This project aims to estimate the size of the “gray market” home care workforce—self-employed workers hired directly by consumers and paid out of pocket—and to examine the characteristics of consumers who employ them. Gray-market home care represents a substantial but largely undocumented segment of the home care sector, as government labor reports exclude these arrangements. Research suggests the gray market is significant, particularly in rural areas, with workers drawn to these jobs for higher wages and flexibility, despite the lack of labor protections and training.

Using pooled data from the Medical Expenditure Panel Survey (MEPS) from 2019 to 2023, this study will provide the first national estimates of gray-market home care utilization, expenditures, and consumer demographics. Findings will help inform strategies to improve job quality for gray-market workers and enhance care quality for individuals and families relying on this segment of the workforce.