Growth and Demographic Implications in Nursing Care Occupations

There is a high demand for nursing and residential care facilities in the United States as many families rely on others to care for their older parents. As a result of the Post–World War II baby boom, the U.S. Census Bureau reports that the number of people ages 65 and older is expected to grow from 40 million to 72 million between 2010 and 2030, representing 19% of the population. Moreover, the U.S. Bureau of Labor Statistics (BLS) reports that this increasing population of older adults will result in job growth for industries that provide care to the elderly. Therefore, employment in nursing care facilities nationwide is predicted to rise by more than 24% from 2008 to 2018. Over this 10-year period, almost 400,000 new jobs will become available. Table 1 reports that although federal, state, and local government industries are not showing much growth, most likely due to the recession, the private industry is growing quickly. From the third quarter of 2010 to the second quarter in 2011 the private industry produced 872 new establishments across the United States.

Table 1.		Number of Establishments
	3rd Quarter 2010	4th Quarter 2010	1st Quarter 2011	2nd Quarter 2011
Private	70,244	70,399	70,891	71,116
Local	822	818	822	820
State	930	926	916	892
Federal	9	9	9	9

Source: Bureau of Labor Statistics, Nursing and Residential Care Facilities: NAICS 623, http://www.bls.gov/iag/tgs/iag623.htm

Occupation and Employment. According to BLS, nursing and residential care employment has grown from 1.6 million workers in May 2010 to 3.2 million workers in January 2012, and is projected to grow faster than other occupations. Furthermore, this industry has a diverse variety of occupations. Figure 1 shows that the largest sub-sector is composed of healthcare support consisting of a total of 686,160 or 42 percent of workers in the whole industry. The healthcare support sector includes occupations such as home health aids, nursing aids, therapy assistants, and medical assistants.

Source: Bureau of Labor Statistics, May 2010 National Industry-Specific Occupational Employment and Wage Estimates, http://www.bls.gov/oes/current/naics4_623100.htm#00-0000

The vast majority of all jobs fall within ten occupations. These occupations accounted for about 78 percent of total employment in the nursing care facilities. Of those 10 occupations, the highest employment is composed of workers who provide direct care under the supervision of nursing and medical staff. Figure 2 shows the highest numbers of workers who provide direct service are nursing aides also known as orderlies or attendants. In May 2010, these positions summed up to 616,590 workers, or 37.2% percent of the total employment in the industry. This occupation is also projected to grow by 19% from 2008 to 2018. Nevertheless, BLS reports that employment growth is not expected to be as fast as for other healthcare support occupations, because nursing aides are concentrated in the slower growing nursing and residential care facilities industry sector. Growth will be hindered because of reliance on government funding, which does not increase as fast as the cost of patient care. As a result, government funding will limit the number of nursing aides that the nursing facilities can afford to have on staff. Since the supply of nursing aids is growing slower than the demand, this generally results in nursing facilities being continuously short-staffed.

Nonetheless, nursing aides have an array of responsibilities. They spend the most amount of time with clients compared to any other staff member, and do tasks such as feeding, dressing, bathing, and cleaning up after clients who are sick or incontinent. As a result they are required to get vaccinated and attend frequent trainings. They are also responsible for monitoring and documenting client’s vital signs, food and fluid intake. Additionally, these workers must possess high physical and emotional strengths with an array of soft skills, such as patience and sensitivity.

Source: Bureau of Labor Statistics, May 2010 National Industry-Specific Occupational Employment and Wage Estimates, http://www.bls.gov/oes/current/naics4_623100.htm#00-0000

Wages. Table 2 shows employment and wages for the 10 largest occupations in the industry. Occupations in food, cleaning, laundry, recreational, and health aid are among the lowest paying, amounting to less than a median of $12 an hour. However, the largest occupation remains that of nursing aids. The top 10 percent of nursing aids earn around $16 while the bottom 10 percent earn a little over $8. It is also important to note that annual earnings may be lower because some people do not work full time or year-round, yet annual wages have been calculated by multiplying the hourly mean wage by “year-round, full-time” hours. In fact, the average hours worked by all employees was around 32, eight hours short of full-time.

Table 2. Occupation with largest employment in nursing care facilities and respective wages: May 2010
Occupation	Employment	Median Hourly	Mean Annual
Nursing aides, orderlies, and attendants	616,590	$11.23	$24,250
Licensed practical and licensed vocational nurses	217,020	$20.06	$42,590
Registered nurses	134,460	$27.97	$59,990
Maids and housekeeping cleaners	80,580	$9.29	$20,740
Home health aides	43,660	$10.40	$22,090
Food preparation workers	43,700	$9.25	$20,920
Cooks, institution and cafeteria	47,190	$10.87	$23,700
Recreation workers	33,760	$11.36	$25,220
Laundry and dry-cleaning workers	30,910	$9.31	$20,780
Food servers, non-restaurant	38,920	$9.23	$20,650

Source: Bureau of Labor Statistics, May 2010 National Industry-Specific Occupational Employment and Wage Estimates, http://www.bls.gov/oes/current/naics4_623100.htm#00-0000

Figure 3 displays a distribution of wages among all of the occupation sectors in the nursing and residential care industry, showing that wages vary widely. Occupations in management have the highest wages with annual mean of $79,980. The second highest paid group, earning an annual mean of over $50,000 consists of occupations in computer & mathematics, life, physical, & social science, and business & financial. The lowest earning occupations, with an annual mean earnings of less than $25,000 consist of healthcare support, transportation, cleaning &maintenance, food preparation & serving, and production. The majority of occupations with the largest employment had an annual wage below the overall median of $33,210.

Source: Bureau of Labor Statistics, May 2010 National Industry-Specific Occupational Employment and Wage Estimates, http://www.bls.gov/oes/current/naics4_623100.htm#00-0000

Demographic Characteristics of Workers and Wages. According to BLS, minority populations occupy about 50% of the positions in the nursing and residential care industry. Around 35% of workers are African-American, 15% are Latino, and 4% are Asian. Furthermore, women are overrepresented in this industry consisting of 88%. More than 1.2 million women provide care for the elderly in nursing and residential care facilities compared to 173,00 men. Moreover, women’s median weekly earnings amount to $427 compared to men who earn $488.

Implications. Throughout history women have generally dominated roles in care taking and social assistance.  The data above shows that wages for these occupations are significantly lower when compared to other occupations. In addition, women earn less than men in the same occupations. In the year of 2007, BLS reported that women overall, who were full-time wage and salary workers, had earnings of 20% less than their male counterparts. What’s more is that African-American and Hispanic women earn less than their white female colleagues.

Although women are earning very low wages with limited advancement opportunities they are also making big sacrifices and facing high risks. Most workers are required to do double shifts when the facility is short staffed as well as work all shifts, including nights, weekends, and holidays. Moreover, according to BLS, the incidence of injury and illness among nursing facility workers is higher than that of workers in other industries. Due to the nature of this job, workers are at constant risk of exposure to infections and diseases and yet their income remains significantly less when compared with other occupations.