An Aging Population and the Ever-Growing Need for Healthcare Workers

Across North Carolina, the healthcare sector plays a vital role in promoting the health and well-being of the state’s 11 million residents. The sector is also an essential part of the state’s economy, employing nearly 690,000 workers and contributing $48 billion to economic output. However, the COVID-19 pandemic was a sobering reminder of the unique challenges the sector faces in building and maintaining a robust workforce.

As pandemic-related disruptions have eased, the healthcare sector faces a different challenge: meeting the complex care needs of a rapidly aging population. This blog examines the aging dynamics driving the increased need for healthcare services and workers in the years to come.

Booming Growth of North Carolina’s Older Population

Like the rest of the nation, North Carolina’s population is getting older. At the turn of the century, 12% of North Carolina’s population was aged 65 or older. Today, that share has climbed to 18%, corresponding to one in every six North Carolinians. And this upward trend is set to continue: by 2030, 20% of the state’s population will belong to this older age group [Figure 1].

Figure 1

Driving this demographic transformation has been the aging Baby Boomer generation—the large cohort of individuals born between 1946 and 1964 during the post-World War II fertility boom. Since 2011, when the oldest Baby Boomers began reaching retirement age, more than 100,000 North Carolinians have turned 65 each year. The next decade will bring another notable milestone: by 2030, all Baby Boomers will be aged 65 or older. Just one year later, older adults (aged 65+) will outnumber children (aged 0-17) in North Carolina for the first time ever.[1]

Not only are more people reaching retirement age, but they’re also generally living longer. Even though average U.S. life expectancy plateaued in the years leading up to the COVID-19 pandemic[2] and suddenly declined afterward, for most of the past half-century, advancements in medicine and medical technology have contributed to meaningful gains in longevity.

Today, a North Carolinian reaching age 65 can, on average, expect to live an additional 18 years. Consequently, the state’s oldest population segment—those aged 85 and older—is projected to grow at a remarkable pace. Over the next 20 years, this age group will grow by a staggering 114% [Figure 2].

Figure 2

Growing Demand for Healthcare Services

A rapidly aging population is certain to drive increased demand for healthcare services. Older adults are more likely than younger individuals to suffer from chronic conditions, such as arthritis, cancer, diabetes, and heart disease. In North Carolina, 8 in 10 adults aged 65 or older live with one or more chronic diseases. Managing these conditions often requires specialized, coordinated care across multiple healthcare providers.

Physical and cognitive disabilities also increase with age, creating additional healthcare demands. Approximately 20% of older adults in North Carolina report mobility difficulties, compared to just 5% of individuals aged 18-64 [Figure 3]. Older adults are seven times more likely to experience hearing difficulties and three times more likely to struggle with independent living. Due to these functional limitations, older adults often rely on direct care workers to help them perform essential daily tasks like walking, bathing, and eating.

Figure 3

Because of their complex care needs, older adults spend far more on healthcare than any other age group. Healthcare expenses consume 13% of total consumer spending for those aged 65 and over—nearly double the 7% spent by those aged 45-54, and more than triple the 4% spent by those under 25 [Figure 4].

Figure 4

Statewide Healthcare Employment Projections

Due to the growing needs of an aging population, North Carolina’s healthcare employment is projected to expand rapidly over the coming decade. Between 2022 and 2032, the Health Care and Social Assistance sector is expected to add nearly 102,000 jobs, far outpacing job creation in any other sector.[3] The Ambulatory Health Care Services sub-sector will lead this growth (+47,400 jobs), followed by Hospitals (+40,000 jobs) and Social Assistance (+13,500 jobs) [Figure 5].

Slower job growth in Nursing and Residential Care Facilities (+800 jobs) may seem counterintuitive at first glance given the rising demand for geriatric care. However, this reflects a broader shift away from institutional settings (e.g., nursing homes) and toward home and community settings across the nation. Older adults are increasingly choosing to age in place.

Figure 5

Occupational projections tell a similar story: overall employment in healthcare occupations will grow significantly over the next decade. Nursing-related occupations will see particularly strong job growth, with Registered Nursing employment projected to rise by 17,500 by 2032 [Figure 6]. Reflecting the growing demand for home-based care, employment of Home Health and Personal Care Aides is expected to grow by 14,600. Other top-growing occupations in North Carolina include Medical Assistants, Physician Assistants, and Pharmacy Technicians.[4]

Figure 6

Looking Ahead

North Carolina’s population is getting older—a process that has been underway for well over a decade due to a growing wave of Baby Boomer retirements. This demographic shift underscores the importance of the healthcare sector in meeting the complex care needs of older adults. However, addressing these needs will depend on attracting, training, and retaining a skilled healthcare workforce.

The road ahead presents various challenges and opportunities that deserve careful consideration. Subsequent articles in this series will explore healthcare workforce topics such as:

• Employer demand for healthcare talent
• Recruitment and retention challenges in the healthcare sector
• Worker job flows into and out of the healthcare sector
• Strategic opportunities to strengthen North Carolina’s healthcare workforce