53

Occupational Composition of the 

Elder Care Industries, May 2005

By Audrey Watson

Audrey Watson is an economist in the Division of Occupation Employment 

Statistics, Bureau of Labor Statistics.

As the first of the baby boomers turned 60 this year, 

the United States is in the midst of one of the most 

notable demographic trends of the past century: the 

aging of the U.S. population. The growth of the elderly population has significant economic implications for the coming 

decades. Among these implications are effects on the Nation’s industrial and occupational structure, as the economy 

adapts to accommodate the special needs of the aged. This 

article looks at four industries: home health care services, 

nursing care facilities, community care facilities for the elderly, and services for the elderly and disabled—here collectively called the elder care industries. Due to their focus 

on a primarily elderly clientele, these industries are likely to 

be highly affected by this demographic trend. In particular, 

the article focuses on the occupational composition of these 

industries, examining both the general occupational structure 

and selected detailed occupations.

The elderly population

The share of the U.S. population that is elderly has risen 

steadily throughout the last 100 years. In 1900, 4.1 percent 

of the U.S. population was age 65 or older. By 1950, the elderly made up 8.1 percent of the population, and by 2000, 

this share had risen to 12.4 percent. This demographic trend 

is expected to continue well into this century. By 2030, 19.7 

percent of the population is projected to be 65 or older, and 

by 2050, nearly 21 percent of the population is projected to 

be in this age group. Within the older population, there has 

been an especially sharp rise in the share of the very old, 

those 85 or older. While this group made up only about 0.2 

percent of the population in 1900 and 0.4 percent in 1950, the 

2000 census showed 1.5 percent of the population to be in 

this age group, a figure that is expected to rise to 2.6 percent 

in 2030 and to nearly 5 percent in 2050.1 

The needs of this growing elderly population differ from 

those of the population at large, particularly with respect to 

health status and physical and mental impairment. Illness and 

disability are especially prevalent among the very old, who 

are also more likely than younger seniors to live in nontraditional residential settings, such as nursing care facilities.2

Older Americans—and in particular the very old, with their 

more specialized needs—constitute the primary clientele for 

the four elder care industries: home health care services, nursing care facilities, community care facilities for the elderly, 

and services for the elderly and persons with disabilities. 

While companies in many industries will need to take the 

expanding elderly population into account as part of a successful business strategy, for these elder care industries the 

number and needs of older Americans serve as fundamental 

determinants of the industries’ size, structure, and future.

Overview of the elder care industries

The four elder care industries provide a variety of residential, health care, and other services to the elderly population. 

The first of these industries, home health care services, specializes in providing skilled nursing services in the patient’s 

own home. In addition, establishments in this industry may 

provide personal care; homemaker and companion services; 

counseling; or physical, occupational, and vocational therapy. Home health care agencies, in-home hospice care, and 

visiting nurse associations are examples of establishments 

found in this industry. Nursing care facilities provide inpatient nursing and rehabilitative services, generally for an 

extended period of time. Nursing homes, homes for the elderly with nursing care, inpatient hospices, and convalescent 

homes or hospitals (except psychiatric) are classified in this 

industry. Community care facilities for the elderly provide 

residential and personal care services, including room, board, 

supervision, and assistance in activities of daily living, for 

1

 Historical census data are from Frank Hobbs and Nicole Stoops, 

Demographic Trends in the 20th Century (U.S. Census Bureau, Census 

2000 Special Reports, Series CENSR-4, 2002), p. 56, figure 2–4. Population 

projections data are from U.S. Census Bureau, U.S. Interim Projections by 

Age, Sex, Race, and Hispanic Origin, table 2a, Projected Population of the 

United States, by Age and Sex: 2000 to 2050. [Online, 2004]. Available at 

http://www.census.gov/ipc/www/usinterimproj/. 2 Older Americans Update 2006: Key Indicators of Well-Being 

(Washington, Federal Interagency Forum on Aging-Related Statistics, 

2006), p. 54.
54

the elderly and other persons who either are unable or prefer 

not to live independently. Establishments in this industry may 

also provide nursing care in separate onsite facilities. Assisted living facilities, continuing care retirement communities, 

and rest homes or homes for the elderly without nursing care 

are found in this industry. Finally, services for the elderly 

and persons with disabilities provide a variety of nonresidential social assistance services to the elderly and disabled. 

These services include adult day care, nonmedical home care 

or homemaker services, social activities, group support, and 

companionship.

With over 1.6 million employees in 2005, nursing care facilities have the highest employment among the elder care 

industries, nearly twice as high as employment in the next 

largest industry, home health care services. Nursing care facilities represent approximately 10 percent of healthcare and 

social assistance sector employment, and home health care 

services represent an additional 5 percent. Community care 

facilities for the elderly employed over 600,000 workers in 

2005, or about 4 percent of total healthcare and social assistance employment. Services for the elderly and persons with 

disabilities has the smallest employment of the four industries; with just under 500,000 workers, this industry employs 

about 3 percent of all workers in the healthcare and social 

assistance sector.3

Employment growth

With the exception of nursing care facilities, the elder care industries have experienced phenomenal employment growth 

over the last decade and a half. Total nonfarm employment grew by 22 percent between 1990 and 2005, and by 

only slightly more than 1 percent between 2000 and 2005.4

In contrast, employment in home health care services grew 

by 183 percent between 1990 and 2005, and 29 percent between 2000 and 2005. Services for the elderly and disabled 

experienced a comparable employment growth rate of 173 

percent over the 1990–2005 period, and in recent years has 

grown even more rapidly than home health care services: 56 

percent between 2000 and 2005. While below the extraordinary growth rates of these two industries, the growth rate for 

community care facilities for the elderly has also been much 

higher than average: 85 percent between 1990 and 2005, and 

28 percent between 2000 and 2005. Nursing care facilities, 

however, have grown at a rate much more comparable to that 

of total nonfarm employment. Between 1990 and 2005, employment in nursing care facilities grew by 35 percent, but 

between 2000 and 2005, it grew by only about 4 percent. The 

relatively slow growth rate of this industry may reflect the 

increased availability of alternative forms of care, such as 

home health care or community care facilities, which may be 

preferred to nursing care facilities by the elderly population. 

Trend data show that nursing home residents have become 

older and less independent since the 1970s, consistent with 

this interpretation of nursing homes as a “last resort” for the 

oldest and frailest of seniors.5

Building on this history of fast employment growth, several of the elder care industries are expected to continue to 

grow rapidly in the near future. While overall nonfarm employment is projected to grow 13 percent between 2004 and 

2014, employment in the home health care services industry 

is projected to grow by nearly 70 percent, or over 537,000 

workers, over this same period. Based on this projection, 

home health care services is expected to be the second-fastest-growing industry in percentage terms over this period, 

and the eighth largest in terms of absolute job growth. Similarly, community care facilities for the elderly are projected 

to grow by over 319,000 workers between 2004 and 2014; 

this projected 55-percent employment increase is sufficient 

to make it the fifth-fastest-growing industry in percentage 

terms. Services for the elderly and disabled are projected to 

grow by over 150,000 workers, or nearly 39 percent. Nursing care facilities are the exception: with projected employment growth of less than 12 percent (181,300 workers), this 

industry is expected to grow more slowly than employment 

as a whole.6

Aging of the elderly

The elder care industries—at least those for which supplemental data are available—appear to serve a particularly vulnerable segment of the elderly population. According to data 

from the 2000 census, of the population 65 and older, approximately 53 percent were 65 to 74, 35 percent were 75 to 84, 

and the rest were 85 or older.7 However, of the 71 percent of 

3

 Bureau of Labor Statistics, Quarterly Census of Employment and 

Wages. [Online]. Available at http://www.bls.gov/cew/home.htm/. The 

Quarterly Census of Employment and Wages (QCEW) program publishes a 

quarterly count of employment and wages reported by employers covering 

98 percent of U.S. jobs, available at the county, MSA, state, and national 

levels by industry. Data are preliminary 2005 annual averages for all 

employees. Data represent all types of ownership, although 92 percent or 

more of employment in these industries is in the private sector. 4

 Bureau of Labor Statistics, Current Employment Statistics. [Online]. 

