers face, and intersecting with the ableism and ageism faced by those they care for. The result is policy choices that marginalize and deprioritize long-term services and supports, including the historical exclusion of domestic workers—a group that includes some direct care workers—from important labor standards (Gould, Sawo, and Banerjee 2021).
Raising the minimum wage to $15 is an important step toward ensuring economic security for direct care workers and their families. However, raising the minimum wage does not in itself guarantee adequate and equitable wages for care workers nor does it address the care work and demographic pay penalties they face (Gould, Sawo, and Banerjee 2021). Lawmakers at all levels of government should also take further action by passing policies that encourage even stronger wages, benefits, and protections for these workers—such as strengthening collective bargaining rights and following the lead of the 10 states and two major cities that have passed Domestic Workers Bills of Rights (NDWA 2021). Raising labor standards for direct care workers should be coupled with public investments that make long-term support services more accessible and affordable (Palladino and Mabud 2021).
Methodology
The estimates in this report combine two different data sources: shares and distributions of affected workers from the Economic Policy Institute Minimum Wage Simulation Model (Cooper, Mokhiber, and Zipperer 2019) and direct care workforce employment counts from Campbell et al. (2021).
The estimates of the shares and demographics of affected workers and expected wage increases come from our analysis of the 2021 Raise the Wage Act using the Economic Policy Institute Minimum Wage Simulation Model. The results in this memorandum are the projected effects of the policy in 2025. The model incorporates all already scheduled state and local minimum wage increases through 2025 and includes all wage and salary workers with valid wage values, excluding the self-employed and those working abroad. A description of the detailed methodology can be found in Cooper, Mokhiber, and Zipperer 2019.
In the simulation, direct care workers who work in LTSS settings are defined using the 2018 American Community Survey (ACS) occupation categories personal care aides (3602), home health aides (3601), and nursing assistants (3603) and the 2017 ACS industry codes nursing care facilities (8270), residential care facilities (8290), home health care services (8170), and individual/family services (8370).
The ACS-based employment counts for these occupation categories are lower than establishment survey-based counts such as the BLS Occupational Employment and Wage Statistics (OEWS). We make the assumption that the household-based ACS survey undercounts this workforce and that the OEWS is the more accurate of the two surveys. We therefore estimate the total direct care employment levels using the 2018 OEWS-based values on page 18 of Campbell et al. 2021 for direct care employment in home care and in nursing and residential care homes. Conceptually these are similar to the ACS categories we use, except that Campbell et al.’s (2021) estimates use the narrower “services for the elderly and persons with disabilities” industry in the place of the broader “individual/family services,” which is the most detailed industry category available for these workers in the ACS.
To estimate 2025 total and affected direct care LTSS counts, we increase the Campbell et al. 2021 workforce estimates for 2018 by a projected 4.22% population growth factor (see Cooper, Mokhiber, and Zipperer 2019) and multiply them by the shares affected, which we estimate using ACS data.
Using the overall share of LTSS direct care workers who are affected (rather than using separate “affected” shares from the ACS for the two subsets of LTSS direct care workers, in-home and nursing and residential care home workers), we estimate that 23,000 more workers will be affected. To ensure that the values in the last two rows of Table 1 sum to a consistent level, we distribute these 23,000 affected workers to the two subcategories based on their share of the overall LTSS direct care workforce. This changes the separate estimates of the shares of workers affected in these two subcategories by less than 1%.
