State policy solutions for good home health care jobs—nearly half held by Black women in the South—should address the legacy of racism, sexism, and xenophobia in the workforce


Home health care workers are part of the “care economy” that makes all other work possible.

These workers include nursing, psychiatric, and home health aides; personal and home care aides; and nursing assistants working in private households. They provide services and support for older adults, people with chronic illnesses, and people with disabilities allowing them to stay in their homes and communities, rather than nursing homes or other institutions. And the COVID-19 public health emergency further highlighted the importance of this workforce, who provide long-term care at a time when congregate settings are limited in their ability to support physical distancing or quarantining.

So why don’t we value these workers?

The underappreciation of care jobs historically and today reflects the prevailing legacy of racism, sexism, and xenophobia. Black women are vastly overrepresented among home health care workers, especially in the Southern United States, where these workers are paid the least. (Louisiana, West Virginia, Texas, Mississippi, and Oklahoma).

There is a disproportionate representation of Black, Latinx, and immigrant women in the Southern home health care workforce and there is an eye-opening history of how Black women in the South became the single largest group of workers in these jobs.

Home health care workers, who make up a substantial share of the larger domestic worker job classification, have long been coming together for fair wages and working conditions. The current policy climate in the South needs an overhaul and there are opportunities for state policymakers to support good jobs for home health care workers. 

Demographic Profile of Home Health Care Workers

Home health care work is both highly racialized and gendered, especially in the South. As shown in Figures A and B, Black and Latinx women are overrepresented in the home health care workforce compared to the overall labor force. While Black women make up 11% of all workers in the South, they account for a remarkable 43% of home health care workers, nearly four times their share in the labor force. Similarly, Latinx women account for an estimated 7% of the Southern labor force, yet they make up more than twice that share among home health care workers at 17%. White women in the South are proportionately represented in the home health care work force relative to their share in the overall Southern labor force.

Black and Latinx women are highly concentrated in home health care in the South compared to other regions: Breakdown of all workers and home health care workers by race/ethnicity, gender, and region

Group Black women Latinx women White women Women of other races Men
Home Health Care workers 28% 22% 31% 8% 10%
All workers 6% 6% 34% 3% 51%
Home Health Care workers 43% 17% 28% 4% 8%
All workers 11% 7% 28% 2% 52%
Home Health Care workers 10% 28% 30% 16% 16%
All workers 2% 13% 24% 7% 53%
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