The Worst Job in Healthcare?

Home health aides have a very difficult and unpleasant job. Helping bathe, dress, groom, and feed people who can’t do this for themselves is demanding, even before factoring in housekeeping tasks and the work of moving clients around. In a perfect world, aides also provide companionship and emotional support for their clients, but often, their patients are not feeling their best, and may even be embarrassed to need the help they’re receiving. In other words: being a home health aide often means spending your days performing unpleasant tasks for a client who may not appreciate your presence. It can be exhausting and thankless work. 

These challenges don’t change the fact that this is an incredibly important job because the US population is aging, which means we are relying, increasingly, on the kind of elder care that home health aides provide. Among occupations with at least 25,000 workers nationwide, Lightcast data on projected growth shows that out of the 20 occupations with the highest percentage growth in demand through 2030, seven are in healthcare (including the top overall, Nurse Practitioners), and three of those are aides of some sort: Home Health and Personal Care Aides (16% projected growth) Occupational Therapy Assistants and Aides (15% projected growth), and Physical Therapist Assistants and Aides (also 15%).

Looking at raw numbers, not percentages, home health aides are projected to have the biggest overall growth in demand through 2030—by far. Demand is set to increase by over 714,000. (Second place goes to Laborers and Materials Movers, which are projected to add 467,000 jobs). 

Who Will Care for the Caregivers? 

One reason the need for home health aides is set to increase so much is because they are not distinct from America’s aging population; they’re right in the middle of it. Even though home health aides need to do very physical tasks, 55.3% are over age 45, and one in three are over 55 themselves. Looking at the share of workers aged 65 and older, home health aides are in the 80th percentile among all occupations, and have the second-highest share among healthcare occupations. So while this isn’t the oldest job overall, four in five occupations are younger. (The oldest occupations, incidentally, are Funeral Attendants, with 45% aged 65+, and Embalmers and Crematory Operators, with 42% 65+).

This means that a large share of home health aides are right on the threshold of switching from helper to patient. The occupation is being squeezed at both ends: the US is looking at a larger elderly population to serve, and a smaller pool of aides (only 9% are under age 25) available to serve them. It isn’t an unlucky coincidence that these things are happening at once—as aides age out of the workforce and into the population needing care,  not as a coincidence, but as a function of one another. 

With the importance of these workers clear and the need for them increasing so dramatically, one might think that they would be well paid and well respected. But one would be wrong. 

Home health aides are right on the threshold of switching from helper to patient.

The Worst Job in Healthcare

The median salary for home health aides is $33,297, according to Lightcast data. That’s the lowest among healthcare workers (less than half of the average annual salary for the field), and roughly in the 25th percentile among all jobs.

This low salary is due in part to the low barrier to entry; over half of postings for home health aides require a high school diploma or less. Unlike many healthcare occupations, which require extensive education, home health aide jobs require minimal training. But this is a double-edged sword: while the job offers an immediate employment opportunity for those with limited academic credentials, it simultaneously traps workers in a low-wage, low-mobility career path.

The low barrier to entry has made this a fairly attractive job for recent immigrants without a degree. Almost 40% of all health aides in the US are immigrants, and nearly 250,000 are believed to be undocumented. So if immigration decreases just as demand increases in the coming years, the talent gap is going to widen. 

Earlier, we said that home health aides had among the highest projected growth in demand among all occupations. That’s an accurate read on how much need there will be, how much demand we might anticipate for these essential workers, but that’s not to say we should expect 700,000 new workers to join the field, to join the 4.2 million already in it. 

Why would they? The conditions are difficult, the path to a better job isn’t clear, and the pay isn’t great. 

A clear progression could transform home health aide work into to a launching pad for healthcare careers.

From Dead End to First Step

Two main factors limit how many workers would want to pursue careers as home health aides: wages and opportunity. The other challenges, like the nature of the work, could be overcome if the economic situation for workers were better. 

Higher wages would be a good start, but markets are efficient: healthcare companies pay the rates that workers will accept—particularly if immigrant workers are willing to work for wages that US-born workers are not. As the US population continues to age, and demand increases for home health aides, salaries may creep higher, but not extravagantly. If a company were willing to pay more, however, they would have a significant advantage in recruiting and retaining talent for this increasingly important position.

The more nuanced solution would be strategic professional mobility. Lightcast Career Pathways use overlapping skills to identify the next potential titles for a given role, and salary data to quantify how big of a step up it would be for the individual. Here are those roles for the occupation of Home Health and Personal Care Aides:

Most lateral and advancement opportunities offer meaningful salary increases—Psychiatric Aides, for instance, represent an advancement path with a nearly $21,000 mean salary difference, while Social and Human Service Assistants offer a lateral move with a $12,013 salary bump. 

Many workers are willing to endure low salaries and difficult working conditions if they know it’s leading to a better career down the line. Right now, home health aides don’t fit that criteria, but they could: creating a clear, structured progression could transform home health aide work from a dead-end job to a launching pad for broader healthcare careers—and help bring younger workers into this field that is disproportionately old. Perhaps pre-med/medical programs could even some kind of work-study credit or scholarship to incoming students who work in this field. By designing intentional career bridges with targeted training, certification programs, and clear advancement tracks we could reimagine this essential work, to transform this vital position from  the worst job in healthcare into a strategic first step to rewarding career. 

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