New Study Shows Caregiving Matching Platform Dramatically Improves Jobs and Access to Home Care
PHI, the nation’s leading authority on the direct care workforce, today released findings from an independent evaluation of the Carina matching service registry in Washington State. The comprehensive report presents the first robust evidence that matching service registries can effectively connect home care workers with consumers, while enhancing job quality and supporting independent living.
Conducted in 2024, the evaluation found that Carina—a nonprofit, web-based platform—has achieved notable success in facilitating quality matches between self-directing Medicaid consumers and individual providers (home care workers).
Evidence of Quality Matches and Job Improvements
PHI used a comprehensive mixed-methods approach to evaluate Carina’s impact — including administrative and platform data with more than 25,000 in-app survey responses along with first-hand perspectives from nearly 600 caregivers and consumers through in-depth surveys and interviews. Carina was found to:
- Support independent living and workforce retention. Notably, 92% of consumers shared Carina has helped them remain living at home rather than move to a nursing home, and 91% of workers reported Carina has helped them stay in the workforce.
- Attract users seeking choice, control, and convenience. Consumers reported that they use Carina to find caregivers who can meet their specific scheduling and care needs.
- Generate strong endorsement, with 98% of individual providers and 91% of consumers surveyed indicating they would recommend Carina to others.
- Facilitate a good “fit” between consumers and providers, defined in terms of well-matched needs, preferences, skills, and availability.
- Support lasting caregiving relationships with median matches of 12 to 15 months, and many matches lasting two years or more.
- Enhance job quality by helping workers achieve better schedules and maintain health insurance. Notably, 28% of individual providers reported using Carina specifically to maintain eligibility for health insurance.
“At Carina, we believe a strong care economy supports both the people receiving care and those providing it,” says Nidhi Mirani, Chief Executive Officer of Carina. “This evaluation highlights how quality job matches can help caregivers meet critical needs, whether it’s finding the schedules that match their availability or the hours needed to qualify for health insurance. That’s a tangible impact on economic security for the caregiving workforce.”
Addressing Critical Workforce and Care Access Challenges
The study comes at a crucial time, as the nation faces an acute shortage of home care workers. In Washington State alone, nearly 61,000 individuals are enrolled in self-direction programs, with approximately 30% needing to recruit caregivers from their broader communities rather than relying on family members.
“This evaluation provides compelling evidence that matching service registries like Carina are not just connecting workers and consumers—they’re facilitating quality, lasting relationships that help people to remain living in their homes, while keeping workers employed in good jobs,” said Kezia Scales, PhD, PHI’s Vice President of Research & Evaluation. “These findings should inform policy decisions in states across the country that are struggling to support their growing self-direction programs.”
A Model for Replication
Carina represents a replicable model for Medicaid home care programs, rooted in a strong tripartite partnership between SEIU 775, Washington State, and Consumer Direct Care Network Washington. Since its creation in 2016 and statewide expansion in Washington State, Carina has also launched in Oregon and built partnerships across multiple states with public agencies, employers, labor unions, and community organizations to address evolving care workforce and consumer needs.
“Carina works because it gives caregivers and consumers more control, choice, and convenience to find what they need,” says Mirani. “What makes it powerful is our ability to scale within — and strengthen — the care infrastructure by partnering with states, labor unions, and employers. Together, we’re building a future where care work is supported and accessible.”
Policy Implications and Recommendations
Because only one in five U.S. states has implemented matching service registries, learning from Washington’s experience can be a powerful example to inform state-level innovation going forward.
As looming potential cuts to safety net programs like Medicaid bring uncertainty and potential instability to our nation’s long-term services and supports (LTSS) systems, matching service registries like Carina offer a strong model for states to consider to keep people and families connected to the care and support they need.
The evaluation report offers four key takeaways for states considering matching service registries:
- Honor the caregiving relationship by enabling personalized connections
- Engage all partners in developing a collaborative vision
- Proactively build the market to reach critical mass through geographic scaling and proactive outreach
- Ground registries in broader systems change to address structural job quality challenges
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About the Study
The evaluation was commissioned by Carina and conducted by PHI from February through August 2024. The study focused on the value and impact of the platform for users, examining match quality and longevity.
About PHI
PHI is a national nonprofit organization working to transform eldercare and disability services by creating quality direct care jobs. Founded in 1992, PHI promotes quality jobs as the foundation for quality care. Through advocacy, research, consulting, and direct services, PHI supports the workers who provide home and residential care to millions of Americans. Learn more at phinational.org.
About Carina
Carina is a nonprofit, web-based matching service platform guided by a vision of a care economy that strengthens communities by respecting and supporting workers, families, and people who need care. Available statewide in Washington since 2018, Carina has expanded into multiple states, providing innovative home care solutions. Learn more at carina.org.
Additional Resources:
- PHI’s full evaluation report: Making the Right Match: Evaluating the Carina Matching Service Registry in Washington State’s Self-Directed Home Care Program
- PHI’s matching service registry resources: https://www.phinational.org/advocacy/matching-service-registries/
- Carina’s website: https://www.carina.org/about
