Recent literature highlights longstanding structural inequalities in the US care economy, particularly along gender, racial, and ethnic lines. However, limited attention has been paid to the role of geography in structuring these disparities. This paper addresses this gap by descriptively analyzing of occupational segregation in the US low-wage care sector across commuting zones from 1980 to 2020. Our findings show that women are still more likely than men to work in low-wage care occupations. Moreover, local racial and ethnic composition plays a key role in determining who performs low-wage care work, with racialized women persistently overrepresented in low-wage care employment both nationally and regionally. While there is significant regional variation in occupational segregation, there is evidence of convergence in recent decades. Finally, using group-based trajectory modeling, we identify distinct regional trajectories in the evolution of occupational segregation in the low-wage care sector, demonstrating that national averages mask underlying regional trends.