Health and Health Care Experiences of Direct Care Workers

Direct care workers — who include 4.6 million personal care aides, home health aides, and nursing assistants — support the health and well-being of older adults and people with disabilities across long-term care settings. However, as primarily low-income women of color and immigrants, these workers are likely to experience considerable health disparities themselves. As one example, less than half of all direct care workers (46%) have employer-sponsored health insurance, and 15% have no coverage. Lack of health insurance and other barriers to health care put direct care workers at risk of missing work or leaving the workforce altogether, with catastrophic consequences for their economic security and for the continuity and quality of the services they provide. Beyond this general understanding, however, little is known about direct care workers’ health and the specific barriers to health care they face. By addressing this knowledge gap, this study will help inform efforts to support the health of direct care workers and, in turn, stabilize this essential workforce.

The purpose of this study is to describe direct care workers’ health and their experiences with the health care system. Specifically, we will analyze National Health Interview Survey (NHIS) data to provide a detailed picture of direct care workers’ health status; health insurance coverage; and ability to access, utilize, and afford health care services. We will also examine how these factors vary across the direct care workforce by demographic and other characteristics.


Key Questions

  • What is the health status of direct care workers, defined as self-reported health and likelihood of experiencing common health conditions?
  • What proportion of direct care workers have health insurance and what are the key characteristics of their coverage?
  • What are direct care workers’ experiences with health care access, utilization, and affordability?
  • How do these health-related factors vary across different segments of the direct care workforce?


This study is a collaboration with PHI.

For more information, contact Laura Wagner.