Available at http://www.bls.gov/ces/home.htm/. The Current Employment 

Statistics (CES) program conducts a monthly survey of about 160,000 

businesses and government agencies, representing approximately 400,000 

individual worksites, in order to provide detailed industry data on 

employment, hours, and earnings of workers on nonfarm payrolls.

5

 Decker, F. H. Nursing homes, 1977–99: What has changed, what has 

not? (Hyattsville, MD, National Center for Health Statistics, 2005), p. 5. 

For example, less than 6 percent of nursing home residents could bathe 

independently and less than 13 percent could dress independently in 1999, 

down from 13 percent and 30 percent, respectively, in 1977. However, 

disability rates in the general elderly population have fallen in recent years: 

an age-adjusted 20 percent of Medicare enrollees 65 and older were disabled 

in 1999, down from 25 percent in 1984 (Older Americans Update 2006, p. 

28).

6

 Bureau of Labor Statistics, 2004–2014 employment projections. 

[Online]. Available at http://www.bls.gov/emp/home.htm/. Data on 

industries with the largest projected employment increases are from 

Bureau of Labor Statistics, 2004–2014 employment projections, ”Fastest 

Growing Industries.” [Online, 2005]. Available at http://www.bls.gov/

emp/empfastestind1.htm/. The Office of Occupational Statistics and 

Employment Projections develops information about the labor market for 

the Nation as a whole for 10 years in the future. 7

 Hetzel, Lisa, and Annetta Smith, The 65 Years and Older Population: 

2000 (U.S. Census Bureau, Census 2000 Brief, C2KBR/01-10, 2001), table 1. 
55

home health care patients who are 65 or older, about 25 percent are in the 65 to 74 age group, 44 percent are 75 to 84, and 

31 percent are 85 or older.8 The nursing home population is 

skewed even more heavily towards the oldest seniors. Ninety 

percent of nursing home residents are 65 or over; of these, 

only 13 percent are 65 to 74, 35 percent are 75 to 84, and the 

majority―nearly 52 percent―are 85 or older.9 Community 

care facilities are also disproportionately utilized by older seniors. While only about 1 percent of those 65 through 74 live 

in community housing with services, 8 percent of those 85 

and older live in this type of residential setting.10

Users of these services are older than the general senior 

population and are more likely to have functional limitations. 

Of the population 65 and older who live in a traditional community, 27 percent have limitations in one or more activities 

of daily living (ADLs). However, about 47 percent of residents of community housing with services and 82 percent of 

residents of long term care facilities have ADL limitations.11

Similarly, of users of home health care services 65 and over, 

59 percent received help with one or more ADLs.12 For 

both nursing home residents and clients of home health care 

services, bathing and dressing were the two activities most 

likely to require assistance.13 In addition to assistance with 

ADLs, elderly clients also received a range of medical and 

other services. Of home health care patients 65 and older, 74 

percent received skilled nursing services; 51 percent received 

personal care; and 36 percent received therapeutic services, 

such as occupational or physical therapy.14 In nursing homes, 

nearly all patients 65 and older—over 96 percent—had received nursing services in the last 30 days. Nearly 91 percent 

had received personal care, 71 percent had received social 

services, 26 percent had received physical therapy, and 18 

percent had received occupational therapy. 

The needs of this population, coupled with the types of 

services provided by these establishments, offer clues to the 

occupational composition of these industries. Because of the 

high levels of nursing and other health care services provided, 

healthcare workers are clearly a vital component of these industries. Social service and personal care occupations are also 

important, while nursing care and community care facilities 

must provide additional services associated with a residential 

setting, such as food service and housekeeping. The next section provides a broad overview of the staffing patterns in the 

four elder care industries, focusing on the breakdown among 

major occupational groups.

General occupational composition

Because they serve the same general population and provide some overlap in services, the four elder care industries 

share some basic features of occupational composition. For 

example, health care workers make up a large percentage of 

employment in all four industries, while personal care and 

service occupations are also important in several of the industries. Similarly, employment of certain other occupational 

groups, such as computer and mathematical occupations and 

construction and extraction occupations, is negligible in all 

four industries. However, the four industries also exhibit 

some variation in occupational composition, with the industries providing the narrowest range of services or focusing 

strongly on a particular subset of the elderly population generally showing the least occupational diversity. This section 

provides a broad overview of occupational composition in the 

four elder care industries. Although the focus is on the distribution of employment across major occupational groups, key 

detailed occupations will also be highlighted, some of which 

will be discussed later in more detail.

Home health care, which provides the narrowest range of 

services—primarily health care and personal care services 

in the client’s own home—appears to have the least varied 

occupational composition of the four industries. Nearly 84 

percent of employment is concentrated in just three occupational groups: healthcare support occupations, healthcare 

practitioner and technical occupations, and personal care and 

service occupations. These occupations make up 33 percent, 

26 percent, and 25 percent of industry employment, respectively. (See table 1 and chart 1.) 

Employment also tends to be concentrated in only a few 

occupations within each of these groups. In the healthcare 

support occupational group, 84 percent of employment is 

in a single occupation, home health aides. Because of this 

occupation’s close association with the home health care services industry, home health aides is also the industry’s largest occupation, employing over 224,000 workers and making 

up nearly 28 percent of total industry employment. Almost 

all of the remaining employment in the healthcare support 

8

 National Center for Health Statistics, National Home and Hospice 

Care Survey, current home health care patients, p. 1, table 1, and author’s 

calculations. [Online, 2004]. Available at http://www.cdc.gov/nchs/data/

nhhcsd/curhomecare00.pdf/. NCHS surveys hospice care separately from 

nursing homes and home health care, although under the North American 

Industry Classification System, inpatient hospice care is classified in nursing 

care facilities and home hospice care is classified in home health care 

services. 9 The National Nursing Home Survey, 1999 Summary [Hyattsville, MD, 

National Center for Health Statistics, DHHS Publication No. (PHS) 2002–

1723, 2002], p. 12, table 7, and author’s calculations. 10 Older Americans Update 2006, p. 54. 11 Older Americans Update 2006, p. 56. Persons with ADL limitations 

have difficulty performing or are unable to perform for health reasons 

one or more of the following: bathing, dressing, eating, getting in/out of 

chairs, walking, or using the toilet. Persons without ADL limitations may 

still require assistance with instrumental activities of daily living, such as 

using the telephone, light or heavy housework, meal preparation, shopping, 

or managing money. 12 National Home and Hospice Care Survey, 2004, p. 10, table 9, and 

author’s calculations. Note that these data measure the percentage of 

patients for whom home health care agencies provide help with a functional 

limitation; this may not be the same as the percentage who possess a 

functional limitation, since some patients may receive help from other 

sources, such as friends or relatives. 13 National Home and Hospice Care Survey, 2004, p. 10, table 9; National 

Nursing Home Survey, 1999 Summary, 2002, p. 24, table 19; and author’s 

calculations. 14 National Home and Hospice Care Survey, 2004, p. 7, table 7; National 

Nursing Home Survey, 1999 Summary, 2002, p. 26, table 21; and author’s 

calculations.
56

group is composed of nursing aides, orderlies, and attendants. 

