More than 2.4 million U.S. workers provide in-home personal and health care for older adults and people with disabilities, a labor force that has more than doubled since 2010, according to PHI, a New York–based nonprofit advocacy group that works to improve the quality of direct-care services and jobs.

A shift in long-term care from institutional settings like nursing facilities to people aging in place in their own homes and communities has fueled the growth, PHI says. The change is likely to continue as the population ages. The U.S. Census Bureau projects that the 65-and-older population, which was just over 54 million in 2019, will grow to 94.7 million by 2060.

Types of home care workers

Several types of paid in-home caregivers provide a range of services, everything from help around the house to skilled health care.

Personal care aides (PCAs) are not licensed and have varying levels of experience and training. They serve as helpers and companions, providing bathing and dressing, conversation, light housekeeping, meals and neighborhood walks. They can offer transportation to shopping and appointments, as well as pick up prescriptions.

Training requirements vary by state, and some states do not have formal standards.

Expect PCA services to be an out-of-pocket expense; Medicare or private health insurance typically does not cover them.

Home health aides (HHAs) monitor the patient’s condition, check vital signs and assist with activities of daily living, including bathing, dressing and using the bathroom. These aides also provide companionship, do light housekeeping and prepare meals.

HHAs must meet a federal standard of 75 hours of training, but otherwise training and certification requirements vary by state.

The median hourly wage for PCAs and HHAs is $13.02, according to May 2020 data from the U.S. Bureau of Labor Statistics (BLS), the most recent figures available. (The BLS combines home health and personal care aides into a single occupational category.) But the charge for this and other in-home health services can be considerably higher in tight markets and urban areas, especially if you hire an aide through an agency that acts as a middleman.

Licensed nursing assistants (LNAs) and certified nursing assistants (CNAs) observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments. All medical-related tasks are performed as directed by a registered nurse (RN) or nurse practitioner.

Certified nursing assistants also provide help with personal care, such as bathing, bathroom assistance, dental tasks and feeding, as well as domestic chores like changing bed linens and serving meals.

As with home health aides, federal law requires nursing assistants to get at least 75 hours of training, but some states set higher bars. The median hourly wage is $14.30.

Skilled nursing providers, also known as licensed practical nurses (LPNs), meet federal standards for health and safety and are licensed by states.

They evaluate, manage and observe your family member’s care and provide direct care that nonmedical and home health aides cannot. Tasks could include administering IV drugs, tube feedings and shots; changing wound dressings; providing diabetes care; and educating caregivers and patients.

Some LPNs are trained in occupational therapy, physical therapy and speech therapy. Medicare covers home health skilled nursing care that is part-time or intermittent, doctor-prescribed and arranged by a Medicare-certified home health agency. The median hourly wage for home-health skilled nursing is $24.80, according to the Bureau of Labor Statistics.

Registered nurses hold a nursing diploma or an associate’s degree in nursing; have passed the National Council Licensure Examination, administered by the National Council of State Boards of Nursing; and have met all other licensing requirements mandated by their state’s nursing board.

They provide direct care, administer medications, advise family members, operate medical monitoring equipment and assist doctors in medical procedures. The median hourly wage for registered nurses providing home care services is $36.48.