The Hidden Workforce Holding American Healthcare Together and Why So Many of Them Are Walking Out
American hospitals and care homes are losing the aides who wash patients, record vital signs and keep wards moving, even as the healthcare workforce shortage deepens. BLS estimates that about 4.7 million jobs were held by home health and personal care aides and about 1.6 million by nursing assistants and orderlies in 2025.
Openings far outrun net job growth.
A Harris Poll survey this summer found 59 per cent of patient-care workers likely to look for another role within a year.
The Hidden Workforce Holding American Healthcare Together
Nursing assistants bathe, feed and turn patients under licensed nurses. Home health and personal care aides do much the same in private houses. Medical assistants take histories and vital signs in clinics.
Healthcare support occupations had a median wage of $38,340 in May 2025, below the national figure. Nursing assistants and orderlies earned a median $41,970. Home health and personal care aides earned $35,800.
The bureau projects about 760,500 openings a year for home health and personal care aides from 2025 to 2035, and about 203,300 a year for nursing assistants and orderlies.
Employment of the latter pair is expected to rise by only 41,100 over the decade. PHI reported on 15 September that the US direct-care workforce had grown to nearly 5.8 million, making it the country's largest occupational group.
Pay, Burnout and the Healthcare Workforce Shortage
The Harris Poll's 2026 Healthcare Workforce Barometer, based on 1,514 full-time patient-care staff and 304 employers surveyed between 12 June and 1 July 2026, found employers guessed that only 39 per cent of staff would look to move. Burnout and thin promotion prospects were the reasons most often given.
Seventy per cent of Generation Z workers in the sample said they would search for a new role. The report cited a Health Resources and Services Administration projection of a shortfall of nearly 500,000 critical healthcare workers by 2038.
Economist Heather Long wrote on X that high turnover among direct care workers is hardly a surprise when so many earn far less than a typical wage.
64% of “direct care” workers (mainly home health aides) make less than $35,000 a year.
— Heather Long (@byHeatherLong) February 22, 2026
It’s not surprising that turnover is high, care quality inconsistent and everyone is frustrated. It’s probably going to get worse as more Americans age…
This is also a reminder that all… pic.twitter.com/QUR6ROrNnw
Medical assistant employment is projected to grow 13 per cent from 2025 to 2035, with about 109,700 openings a year.
Staffing Rules Recede as Rural Homes Feel the Strain
On 2 December 2025 the Department of Health and Human Services repealed a 2024 rule that would have required Medicare and Medicaid nursing homes to deliver 3.48 nurse hours per resident day and keep a registered nurse on site around the clock.
The change took effect on 2 February 2026. HHS Secretary Robert F. Kennedy Jr said, 'Safe, high-quality care is essential, but rigid, one-size-fits-all mandates fail patients.'
The bureau still projects about 1.9 million openings a year across healthcare occupations, many in support roles that rarely make headlines. Those vacancies are not a mystery of missing applicants so much as a measure of how quickly the same roles empty again.
Until pay and day-to-day conditions match the work asked of aides and assistants, hospitals will keep hiring for jobs they have already filled once.
Key facts: aides and assistants outnumber many licensed groups, wages sit below the national median, and many of the projected openings are expected to come from replacing workers who leave their occupations rather than from net employment growth. PHI finds 34 per cent of direct care workers live in low-income households.