Employment in the personal care and services occupational 

group is even more concentrated, with over 98 percent of 

workers in this group employed as personal and home care 

aides. With over 198,000 workers, this is the second largest 

occupation in the industry. 

Employment in the healthcare practitioner and technical 

occupations is slightly more diversified. About 56 percent of 

employees in this occupational group are registered nurses 

(117,050 workers), and an additional 25 percent are licensed 

practical and licensed vocational nurses (52,700 workers). 

In addition to nursing care, general home health care, and 

personal care, establishments in this industry may also provide more specialized services, including various types of 

therapy, nutrition services, and medications. Consequently, 

an additional 8 percent of employment in this group is made 

up of physical therapists (16,360 workers), and the industry 

also employs smaller but still significant numbers of occupational therapists, respiratory therapists, speech language 

pathologists, dietitians and nutritionists, pharmacists, pharmacy technicians, and medical records and health information technicians.

Outside of these healthcare and personal care occupations, 

only three other occupational groups make up more than 1 

percent of employment in home health care services. Office and administrative support occupations make up about 

8 percent of industry employment, with employment split 

across a variety of occupations in this group. Management 

occupations account for an additional 3 percent of industry 

employment. Within this occupational group, medical and 

health services managers make up about 42 percent of employment, and general and operations managers account for 

about another 32 percent. Finally, community and social service occupations make up 2 percent of industry employment. 

Medical and public health social workers, social and human 

service assistants, and clergy are the three largest occupations 

in this group.

Healthcare support and healthcare practitioner and technical workers are the two largest occupational groups in nursing care facilities. (See table 1 and chart 2.) Because nursing homes generally serve the oldest and most ill segment 

of the elderly population, healthcare occupations make up 

an even larger percentage of employment in this industry 

than in home health care services. Although healthcare practitioner and technical occupations make up only 23 percent 

of this industry, as compared with nearly 26 percent of the 

home health care industry, this is more than offset by a higher 

percentage of healthcare support workers, who make up 42 

Table 1. Employment in elder care industries by major occupational group, May 2005 

Services for the

Home health Nursing care Community care elderly and 

care services facilities facilities persons with 

for the elderly disabilities

Major occupational group

Percent Percent Percent Percent 

Employ- of Employ- of Employ- of Employ- of

ment industry ment industry ment industry ment industry

total total total total 

Total.................................................................................. 806,460 1,576,680 602,640 438,210

Management occupations ................................................... 24,890 3.1% 43,470 2.8% 20,540 3.4% 15,610 3.6%

Business and financial operations occupations................... 7,160 0.9 9,180 0.6 4,000 0.7 5,450 1.2

Computer and mathematical occupations ........................... 1,720 .2 640 .0 330 .1 660 0.2

Life, physical, and social science occupations .................... 870 .1 1,080 .1 740 .1 1,200 .3

Community and social services occupations....................... 19,260 2.4 24,700 1.6 10,260 1.7 48,300 11.0

Legal occupations................................................................ 30 .0 110 .0 NA NA 140 .0

Education, training, and library occupations........................ 220 .0 470 .0 200 .0 10,810 2.5

Arts, design, entertainment, sports, and media 

 occupations ....................................................................... 880 .1 890 .1 610 .1 1,270 .3

Healthcare practitioner and technical occupations.............. 208,330 25.8 363,640 23.1 70,180 11.6 15,300 3.5

Healthcare support occupations.......................................... 266,060 33.0 666,940 42.3 227,230 37.7 88,420 20.2

Protective service occupations............................................ 170 .0 3,020 .2 4,650 .8 430 .1

Food preparation and serving related occupations ............. 1,430 .2 176,950 11.2 110,450 18.3 10,060 2.3

Building and grounds cleaning and maintenance

 occupations ....................................................................... 3,330 .4 108,170 6.9 47,720 7.9 8,810 2.0

Personal care and service occupations............................... 201,410 25.0 44,610 2.8 44,260 7.3 179,100 40.9

Sales and related occupations ............................................ 2,460 .3 1,570 .1 1,690 .3 1,060 .2

Office and administrative support occupations.................... 64,710 8.0 71,440 4.5 35,300 5.9 33,440 7.6

Construction and extraction occupations............................. NA NA 190 .0 320 .1 NA NA

Installation, maintenance, and repair occupations .............. 880 .1 21,100 1.3 12,830 2.1 1,660 .4

Production occupations ....................................................... 320 .0 34,950 2.2 6,470 1.1 NA NA

Transportation and material moving occupations................ 2,310 .3 3,540 .2 4,810 .8 15,340 3.5

NOTE: Data may not add to 100 percent due to rounding. 

NA indicates data not available. 
57

Chart 1. Percent distribution of employment in home health care services by major occupational group, 

May 2005

Healthcare support

occupations (33.0%)

Personal care and service

occupations (25.0%)

Healthcare practitioner and

technical occupations (25.8%)

Community and social

services occupations (2.4%)

Management occupations

(3.1%) All other occupational groups 

(2.7%)

Office and administrative

support occupations (8.0%)

percent of nursing home employment, versus 33 percent in 

home health care services. In addition, the greater size of this 

industry means that it employs a larger absolute number of 

healthcare workers than do the other elder care industries. 

Nursing care facilities employ over 363,000 healthcare practitioner and technical workers and nearly 667,000 healthcare 

support workers, while home health care services, the second 

largest employer of both types of workers among the elder 

care industries, employs about 208,000 and 266,000 workers, 

respectively.

While home health aides constitute the largest occupation 

in the home health care services industry, nursing aides, orderlies, and attendants are the backbone of the nursing home 

workforce. This occupation makes up nearly 90 percent of 

healthcare support workers in nursing homes and, with over 

599,000 workers, is the largest single occupation in this industry. Home health aides, who made up nearly the entire 

healthcare support occupational group in the home health 

care services industry, account for less than 7 percent of 

healthcare support employment in this industry. As in the 

home health care services industry, registered nurses and licensed practical and licensed vocational nurses are the two 

largest healthcare practitioner and technical occupations by a 

large margin, together making up about 84 percent of this occupational group. However, the relative importance of these 

two occupations differs between the two industries. Nursing 

homes employ about 120,000 registered nurses and nearly 

187,000 licensed practical and licensed vocational nurses, or 

about 1.6 licensed practical and licensed vocational nurses 

per registered nurse. This differs noticeably from the ratio of 

approximately 0.5 licensed practical and licensed vocational 

nurses per registered nurse found in home health care services. The third largest occupation in this group, medical records 

and health information technicians, employs 12,660 workers. 

Nursing homes also employ significant numbers of dieticians 

and nutritionists, dietetic technicians, physical therapists, 

occupational therapists, recreational therapists, respiratory 

therapists, and speech language pathologists.

Although personal care and service occupations, and in 

particular personal and home care aides, made up a large 

proportion of home health care services employment, this 

occupational group makes up less than 3 percent of employ-
58

ment in nursing care facilities. Recreation workers make up 

about 69 percent of employment in this group, with personal 

and home care aides making up most of the remainder. The 

tasks carried out by personal and home care aides in a home 

care setting—such as cleaning, doing laundry, and preparing 

meals— are generally carried out by other staff in nursing 

homes. For example, over 11 percent of workers in nursing 

care facilities are in food preparation and serving related occupations, while nearly 7 percent are in building and grounds 

cleaning and maintenance occupations, primarily maids and 

housekeeping cleaners and janitors. Similarly, slightly over 

2 percent of employment is made up of production workers, 

almost all of whom are laundry and dry-cleaning workers.

