Home Care Industry Statistics: Workforce, Utilization, and Market Data

The home care industry represents one of the largest and fastest-growing segments of the United States health care system, driven by an aging population, expanding Medicare and Medicaid coverage structures, and a documented preference among patients for receiving care in residential settings. This page compiles workforce figures, utilization rates, and market size data drawn from named federal agencies and public research bodies. Understanding the scale and composition of the industry informs decisions about certified home health agency standards, workforce policy, and reimbursement design.

Definition and Scope

Home care, as defined and tracked by federal agencies, encompasses two overlapping but distinct categories: skilled home health services and personal care or supportive services. The Centers for Medicare & Medicaid Services (CMS) governs skilled home health under Conditions of Participation codified at 42 CFR Part 484, which applies to Medicare-certified agencies providing nursing, therapy, and aide services under a physician-authorized plan of care. Personal care and homemaker services occupy a separate regulatory tier, predominantly funded through Medicaid Home and Community-Based Services (HCBS) waivers authorized under Section 1915(c) of the Social Security Act.

The Bureau of Labor Statistics (BLS) classifies home care workers under two primary occupational codes: Home Health and Personal Care Aides (SOC 31-1120) and Registered Nurses employed in home health settings (SOC 29-1141). These classifications shape how workforce data are collected and reported nationally. For a broader view of how these categories interact with service delivery, the medical and health services topic context page provides structural framing.

How It Works

Federal data collection on home care operates across three major reporting channels:

1. CMS Home Health Agency (HHA) data — CMS publishes aggregate enrollment, utilization, and quality data through the Home Health Compare dataset and the CMS Medicare Provider Utilization and Payment Data series. As of the 2023 Medicare Program Statistics release, CMS tracked approximately 11,500 Medicare-certified home health agencies operating nationally (CMS Medicare Fee-for-Service Provider Utilization & Payment Data).

2. Bureau of Labor Statistics Occupational Employment and Wage Statistics (OEWS) — The BLS OEWS program surveys employers annually to produce national and state-level employment counts and wage medians. The May 2023 OEWS reported approximately 3.6 million Home Health and Personal Care Aides employed nationally, making this the single largest occupational group in the health care sector by headcount (BLS OEWS May 2023).

3. National Home and Hospice Care Survey and successor data — The National Center for Health Statistics (NCHS) has periodically surveyed home health and hospice providers to measure patient census, discharge disposition, and diagnosis composition. These surveys provide utilization denominators used in academic and policy research.

Market valuation estimates are produced by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS, and by CMS in its annual National Health Expenditure Accounts (NHEA). The NHEA categorizes home health care spending as a discrete line item; the 2022 NHEA reported national home health care expenditures at approximately $142.1 billion, representing roughly 3.3 percent of total national health expenditures (CMS National Health Expenditure Data).

Common Scenarios

Home care statistics are applied in several distinct policy and operational contexts:

Workforce planning — State health departments and area agencies on aging use BLS employment projections to model shortfalls. The BLS Occupational Outlook Handbook projects a 22 percent employment growth rate for Home Health and Personal Care Aides between 2022 and 2032, adding an estimated 711,700 positions over that decade — the largest absolute numerical increase of any single occupation (BLS Occupational Outlook Handbook). This projection directly shapes discussions around home care aide training requirements and pipeline funding.

Reimbursement modeling — CMS uses utilization data — average visit counts per episode, OASIS assessment scores, and diagnosis groupings — to calibrate the Patient-Driven Groupings Model (PDGM), the case-mix payment system that replaced the previous Home Health Prospective Payment System in 2020. PDGM organizes home health episodes into 432 payment groups based on admission source, timing, clinical grouping, functional impairment level, and comorbidity adjustment. Reimbursement modeling activity increased following enactment of the Social Security Fairness Act of 2023, Pub. L. 118-310 (effective January 5, 2025), which repealed the Windfall Elimination Provision (WEP) and Government Pension Offset (GPO). The repeal is in effect as of January 5, 2025, and has expanded Social Security benefit eligibility and payment amounts for a significant portion of the home care workforce — particularly workers who also receive public pensions — affecting compensation benchmarking and workforce retention analyses conducted by home health agencies. Agencies are actively revising total compensation models to reflect the increased Social Security benefit amounts now payable to affected workers. The Social Security Administration (SSA) is administering benefit recalculations for eligible recipients, and agencies should monitor SSA guidance for implementation details as recalculations are processed.

