This massive labor shift toward service work has been well underway across the US. See, eg, this excellent case study of how Pittsburgh's aging, shrinking cohort of unionized steel workers (with good health insurance) has been demographically offset by a growing (precarious, non-unionized) medical and care industry. Now the largest employer in Pittsburgh is the university medical center, and the largest sector is care workers.
https://shop.nplusonemag.com/products/the-next-shift-by-gabr...
This pattern isn't unique to Pittsburgh, of course, and has played out broadly across the US.