At nearly 3 percent of total employment, the proportion 

of management occupations in nursing homes is similar to 

that in home health care services, with medical and health 

services managers and general and operations managers the 

two largest occupations in this group. Office and administrative support workers make up about 4.5 percent of employment. Finally, community and social services occupations 

make up about 1.6 percent of industry employment. About 

44 percent of these employees are medical and public health 

social workers, with social and human service assistants, rehabilitation counselors, and clergy making up most of the 

remaining employment in this group. Each of the remaining 

occupational groups makes up less than 1 percent of employment in this industry.

Like nursing care facilities, community care facilities provide the fuller variety of services associated with a residential 

environment, and therefore have a more diversified staffing 

pattern than found in home health care services. (See table 1 

and chart 3.) The two healthcare occupational groups make up 

nearly half (49 percent) of employment; however, this is less 

than the corresponding shares of 59 percent in home health 

care services and 65 percent in nursing care facilities. Within 

the healthcare practitioner and healthcare support group, registered nurses and licensed practical and licensed vocational 

nurses are once again the two largest occupations, making 

up about 85 percent of employment in this group. The ratio 

of 1.5 licensed practical and vocational nurses to registered 

nurses is about the same as the ratio of 1.6 found in nursing 

homes. This is perhaps not surprising, since establishments in 

Installation, maintenance, and

repair occupations (1.3%)

Management occupations

(2.8%)

Food preparation and serving

related occupations (11.2%)

Building and grounds

cleaning and maintenance

occupations (6.9%)

Office and administrative

support occupations (4.5%)

Community and social 

services occupations (1.6%)

All other occupational groups

(3.5%)

Personal care and service

occupations (2.8%)

Healthcare practitioner and

technical occupations

(23.1%)

Chart 2. Percent distribution of employment in nursing care facilities by major occupational group,

May 2005

Healthcare support

occupations (42.3%)
59

this industry may provide skilled nursing care in separate onsite facilities, which presumably use a staffing pattern similar 

to that found in stand-alone nursing homes. Dieticians and 

nutritionists, dietetic technicians, medical records and health 

information technicians, occupational therapists, physical 

therapists, and recreational therapists are among the other occupations with significant employment in this group, though 

at levels far below those for the nursing occupations. 

Home health aides and nursing aides, orderlies, and attendants make up nearly 97 percent of the healthcare support 

group. While one or the other of these occupations dominated in the home health care and nursing care industries, both 

occupations are prevalent in this industry: community care 

facilities employ approximately 92,000 home health aides 

and 128,000 nursing aides, orderlies, and attendants. The two 

occupations may be relatively similar in importance because 

these facilities can provide healthcare services both in home 

and in nursing facilities, with residents moving between the 

two settings as their needs dictate.

With over 18 percent of total employment, food preparation and serving related occupations are the second largest 

occupational group in this industry, after healthcare support 

occupations (38 percent of employment) and ahead of healthcare practitioner and technical occupations (12 percent of 

employment). Institutional and cafeteria cooks are the largest 

occupation in this group, followed by waiters and waitresses; 

nonrestaurant food servers; food preparation workers; and 

combined food preparation and serving workers, including 

fast food. Building and grounds cleaning and maintenance 

occupations, primarily maids and housekeeping cleaners, 

make up nearly 8 percent of industry employment. Personal care and service occupations make up over 7 percent of 

employment, with two occupations, personal and home care 

aides and recreation workers, making up about 84 percent 

of employment in this group. Office and administrative support occupations make up a further 6 percent of industry 

employment. At around 3 percent of industry employment, 

the proportion of management occupations in this industry is 

Chart 3. Percent distribution of employment in community care facilities for the elderly by major 

occupational group, May 2005

Management occupations

(3.4%) All other occupational groups

(4.0%)

Installation, maintenance, and

repair occupations (2.1%)

Healthcare support

occupations (37.7%)

Community and social 

services occupations (1.7%)

Healthcare practitioner and

technical occupations

(11.6%)

Personal care and service

occupations (7.3%)

Office and administrative

support occupations (5.9%)

Building and grounds

cleaning and maintenance

occupations (7.9%)

Food preparation and serving

related occupations (18.3%)

Note: Data may not add to 100 percent due to rounding.
60

roughly comparable to that in both nursing care facilities and 

home health care services. General and operations managers 

and medical and health services managers are the two largest 

occupations in this group, with about 6,000 workers each. 

Installation, maintenance, and repair occupations account 

for about 2 percent of industry employment, with about 92 

percent of workers in this group classified as general maintenance and repair workers. Community and social service 

occupations also make up about 2 percent of industry employment. As in the nursing home industry, social and human 

service assistants, medical and public health social workers, 

rehabilitation counselors, and clergy are among the largest 

occupations in this group. Production workers are the only 

remaining group making up at least 1 percent of employment; 

this industry is similar to nursing care facilities in that almost 

all of the employees in this group are laundry and dry-cleaning workers.

The final industry, services for the elderly and persons with 

disabilities, provides a variety of primarily nonmedical services, including day care, homemaking, and social activities. 

Consequently, this industry has a much lower concentration 

of employment in healthcare occupations than do the other 

elder care industries. Less than 25 percent of workers are employed in the two healthcare occupational groups, compared 

with nearly half or more in the other elder care industries. 

(See table 1 and chart 4.) With slightly over 20 percent of 

industry employment, healthcare support occupations remain 

a major source of employment, representing the second largest occupational group in this industry. However, healthcare 

practitioner and technical occupations make up less than 4 

percent of industry employment, roughly comparable to the 

employment share of management occupations. Within the 

healthcare support group, home health aides make up about 

90 percent of employment; nursing aides, orderlies, and attendants comprise most of the remainder. About 49 percent of 

healthcare practitioner and technical workers are registered 

nurses. Licensed practical and licensed vocational nurses 

make up an additional 23 percent of employment in this 

group. Occupational therapists and speech-language pathologists are the third- and fourth-largest occupations, although 

the employment difference between these two occupations is 

not statistically significant.

Although healthcare support workers represent the largest occupational group in the other three eldercare industries, 

Personal care and service

occupations (40.9%)

Office and administrative

support occupations (7.6%)

Transportation and material

moving occupations (3.5%)

All other occupational groups

(3.0%)

Management occupations

(3.6%)

Community and social

services occupations (11.0%)

Education, training, and

library occupations (2.5%)

Healthcare practitioner and

technical occupations (3.5%)

Healthcare support

occupations (20.2%)

Food preparation and serving

related occupations (2.3%)

Building and grounds

cleaning and maintenance

Note: Data may not add to 100 due to rounding. occupations (2.0%)

Chart 4. Percent distribution of employment in services for the elderly and persons with disabilities

by major occupational group, May 2005
61

personal care and service occupations have by far the largest employment share in services for the elderly and persons 

with disabilities. At nearly 41 percent of total employment, 

these occupations have more than twice the employment 

share of healthcare support workers. This employment share 

is also much higher than the 25 percent share of personal care 

and service occupations in the home health care industry. 

However, because of its larger size, the latter industry employs a larger absolute number of these workers. As in the 

home health care industry, the vast majority of workers in 

this group are personal and home care aides, who make up 

about 89 percent of occupational group employment. Recreation workers, child care workers, and first-line supervisors/

managers of personal care and service workers are the next 

largest occupations in this group, each making up between 3 

and 4 percent of occupational group employment.

Community and social service occupations represent the 

third largest occupational group in this industry, with 11 percent of industry employment. By comparison, this occupational group has an employment share of about 2 percent or 

less in the other elder care industries. No single occupation 

dominates in this major group. While social and human service assistants represent the largest occupation, with about 

35 percent of group employment, the remaining employment 

is split among rehabilitation counselors, medical and public 

health social workers, mental health and substance abuse social workers, and several other occupations.

