Close to 20% of nursing home assistants are living below the federal poverty line, a result of low wages and part-time positions, according to The Paraprofessional Healthcare Institute’s new report.

Nearly 40% rely on some form of public assistance.  Wages “barely kept up with inflation” over the past decade. The average hourly wage for a direct care worker was $12.34 in 2016, compared to $12.35 in 2006, the report found.  [It is much less in South Carolina].

Despite the profound support they offer to millions of older people and people with disabilities nationwide, direct care workers remain undervalued and poorly compensated,” PHI President Jodi M. Sturgeon said in a statement. “Our country needs to improve wages and hours, provide more training and career paths, and implement workforce innovations that transform this sector — improving care for all of us.”

The data predicts new nursing assistant jobs will make up 39% of total employment growth in the sector, adding to the more than 600,000 frontline positions currently held in the U.S.

Click here to read the full PHI report, which also includes data on workers’ insurance coverage, injury rates, education and demographics.

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