← Analysis
The Largest Job in America Pays the Least
Home health and personal care aides are the single largest occupation in the US economy — bigger than registered nursing — and among the lowest-paid. The workforce filling it is disproportionately immigrant, at nearly twice the rate of the labor force overall, in a job category growing faster than almost any other.

The single largest occupation in the American economy is not software engineer, not retail salesperson, not truck driver. It is home health and personal care aide — 4.3 million jobs in 2024, more than any other job title in the country, including registered nurses.[1] It is also one of the lowest-paid.

Bigger than nursing, and not close. Home health and personal care aides held 4.3 million jobs in 2024. Registered nurses, the occupation most people would guess sits at the top of the healthcare workforce by size, held 3.4 million.[1][2] Nearly a million more people go to work every day helping someone bathe, eat, or move around their own home than go to work as a nurse.

And the pay gap runs almost exactly the opposite direction of the size gap. The median annual wage for home health and personal care aides was $34,900 in May 2024. For registered nurses, it was $93,600 — nearly triple.[1][2] The larger workforce, doing work that keeps people out of hospitals and nursing homes, is paid a fraction of the smaller one.

And demand for it is growing faster than almost anything else in the economy. The Bureau of Labor Statistics projects 17% growth in home health and personal care aide jobs from 2024 to 2034 — about 765,800 openings a year, on average, over the decade. Registered nursing is projected to grow 5% over the same period, with about 189,100 annual openings.[1][2] The fastest-growing, largest-volume job in American healthcare is also the one paying the least.

Immigration is not a side note to this field. It is a structural fact of who currently does the work. As of 2025, an estimated 41% of home health aides in the United States are foreign-born.[3] In 2019, the immigrant share of the home health aide workforce was 36.5% — more than double immigrants’ 17.1% share of the overall US workforce that same year.[4] In states with large immigrant populations, foreign-born workers make up nearly half of the entire direct-care workforce — home health aides, personal care aides, and certified nursing assistants combined.[4]

Put together, the three facts describe one structural position, not three separate ones. The largest occupation in the American economy. The fastest-growing major job category in healthcare. The lowest-paid of the health occupations compared here. And the workforce filling it is disproportionately immigrant, at nearly twice the rate of the labor force overall. An aging US population is going to need more of this work every year for the foreseeable future — the growth rate alone guarantees that — and the current answer to who does it, at the wage currently offered, is a workforce immigration policy can expand or constrict directly.

The takeaway Who’s on the lever Wages in this field are not set by one employer or one union contract -- they are set across a fragmented mix of Medicaid reimbursement rates, private home-care agencies, and family out-of-pocket pay, with no single point where a raise for 4.3 million workers gets decided at once. That fragmentation is itself part of why the wage has stayed low while demand has climbed: there is no single lever to push, in a field where almost everyone agrees more workers will be needed every year for the rest of this decade.
Sources
  1. US Bureau of Labor Statistics, Home Health and Personal Care Aides
  2. US Bureau of Labor Statistics, Registered Nurses
  3. American Immigration Council, Amid a Severe Shortage of Home Health Aides, Immigrants Help Care for Our Seniors
  4. Migration Policy Institute, Immigrant Health-Care Workers in the United States