Office and administrative support occupations make up 

nearly 8 percent of industry employment, and transportation and material moving occupations account for nearly 4 

percent. Of the four elder care industries, services for the 

elderly and persons with disabilities is the only industry to 

have an employment share of more than 1 percent in this occupational group. Bus drivers, school (including drivers of 

disabled and elderly clients); taxi drivers and chauffeurs; 

and truck drivers, light or delivery services make up about 

83 percent of these workers. This industry is also the only 

one of the four to employ a significant number of education, 

training, and library workers. However, with the exception 

of self-enrichment education teachers, most of the workers 

in this group appear to be more likely to serve the industry’s 

other constituency, persons with disabilities, than to serve the 

elderly. Within this group, teacher assistants are the largest 

occupation, representing about 43 percent of group employment; special education teachers, preschool, kindergarten, 

and elementary school; self-enrichment education teachers; 

and preschool teachers, except special education, make up 

most of the remaining employment. 

Food preparation and serving related occupations and 

building and grounds maintenance and cleaning occupations 

each represent about 2 percent of industry employment. Reflecting the nonresidential nature of these establishments, 

these employment shares are lower than the corresponding 

shares in nursing care facilities and community care facilities for the elderly, although slightly higher than the shares in 

home health care services. The remaining occupational groups 

each make up roughly 1 percent or less of this industry.

Selected detailed occupations in the elder care 

industries

The preceding discussion illustrates the consistent importance 

of several occupations across the elder care industries, such 

as registered nurses and personal and home care aides. This 

section takes a closer look at these two occupations as well 

as licensed practical and licensed vocational nurses; nursing 

aides, orderlies, and attendants; home health aides; medical 

and public health social workers; occupational therapists; 

physical therapists; speech-language pathologists; physical 

therapist assistants; and physical therapist aides. These occupations were chosen either because they make up a large 

proportion of employment in the elder care industries, or 

because one or more of the elder care industries represent 

major employers of workers in the occupation. In addition, 

all are occupations having direct contact with elderly patients 

or clientele. Finally, these occupations represent a wide spectrum of skill and education requirements, ranging from jobs 

requiring a bachelor’s or master’s degree, such as registered 

nurses and the therapist professions, to those requiring only 

a short period of on-the-job training, such as personal and 

home care aides. 

As a group, these occupations share some common features that are worth noting. First, they are highly female 

dominated. According to the 2005 Current Population Survey (CPS), with about 69 percent, physical therapists have 

the lowest proportion of women among the selected occupations15 (By comparison, women make up about 46 percent 

of the overall labor force.) The remaining occupations have 

even higher percentages of women, with the two nursing occupations, occupational therapists, and speech-language pathologists, each employing over 90 percent.

Second, with some exceptions, black and Hispanic workers appear to be concentrated in the less skilled and lower 

paying of these occupations. CPS data show that about 13 

percent of the overall labor force is Hispanic or Latino. 

However, the percentage of Hispanic workers is well below 

the labor force average in nearly all of the selected occupations. Of the 11 occupations under review, only personal and 

home care aides, nursing aides, and home health aides have 

higher-than-average percentages of Hispanic workers. For 

example, nearly 16 percent of personal and home care aides 

are Hispanic, and although no separate data are available for 

the other two occupations, the combination of nursing, psychiatric, and home health aides is 15 percent Hispanic. Similarly, these lower skilled occupations have a relatively high 

15 Bureau of Labor Statistics, Employment and Earnings, table 11, 

Employed persons by detailed occupation, sex, race, and Hispanic or Latino 

ethnicity. [Online, 2006]. Available at http://www.bls.gov/cps/cpsaat11.

pdf/. The Current Population Survey is a monthly survey of households 

conducted by the Bureau of Census for the Bureau of Labor Statistics. It 

provides a comprehensive body of data on the labor force, employment, 

unemployment, and persons not in the labor force.
62

proportion of black or African American workers. Over 24 

percent of personal and home care aides and nearly 33 percent of nursing, psychiatric, and home health aides are black 

or African American, compared with nearly 11 percent of the 

overall labor force. However, unlike Hispanic workers, black 

or African American workers appear to be well represented in 

the highly skilled nursing professions. Nearly 22 percent of 

licensed practical and licensed vocational nurses are black or 

African American, while the percentage of registered nurses 

who are black or African American is, at 10 percent, close 

to the labor force average. Although separate data are not 

available for medical and public health social workers, social 

workers as a whole have relatively high minority representation: 19 percent of them are black or African American and 

nearly 10 percent are Hispanic or Latino. This stands in sharp 

contrast to the similarly highly skilled therapist professions, 

which have low percentages of both black and Hispanic 

workers. The percentage of Asian workers in these selected 

occupations ranges from less than 1 percent for speech-language pathologists to 12 percent for occupational therapists, 

but most occupations are within 1 or 2 percentage points of 

the 4.4-percent labor force average.

Third, because of their association with the fast growing elder care industries, and with the health care sector in 

general, employment growth in several of the occupations is 

predicted to be extremely strong over the next few years. For 

example, home health aides have the fastest projected growth 

rate of any occupation, with an expected 56 percent employment increase between 2004 and 2014.16 This occupation is 

also eighth in terms of projected employment increase, with 

an expected increase of 350,000 jobs over the same period.17

Similarly, registered nurses are projected to add the second 

largest number of jobs between 2004 and 2014, approximately 703,000 workers. For some of these occupations, 

strong projected growth is compounded by high replacement 

needs due to the aging of the current workforce. In particular, 

the average age of registered nurses was nearly 47 in 2004, 

higher than the workforce average, and has been increasing 

steadily over the past two decades.18 

The remainder of this section focuses on industry employment and wage information for these selected occupations, 

along with brief descriptions of the occupations’ duties and 

education and training requirements.

Registered nurses. These workers provide direct patient care, 

but may also have supervisory and administrative duties. For 

example, in nursing homes, registered nurses may develop 

treatment plans and supervise licensed practical and licensed 

vocational nurses and nursing aides. In home health care, on 

the other hand, they may supervise home health aides and 

instruct family members in patient care.19 Registered nurses 

are employed in all four of the elder care industries, but are 

particularly important in nursing care facilities and home 

health care services. Registered nurses make up about 8 percent of total employment in the former industry, and about 15 

percent of employment in the latter. 

Approximately 57 percent of registered nurses are employed in a single industry, general medical and surgical hospitals, making this industry by far the largest employer of 

workers in this occupation. Other large employers are offices 

of physicians, which employ about 9 percent of registered 

nurses; nursing care facilities and home health care services, 

which each employ about 5 percent of registered nurses; and 

employment services, which employ about 4 percent. (See 

table 2.) By comparison, community care facilities for the 

elderly and services for the elderly and persons with disabilities are relatively small employers of registered nurses. 

This occupation makes up about 4 percent of employment 

in community care facilities and 1 percent of employment 

in services for the elderly and persons with disabilities, and 

each of these industries employs 1 percent or less of the total 

registered nurse workforce.

