The fastest-growing job in America is also one of the hardest.

Angelica Rios is a home health aide, she cares for the elderly, but who’s caring for her? Photographs by Adria Malcolm for Vox

Angelica Rios is a home health aide, she cares for the elderly, but who’s caring for her?
Photographs by Adria Malcolm for Vox

This story is by Alexia Fernández   

Angelica already works seven days a week as a home health aide, caring for an 89-year-old widow with dementia who lives alone. The $12.50 an hour Angelica earns isn’t enough, so she and her son rely on government assistance, such as food stamps and Medicaid.

Angelica drives a 2002 Ford Taurus (it has “stage 4 cancer,” she joked) along the dry, dusty foothills of the Sandia mountain range where she lives. Angelica turned right into a neighborhood of tidy beige houses with two-car garages —a world apart from where she lives and the cramped row house where she grew up in Philadelphia.

Her client was in a good mood, but that wouldn’t last long. Later, she would get cranky and yell at Angelica for not following her orders. She carefully wrote down each task she completed; “finished doing dishes, cleaned dog poop from backyard. Disinfected stovetop and sink,” she scribbled. The list went on for about half a page. Angelica keeps track of each chore she completes to help her stay organized, and for other caregivers and relatives to reference.

This is what it’s like to do one of the most in-demand jobs in the US, a job that has many names, depending on the state and tasks involved: Home caregiver. Personal care assistant. Home care worker. Home health aide. The title doesn’t matter; what’s important is that this is the future of work for millions of Americans.


According to the latest estimates from the Bureau of Labor Statistics, the US economy is expected to create about 1.2 million new positions for home caregivers like Angelica by 2026 — a 41 percent increase from the 2.9 million personal care and home health aides working in 2016.

Aging baby boomers and expanded Medicaid coverage have led to the surge in the need for workers to care for the sick and elderly in their own homes. But these positions, which require minimal training and no college degree, are among the lowest-paid in the country.

There’s a lot of hype about the future of work. You may have heard dire warnings about robots taking jobs, or that work will be all digital. There’s a grain of truth in that thinking, but the reality is that the future of work will also include a lot of low-skilled, unglamorous service jobs, just like the one Angelica does. Only one industry is expected to grow faster and add more jobs to the US economy than home care work in the coming years: the renewable energy business.