Number and share of direct care workers in LTSS who would benefit from the Raise the Wage Act of 2021, by state
| State | Total LTSS direct care workforce | Total number of affected LTSS direct care workers | Share of LTSS direct care workers affected |
|---|---|---|---|
| Alabama | 37,000 | 31,000 | 84.8% |
| Alaska | NA | NA | NA |
| Arizona | 59,000 | 39,000 | 66.3% |
| Arkansas | 36,000 | 32,000 | 87.4% |
| California | 471,000 | NA | NA |
| Colorado | 44,000 | 24,000 | 55.1% |
| Connecticut | 54,000 | NA | NA |
| Delaware | NA | NA | NA |
| District of Columbia | NA | NA | NA |
| Florida | 152,000 | 115,000 | 75.7% |
| Georgia | 61,000 | 49,000 | 80.7% |
| Hawaii | NA | NA | NA |
| Idaho | 19,000 | 15,000 | 78.2% |
| Illinois | 145,000 | 2,000 | 1.4% |
| Indiana | 66,000 | 52,000 | 79.6% |
| Iowa | 41,000 | 31,000 | 75.0% |
| Kansas | 34,000 | 29,000 | 83.5% |
| Kentucky | 32,000 | 26,000 | 80.4% |
| Louisiana | 54,000 | 48,000 | 89.3% |
| Maine | 22,000 | 15,000 | 67.6% |
| Maryland | 53,000 | NA | NA |
| Massachusetts | 96,000 | NA | NA |
| Michigan | 115,000 | 84,000 | 73.2% |
| Minnesota | 97,000 | 41,000 | 42.3% |
| Mississippi | 26,000 | 23,000 | 90.7% |
| Missouri | 77,000 | 65,000 | 84.4% |
| Montana | NA | NA | NA |
| Nebraska | 23,000 | 17,000 | 75.6% |
| Nevada | NA | NA | NA |
| New Hampshire | NA | NA | NA |
| New Jersey | 90,000 | NA | NA |
| New Mexico | 34,000 | 29,000 | 84.8% |
| New York | 423,000 | 68,000 | 16.1% |
| North Carolina | 98,000 | 82,000 | 83.3% |
| North Dakota | NA | NA | NA |
| Ohio | 146,000 | 120,000 | 82.1% |
| Oklahoma | 35,000 | 30,000 | 85.9% |
| Oregon | 54,000 | 24,000 | 44.4% |
| Pennsylvania | 187,000 | 146,000 | 78.1% |
| Rhode Island | NA | NA | NA |
| South Carolina | 43,000 | 36,000 | 82.3% |
| South Dakota | NA | NA | NA |
| Tennessee | 58,000 | 45,000 | 78.2% |
| Texas | 324,000 | 270,000 | 83.2% |
| Utah | NA | NA | NA |
| Vermont | NA | NA | NA |
| Virginia | 74,000 | 52,000 | 71.1% |
| Washington | 77,000 | 32,000 | 42.0% |
| West Virginia | 25,000 | 22,000 | 85.3% |
| Wisconsin | 87,000 | 67,000 | 77.5% |
| Wyoming | NA | NA | NA |
Notes: Long-term services and supports (LTSS) are health and social services provided to individuals who need assistance with daily living activities such as bathing, dressing, toilet care, shopping, preparing meals, housekeeping, and managing medications. We do not report data for states in which the total direct care workforce sample size is less than 250. We also do not report counts and shares of affected workers for states in which fewer than 1,000 workers are affected; this is the case for states in which the state minimum wage is already scheduled to reach $15 by 2025.
Sources: Campbell et al. 2021 and Economic Policy Institute Minimum Wage Simulation Model; see Technical Methodology by Cooper, Mokhiber, and Zipperer (2019).
References
Campbell, Stephen, Angelina Del Rio Drake, Robert Espinoza, and Kezia Scales. 2021. Caring for the Future: The Power and Potential of America’s Direct Care Workforce. PHI, January 2021.
Cooper, David, Zane Mokhiber, and Ben Zipperer. 2019. Minimum Wage Simulation Model Technical Methodology. Economic Policy Institute, February 2019.
Cooper, David, Zane Mokhiber, and Ben Zipperer. 2021. Raising the Federal Minimum Wage to $15 by 2025 Would Lift the Pay of 32 Million Workers: A Demographic Breakdown of Affected Workers and the Impact on Poverty, Wages, and Inequality. Economic Policy Institute, March 2021.
Economic Policy Institute (EPI). 2021. Minimum Wage Tracker. Accessed May 17, 2021.
Gould, Elise, Marokey Sawo, and Asha Banerjee. 2021. “Care Workers Are Deeply Undervalued and Underpaid: Estimating Fair and Equitable Wages in the Care Sectors.” Working Economics Blog (Economic Policy Institute), July 16, 2021.
National Domestic Workers Alliance (NDWA). 2021. “Passed Legislation: States and Cities with a Domestic Workers Bill of Rights” (web resource). Accessed July 16, 2021.
Palladino, Lenore M., and Rakeen Mabud. 2021. It’s Time to Care: The Economic Case for Investing in a Care Infrastructure. TIME’S UP Foundation, February 2021.