Registered nurses are the most skilled of the nursing and 

related healthcare support occupations. According to the 

2004 National Sample Survey of Registered Nurses, the 

highest level of preparation was a diploma from a hospitaladministered nursing program for 17.5 percent of registered 

nurses, an associate degree for 33.7 percent, a baccalaureate 

degree for 34.2 percent, and a master’s or doctoral degree 

for 13.0 percent. Over the past 20 years, educational preparation has shifted away from diploma programs towards associate, baccalaureate, and higher degrees, with the highest 

percentage increase (339 percent from 1980 to 2004) occurring among those for whom the highest level of preparation 

was a master’s or doctoral degree.20 This trend reflects the 

greater professional opportunities for those with higher levels of education. A bachelor’s degree is considered a prerequisite for many administrative positions and for admission 

into graduate nursing programs. Advanced practice nurses, 

such as nurse practitioners, nurse anesthetists, clinical nurse 

specialists, and nurse midwives, require at least a master’s 

degree. These nurses often function as primary care specialists, especially in underserved areas.21

The mean wage across all industries for registered nurses 

was $27.35 per hour, or $56,880 annually. However, pay in 

all four of the elder care industries is below this average, 16 Bureau of Labor Statistics, 2004–2014 employment projections, 

”Fastest growing occupations, 2004–2014.” [Online, 2005]. Available at 

http://www.bls.gov/emp/emptab21.htm/. 17 Bureau of Labor Statistics, 2004–2014 employment projections, 

”Occupations with the largest job growth, 2004–2014.” [Online, 2005]. 

Available at http://www.bls.gov/emp/emptab3.htm/. 18 The Registered Nurse Population: National Sample Survey of Registered 

Nurses, March 2004, Preliminary Findings (U.S. Department of Health and 

Human Services, Bureau of Health Professions, 2005), p. 5.

19 The Impact of the Aging Population on the Health Workforce in the 

United States (Albany, NY, Center for Workforce Studies, School of Public 

Health, University at Albany, 2005), p. 109. 20 The Registered Nurse Population, 2005, pp. 3–4. 21 Occupational Outlook Handbook, 2006–2007 Edition (Bureau of 

Labor Statistics, 2006). [Online]. Available at http://www.bls.gov/oco/

home.htm/. 
63

Table 2. Occupational employment in elder care industries by selected detailed occupation, May 2005 

 

Percent Percent Community Percent Services Percent

Home of total Nursing of total care of total for the of total

Selected occupation health occupa- care occupa- facilities occupa- elderly and occupacare tional facilities tional for tional persons tional

services employ- employ- the employ- with employment ment elderly ment disabilities ment

Medical and public health social workers ....... 10,720 9.6% 10,890 9.7% 2,190 2.0% 5,690 5.1%

Registered nurses ................................ 117,050 4.9 120,200 5.1 24,320 1.0 7,540 0.3

Occupational therapists ................................ 5,920 6.8 7,980 9.1 1,050 1.2 1,150 1.3

Physical therapists ................................ 16,360 10.8 9,870 6.5 1,350 0.9 590 .4

Speech-language pathologists ....................... 2,910 3.1 3,840 4.1 540 .6 940 1.0

Licensed practical and licensed vocational 

 nurses ................................ 52,700 7.4 186,560 26.3 35,320 5.0 3,500 .5

Home health aides ................................ 224,410 33.8 44,010 6.6 92,170 13.9 80,020 12.1

Nursing aides, orderlies, and attendants........ 35,170 2.5 599,310 43.1 128,150 9.2 6,180 .4

Physical therapist assistants .......................... 2,750 4.7 5,930 10.1 830 1.4 120 .2

Physical therapist aides ................................ 280 0.7 4,130 9.8 590 1.4 50 .1

Personal and home care aides....................... 198,120 35.0 8,570 1.5 25,560 4.5 159,350 28.1

ranging from $23.87 per hour in community care facilities 

for the elderly to $26.23 in home health care services. (See 

table 3.) Of the five industries with the highest employment 

of registered nurses, employment services, which include 

temporary help services, has the highest pay, with a mean 

hourly wage of $31.12. The two largest employers, general 

medical and surgical hospitals and offices of physicians, pay 

$27.80 and $27.03, respectively, near the cross-industry average and higher than all of the elder care industries. 

Licensed practical and licensed vocational nurses. Providing basic patient care, these workers take vital signs, change 

dressings, take blood or other samples, give injections, and 

attend to patients’ comfort by assisting with bathing, dressing, and personal hygiene. Depending on State law, they may 

also start intravenous fluids or give medications. To qualify 

as a licensed practical or licensed vocational nurse, workers 

must pass a state licensing exam after completing an approved 

training program, usually a 1-year program at a vocational or 

technical school.22

Nursing care facilities are the largest employer of licensed 

practical and licensed vocational nurses, employing over 

186,000 workers, or 26 percent of this occupation. General 

medical and surgical hospitals are the second largest employer, employing an additional 24 percent of these workers. 

Of the other elder care industries, home health care services 

employ about 7 percent of the workers in this occupation. 

Community care facilities for the elderly employ another 5 

percent, while services for the elderly and persons with disabilities employs less than 1 percent of these workers.

The mean hourly wage for licensed practical and licensed 

vocational nurses is $17.41, or $36,210 annually. Among the 

five largest employers of these workers, employment services 

is again the highest paying, with an average wage of $20.31. 

Although registered nurses received lower-than-average pay 

in all of the elder care industries, this is not the case for licensed practical and licensed vocational nurses, where only 

services for the elderly and persons with disabilities pays below the cross-industry average. The mean hourly wage for 

nursing care facilities is $18.06, and for home health care 

services it is $18.18. Community care facilities for the elderly 

pay slightly above the cross-industry average, with a mean 

hourly wage of $17.81.

Nursing aides, orderlies, and attendants. The core of the 

healthcare paraprofessional workforce is nursing aides, orderlies, and attendants. Workers in these entry level jobs 

generally have a high school diploma or equivalent, although 

approximately 17 percent do not meet this requirement. 

Completing 75 hours of training offered by high schools, vocational and technical schools, and some community colleges 

and nursing care facilities and passing a state competency 

exam, qualifies workers as certified nurse assistants (CNAs). 

This certification is required by the Centers for Medicare and 

Medicaid Services for work in nursing care facilities.23 Nursing aides, orderlies, and attendants carry out basic patient 

care tasks under the supervision of nursing and other medical 

staff. These duties may include taking vital signs; helping patients bathe, eat, or dress; serving meals; and helping patients 

in and out of bed.

As with licensed practical and licensed vocational nurses, nursing care facilities are the largest employer of nursing aides, orderlies, and attendants, employing over 599,000 

workers or 43 percent of this occupation. General medical 

and surgical hospitals are again the second largest employer, 

employing an additional 27 percent of these workers. Community care facilities for the elderly employ approximately 

22 Unless otherwise indicated, this and subsequent descriptions of 

occupational duties and qualifications are from Bureau of Labor Statistics, 

Occupational Outlook Handbook, 2006–2007 Edition, 2006.

23 The Impact of the Aging Population on the Health Workforce in the 

United States, p. 113. 
64

9 percent of nursing aides, orderlies, and attendants, making 

this industry the third largest employer of this occupation. 

Home health care services employ about 2.5 percent of these 

workers, reflecting the fact that most of the routine health 

care tasks in this industry are instead performed by home 

health aides, while services for the elderly and disabled employs less than 1 percent of this occupation. 

Nursing aides, orderlies, and attendants is a relatively 

low paid occupation, with a mean hourly wage of $10.67. 

Wages for all four elder care industries pay below this average, while of the five largest employers of these workers, the 

highest paying are local government ($11.78) and employment services ($11.56). Of the four elder care industries, the 

largest employer, nursing care facilities, also has the highest 

mean hourly wage, $10.33. Community care facilities for the 

elderly pay an average of $9.91 per hour, home health care 

services average $10.00 per hour, and services for the elderly 

and persons with disabilities average $9.36 per hour.

Home health aides. Like nursing aides, orderlies, and attendants, home health aides are considered paraprofessional 

workers. These workers perform tasks similar to those performed by nursing aides, except they do so in the patient’s 

own home rather than in an institutional setting. Home health 

aides whose employers receive reimbursement from Medicare must pass a competency exam, and some States require a 

license. However, educational requirements for home health 

aides are generally low, and a high school diploma is not usually required.