Quality benchmarking — Home health agencies are assessed on Star Ratings published through CMS Care Compare, incorporating process measures (e.g., timely initiation of care), outcome measures (e.g., hospitalization rates), and patient experience data from the Home Health CAHPS survey. The home care quality measures page details the specific indicators used in this framework.

Comparative market analysis — Health systems and policymakers compare home health utilization rates against skilled nursing facility (SNF) and inpatient rehabilitation facility (IRF) admission rates when evaluating post-acute care redesign. The Medicare Payment Advisory Commission (MedPAC) publishes annual data on post-acute care spending distribution; in its March 2023 Report to Congress, MedPAC noted that home health accounted for approximately 17 percent of Medicare post-acute care spending (MedPAC March 2023 Report to Congress).

Decision Boundaries

Home care statistics carry important classification boundaries that affect how figures should be interpreted:

Medicare-certified vs. non-certified agencies — CMS enrollment data covers only Medicare- and Medicaid-certified home health agencies. The full universe of home care providers — including non-medical private duty agencies and direct-hire independent contractors — is substantially larger and tracked separately through BLS employer surveys. Conflating these populations produces significant overcounting or undercounting depending on the research question.

Skilled vs. non-skilled services — Utilization and expenditure figures diverge sharply depending on whether the analysis includes only skilled services (nursing, physical therapy, occupational therapy, speech therapy) or also incorporates personal care aide hours. For service-specific data, resources covering skilled nursing at home, physical therapy home care, and home-care reimbursement models provide more granular breakdowns.

Episode vs. visit measurement — CMS reports home health utilization in 30-day payment periods under PDGM. Prior to 2020, the unit was a 60-day episode. Longitudinal comparisons that cross the 2020 PDGM implementation date require adjustment for this structural break in the data series.

Geographic variation — State-level data show substantial variation. Urban markets in states such as California, New York, and Texas account for disproportionate shares of total home health visits and agency counts, reflecting both population density and Medicaid program structure. State-by-state regulatory differences documented in home care licensing by state further complicate direct interstate comparisons.

Social Security benefit structure changes — Effective January 5, 2025, the Social Security Fairness Act of 2023, Pub. L. 118-310, repealed the Windfall Elimination Provision (WEP) and the Government Pension Offset (GPO). These provisions had previously reduced Social Security benefits for workers — including many home care and public health employees — who also received non-covered pension income. Their repeal is now in effect and directly alters the effective total compensation picture for affected workers. Workforce cost models, labor market comparisons, and compensation benchmarking analyses that incorporate Social Security benefit assumptions should be updated to reflect the increased benefit amounts now payable under the post-repeal framework. The Social Security Administration (SSA) is responsible for implementing the benefit recalculations for eligible recipients, and agencies should monitor SSA guidance for implementation details as recalculations are processed.

References

• Centers for Medicare & Medicaid Services — National Health Expenditure Data
• CMS Medicare Fee-for-Service Provider Utilization & Payment Data
• Bureau of Labor Statistics — Occupational Employment and Wage Statistics, SOC 31-1120
• Bureau of Labor Statistics — Occupational Outlook Handbook: Home Health and Personal Care Aides
• Medicare Payment Advisory Commission (MedPAC) — March 2023 Report to the Congress
• Electronic Code of Federal Regulations — 42 CFR Part 484 (Home Health Services)
• National Center for Health Statistics (NCHS) — Home Health and Hospice Care
• CMS Care Compare — Home Health
• Social Security Fairness Act of 2023, Pub. L. 118-310 (enacted January 5, 2025)