Home health care services are the largest employer of 

home health aides, employing approximately 34 percent of 

workers in this occupation. Residential mental health facilities are the second largest employer, with about 16 percent 

of occupational employment. In addition to home health care 

services, the other elder care industries are also significant 

employers of these workers: community care facilities employ nearly 14 percent of this occupation, services for the elderly and persons with disabilities employ about 12 percent, 

and nursing care facilities employ nearly 7 percent. 

Pay for home health aides is somewhat lower than for 

nursing aides, orderlies, and attendants, with a mean hourly 

wage of $9.34. With the exception of nursing care facilities, 

which pay a wage similar to the cross-industry average, the 

elder care industries have below average pay for this occupation. Mean hourly wages are $9.12 in services for the elderly 

and persons with disabilities, $9.06 in home health care services, and $8.89 in community care facilities for the elderly. 

However, none of the largest employers of this occupation 

pays a wage higher than that of nursing care facilities, and 

of these highest paid industries for this occupation, only one, 

State government, with a mean hourly wage of $14.24, employs a significant number of workers (17,100).

Personal and home care aides. These workers provide a variety of services to clients to enable them to live outside of an 

institutional setting. These services may include doing laundry, shopping, housecleaning, planning and preparing meals, 

and assisting with bathing and dressing. Explicitly excluded 

are health care related services. While some States require 

formal training, in others, only on-the-job training is necessary. Voluntary certification is available through the National 

Association for Home Care and Hospice.

Of the four elder care industries, employment of personal and home care aides is highest in the industries that 

are associated with nonresidential settings: home health care 

services and services for the elderly and persons with disabilities. Over 198,000 personal and home care aides, or 35 

percent of total occupational employment, are in home health 

Table 3. Mean hourly wages in elder care industries by selected detailed occupations, May 2005

Mean hourly wages 

Selected occupation Community Services for

All Home health Nusing care facilities the elderly and

industries care services care facilities for the persons with

elderly disabilities

Medical and public health social workers ........................ $20.52 $23.01 $18.57 $18.04 $16.43

Registered nurses ........................................................... 27.35 26.23 24.76 23.87 24.42

Occupational therapists................................................... 28.41 32.85 29.08 27.45 23.51

Physical therapists........................................................... 31.42 34.65 31.12 31.40 26.84

Respiratory therapists...................................................... 22.24 22.99 22.51 21.30 NA

Speech-language pathologists ........................................ 27.89 31.82 32.57 32.63 27.50

Licensed practical and licensed vocational nurses.......... 17.41 18.18 18.06 17.81 16.28

Home health aides........................................................... 9.34 9.06 9.40 8.89 9.12

Nursing aides, orderlies, and attendants......................... 10.67 10.00 10.33 9.91 9.36

Occupational therapist assistants.................................... 19.13 21.52 19.53 20.88 16.52

Occupational therapist aides ........................................... 13.20 14.03 13.16 11.39 11.43

Physical therapist assistants ........................................... 18.98 21.61 20.18 20.09 16.30

Physical therapist aides................................................... 11.01 10.70 11.84 11.60 12.01

Personal and home care aides........................................ 8.52 7.52 9.08 8.87 8.81

NA indicates data not available.
65

care services, making it the largest employer of this occupation. An additional 28 percent of these workers are employed 

in services for the elderly and persons with disabilities. In 

residential settings, many of these services, such as cleaning 

and laundry, are performed by workers specializing in these 

tasks. Consequently, community care facilities for the elderly 

employ less than 5 percent of personal and home care aides, 

and nursing care facilities employ less than 2 percent.

Of the occupations surveyed here, personal and home care 

aides are the lowest paid, with a mean hourly wage of $8.52. 

Home health care services, the largest employer of these 

workers, pay $7.52 per hour. The other elder care industries, 

however, pay somewhat above the cross-industry average, 

ranging from a mean hourly wage of $8.81 in services for 

the elderly and persons with disabilities to $9.08 in nursing 

care facilities. Of the five largest employers of personal and 

home care aides, residential mental health facilities and vocational rehabilitation services are the highest paying, with 

mean hourly wages of $9.41 and $9.35, respectively. 

Medical and public health social workers. These professionals provide services for individuals, families, or populations 

faced with illness. Their services may include counseling, advising family members or caregivers, and arranging for services, such as physical therapy or home care, after discharge 

from a hospital or other facility. In a nursing care or home 

care setting, social workers may also supervise paraprofessional workers, such as nursing aides or home health aides. 

Medical and public health social workers are highly skilled. 

While a bachelor’s degree is the minimum requirement for 

most entry level jobs, many jobs, including those in health 

care settings, typically require a master’s degree in social 

work. In addition, licensing, certification, or registration is 

required in all States and the District of Columbia, although 

the exact requirements vary by State.

With total employment of around 112,000 workers, this 

occupation is numerically less important than those discussed 

above. However, the elder care industries are major employers of these workers. General medical and surgical hospitals 

are the largest employers of medical and public health social 

workers, with about 29 percent of occupational employment. 

Nursing care facilities and home health care services each 

employ about 10 percent of the occupation. Services for the 

elderly and persons with disabilities employ about 5 percent 

of this occupation, while community care facilities for the 

elderly employ about 2 percent.

Wages for medical and public health social workers, 

though below those for registered nurses and the therapy professions, are well above those for nursing aides, home care 

aides, and similar occupations. The mean hourly wage for 

this occupation is $20.52, or $42,690 annually. Of the largest 

employers of these workers, only home health care services 

and general medical and surgical hospitals pay above average wages. The remaining three elder care industries all pay 

below average wages; at only $16.43, services for the elderly 

and persons with disabilities has the lowest wage of the four 

industries. 

Physical therapists, occupational therapists, and speechlanguage pathologists. The therapy professions help patients 

restore functions lost through disease, injury, or aging, and 

assist patients in finding ways of dealing with the loss of these 

functions. Physical therapists focus specifically on improving 

physical functioning, by increasing mobility, reducing pain, 

and preventing or limiting permanent physical disabilities. 

Treatment often includes exercise to restore strength, flexibility, balance, or coordination. Physical therapists may also 

use massage or other techniques to reduce pain, and instruct 

patients in the use of assistive devices, such as wheelchairs 

or prostheses. 

Occupational therapists, on the other hand, focus on helping patients improve their ability to carry out tasks associated 

with daily living, such as dressing, preparing food, or bathing. Occupational therapy may include exercises to improve 

physical proficiency at these tasks, instruction in the use of 

assistive devices to replace lost physical abilities, and exercises and techniques to improve decision making, problem 

solving, and other mental skills. With respect to the elderly 

population, the goal of occupational therapy is to allow patients to maintain or recover the ability to live independently. 

Both physical and occupational therapists may work with assistants and aides; physical therapist assistants and physical 

therapist aides are profiled below. Although speech-language 

pathologists are often associated with helping young children 

overcome speech difficulties, in the older population, they may 

assist patients in reacquiring speech, language, or swallowing 

skills lost because of strokes or other medical conditions.

Like medical and public health social workers, the three 

therapy professions are not numerically as large as nursing 

or health care paraprofessional occupations. However, two 

of the elder care industries, home health care services and 

nursing care facilities, are among the largest employers of 

all three professions. Physical therapists are the largest of the 

three occupations, with total employment of approximately 

151,000 workers. While offices of other health practitioners 

and general medical and surgical hospitals are the two largest 

employers of physical therapists, home health care services 

employ nearly 11 percent and nursing care facilities employ 

nearly 7 percent of physical therapists, making them the 

third- and fourth-largest employers of these workers. Total 

employment of speech-language pathologists is approximately 95,000, with over half of them working in elementary and 

secondary schools. Offices of other health practitioners employ about 14 percent of speech-language pathologists, and 

general medical and surgical hospitals employ an additional 

11 percent. Nursing care facilities make up approximately 4 

percent of occupational employment, and home health care 

services make up 3 percent of employment. 

Finally, there are over 87,000 occupational therapists in 

the workforce. General medical and surgical hospitals em-
66

24 Occupational Outlook Handbook, 2006. Although the current 

minimum education requirement for physical therapists is a bachelor’s 

degree, a master’s degree will be required beginning in 2007.

ploy about 26 percent of this occupation. Other significant 

employers are offices of other health practitioners, with 20 

percent of occupational employment; and elementary and 

secondary schools, with 14 percent of occupational employment. Nursing care facilities employ about 9 percent of occupational therapists, and home health care services employ an 

additional 7 percent. The two remaining elder care industries 

each employ slightly over 1 percent of occupational therapists, and 1 percent or less of speech-language pathologists 

and physical therapists.

The therapy professions require high levels of education. 

All three of these occupations generally require at least a 

master’s degree, and all States have some type of licensing 

or certification requirement for these occupations.24 Reflecting their high educational requirements, these professions 

are relatively high paying. Physical therapists have the highest average wage of the three, with a mean hourly wage of 

$31.42 or $65,350 annually. Occupational therapists have 

a mean hourly wage of $28.41 or $59,100 annually. Wages 

for speech-language pathologists are slightly above those for 

registered nurses, at $27.89 an hour or $58,000 annually. 

Although wages in the elder care industries have not been 

high for many of the occupations examined, these industries 

appear to have better relative wage levels for the therapy professions. Home health care services pay above average wages 

for all three occupations, and is one of the highest paying 

industries for both occupational therapists and physical therapists. Nursing care facilities pay above average wages for two 

of the three occupations (physical therapists are the exception). Community care facilities for the elderly have above 

average wages for speech language pathologists, although 

wages are near the cross-industry average for the other two 

occupations. Only in services for the elderly and persons with 

disabilities are wages for these workers consistently near or 

below the occupational averages.

Physical therapist assistants and physical therapist aides. 

Workers in these occupations assist physical therapists in providing services to clients. Of the two occupations, physical 

therapist assistants are the more skilled; this occupation, like 

licensed practical and licensed vocational nurses, represents 

an intermediate point between the highly skilled registered 

nurse and therapist occupations and lower skilled occupations like nursing aides. Physical therapist assistants typically have an associate degree, and may need to be licensed 

or registered in some States. Under supervision of a physical 

therapist, these workers perform treatment procedures with 

patients, such as exercises, massage, and ultrasound. Physical therapist aides, on the other hand, do not perform clinical 

tasks. Instead, they work under the supervision of a physical 

therapist or physical therapist assistant to keep the treatment 

area organized, prepare for upcoming therapy sessions, and 

assist patients in moving to and from treatment areas. Physical therapist aides usually have a high school diploma, and 

learn their skills through on-the-job training. 

Numerically, both occupations are relatively small: estimated employment for May 2005 was 58,670 for physical 

therapist assistants and 41,930 for physical therapist aides. 

Offices of other health practitioners and general medical and 

surgical hospitals are the largest employers for both occupations. However, nursing care facilities employ approximately 

10 percent of each occupation, making them among the largest employers for both occupations. Home health care services are among the largest employers of physical therapist 

assistants, with nearly 5 percent of occupational employment, 

although this industry is not a significant employer of physical therapist aides. Community care facilities for the elderly 

and services for the elderly and persons with disabilities are 

not major employers of these workers. 

Physical therapist assistants earn a mean hourly wage of 

$18.98, roughly comparable to the $17.41 earned by licensed 

practical and licensed vocational nurses, who have similar 

skill requirements. With the exception of services for the elderly and persons with disabilities, the elder care industries 

have above average wages for physical therapist assistants. 

In fact, home health care services, nursing care facilities, and 

community care facilities for the elderly are among the highest paying industries for this occupation. Wages for physical therapist aides are comparable with, although somewhat 

above, those for the paraprofessional healthcare occupations such as home health aides and nursing aides, orderlies, 

and attendants. The average hourly wage in this occupation 

is $11.01. Although none of the elder care industries ranks 

among the highest paying industries for this occupation, 

home health care, with a mean hourly wage of $10.70, is the 

only one of the four industries that does not have an above 

average wage.

Summary

The growth of the elderly population has significant implications for the U.S. economy, particularly for those industries 

that primarily serve an elderly clientele. This article examines four such industries: home health care services, nursing 

care facilities, community care facilities for the elderly, and 

services for the elderly and persons with disabilities. In line 

with the expected growth in their client population, these industries are projected to be some of the Nation’s fastest growing over the next several years. The exception is nursing care 

facilities, which are affected by consumer preference shifts 

towards other models of care.

For those industries for which data are available, evidence 

suggests that establishments in these industries serve a particularly aged and vulnerable subset of the elderly population. This is reflected in their staffing patterns, which contain 

a high proportion of healthcare practitioner and technical and 

healthcare support occupations. Personal care and service occupations, primarily personal and home care aides, are also a 
67

significant source of employment in several of the industries. 

Overall, BLS Occupational Employment Statistics data suggest that among the four industries, home health care services 

has the least diversified staffing pattern, perhaps because it 

provides the narrowest range of services. Nursing care facilities and community care facilities for the elderly are the 

most similar in terms of staffing patterns of the four industries, despite the smaller number of healthcare practitioner 

and technical occupations in community care facilities. Both 

industries have heavy concentrations of healthcare workers, 

but also have workers associated with the demands of a residential setting, such as food service. Finally, services for the 

elderly and persons with disabilities appears to be least like 

the other industries in terms in its relatively low proportion of 

healthcare workers, though personal care and service occupations and community and social services occupations make 

up a large percentage of this industry.

Finally, the article examines selected detailed occupations 

that either make up a significant proportion of employment 

in one or more elder care industries, or for which the elder 

care industries are important employers. In keeping with the 

overall staffing patterns of these industries, most are healthcare occupations, although medical and public health social 

workers and personal and home care aides are also included. 

Occupational Employment Statistics data are used to look at 

the distribution of these occupations across industries and to 

compare occupational wages in the elder care industries to 

those of other industries. 

The high projected growth rate of the elder care industries and of the health care sector in general, implies correspondingly high growth for key occupations in these industries. Many of the selected occupations are predicted to be 

among the fastest growing occupations in terms of growth 

rates, number of jobs added, or both, over the next several 

years. At the same time, some of these occupations are experiencing the aging of their own workforces, with high 

percentages of workers expected to retire in the near future. 

Most of these occupations are heavily dominated by women; 

for some occupations, such as registered nurses, changing 

employment opportunities for young women may present a 

barrier to recruiting new entrants. In other occupations—particularly lower skilled occupations such as home health aides 

and nursing aides, orderlies, and attendants—low pay and 

benefits, the unpleasant nature of some duties, and the lack 

of opportunity for advancement may create difficulties in recruiting and retaining employees. 

Finally, although there are some exceptions—particularly in home health care services, which pays relatively high 

wages for several occupations—the elder care industries are 

generally not among the highest paid industries for these occupations. This suggests that these industries may have some 

difficulty recruiting scarce workers to these occupations from 

competing industries. Maintaining a sufficiently large workforce to care for the growing elderly population represents a 

potential challenge facing the U.S. economy over the next 

several decades.