PHI Launches Universal Direct Care Workforce Initiative to Transform Training and Career Pathways for Nation’s Five Million Direct Care Workers
PHI announced today the launch of the Universal Direct Care Workforce Initiative, a systemic effort to develop, demonstrate, and establish a transformative universal workforce model with standardized core competencies for workforce training, portable and stackable credentialing, and clear career advancement pathways that can be adopted by every U.S. state. Through strategic partnerships with states, payers, and employers, PHI’s initiative seeks to address the fragmented training systems and limited workforce investments that restrict career mobility for direct care workers, while creating a comprehensive framework for training, credentialing, and workforce advancement across the long-term care sector.
The direct care workforce—comprised of more than 5 million personal care aides, home health aides, and nursing assistants—is projected to add over 860,000 new jobs between 2022 and 2032. This represents the largest growth of any job sector in the country. Despite providing essential care and support to millions of older adults and people with disabilities, direct care workers face siloed and disjointed training systems, limited career mobility, and inadequate compensation, leading to high turnover rates that ultimately compromise care quality.
“Direct care workers are the backbone of our long-term care system, yet they’ve been undervalued and underinvested in for far too long,” said PHI’s President and CEO, Jodi M. Sturgeon. “While current policy shifts challenge this workforce and the care they provide for millions of Americans, positive change is not only possible, but essential.”
“PHI’s Universal Direct Care Workforce Initiative will fundamentally transform how we invest in training, credentialing, and advancement for these essential workers,” said PHI’s Managing Director of Strategic Initiatives, Jeannine LaPrad. “Together with policymakers and providers in states across the country, we can create viable, sustainable career pathways while ensuring high-quality care for those who need it most.”
Universal Workforce Model: Addressing Critical Training and Workforce Gaps
Responsive to direct care recruitment, training, credentialing, and retention challenges in all 50 states, PHI’s Universal Direct Care Workforce Initiative seeks to establish standardized competencies at entry, specialty, and advanced levels that ensure consistent, portable skill sets across all settings. Key elements include:
Universal Entry-Level Competencies: Standardized core competencies that provide all direct care workers with essential skills while enabling seamless movement between private homes, residential care settings, and nursing facilities.
Stackable, Portable Credentialing: A comprehensive framework of portable credentials that workers can build upon throughout their careers, supporting transparent wage progression, economic stability, and workforce mobility across care settings and state lines.
Integrated Career Pathways: Clear advancement opportunities that balance entry-level accessibility, with meaningful specialization and leadership roles, including advanced positions focused on care coordination and peer support.
Accessible Training Infrastructure: Evidence-based programs delivered through multiple formats, including virtual options and language-accessible materials, ensuring equitable participation across diverse worker populations.
Demonstration Projects to Build Momentum
Building on three decades of workforce development experience, PHI is leveraging key foundation support to implement demonstration projects in New York and Wisconsin, with expansion planned to additional states.
In New York, PHI has launched a comprehensive Universal Direct Care Workforce demonstration project with four home care agencies: Jewish Association Serving the Aging, Selfhelp Community Services, Sunnyside Community Services, and Cooperative Home Care Associates; the initiative will draw on collaboration with multiple Managed Long Term Care Providers (MLTCPs); advocacy building from the results of our demonstration will seek to establish a Universal Direct Care Workforce training and credentialing infrastructure in New York State.
In Wisconsin, PHI has worked with Margaret A. Cargill Philanthropies (MACP) support since 2017 to conduct a landscape analysis, test a range of recruitment and retention interventions (including testing entry-level and specialty training approaches), and demonstrate the value of an advanced role for home care workers. Our testing of the Care Integration Senior Aide (CISA) advancement role demonstrated significant positive outcomes, including enhanced care quality and continuity, improved workforce retention, and strong acceptance by clients and care teams. PHI is now developing, implementing, and evaluating a universal workforce demonstration project in the state, with the goal of strengthening statewide training and credentialing infrastructure to improve the quality and availability of direct care services supporting older adults. These efforts will seek to establish training and credentialing infrastructure that supports workforce portability, mobility, and advancement within direct care occupations.
Lead funding for the Universal Direct Care Workforce Initiative in New York City has been provided by The Harry and Jeanette Weinberg Foundation, with additional key support from CD&R Foundation, the New York Community Trust, NYC Workforce Funders, New York Health Foundation, The Clark Foundation, and other sources being requested. Lead funding for our Wisconsin efforts has been provided by MACP, and lead support for our efforts to advance this work within other states and at the national level has been provided by the W.K. Kellogg Foundation.
Seeking National Impact, Focused on Systemic Inequities
Building on these demonstration projects and related efforts in a growing number of states, PHI will collaborate with policymakers, employers, and other stakeholders nationwide to advocate for federal and state investments and policy changes that support universal competency and training standards, fair compensation, career pathways, and economic advancement for this workforce. The initiative includes plans for interstate agreements that facilitate worker mobility, and a National Advisory Council to develop a roadmap for nationwide adoption and scaling of a universal workforce model.
The initiative will also account for racial, gender, and economic inequities that have historically plagued the direct care workforce. With workers who are predominantly women, people of color, and immigrants, more than half rely on public assistance despite providing essential care services.
“Transforming direct care jobs and supporting career advancement requires confronting the systemic inequities at the root of poor job quality in this sector,” emphasized LaPrad. “Our universal workforce model prioritizes worker voices and lived experiences in designing training and credentialing systems that advance both equity and quality care outcomes.”
Meeting Growing Demand with Smart Investment
With 8.9 million total direct care positions needing to be filled nationwide over the next decade, the universal workforce model offers a timely solution to critical staffing shortages. For example, due to growing demand and high turnover, New York alone will need to fill over 1 million direct care jobs between 2022 and 2032.
“Investing in the direct care workforce isn’t just about job quality and strengthening our nation’s economy, it’s about creating a sustainable long-term services and supports system that serves everyone better,” says Sturgeon. “Policymakers, payers, and providers looking to reduce costs and improve the quality and continuity of care in an evolving policy environment should assess their direct care workforce training, credentialing, employment, and advancement practices. A universal workforce model can strengthen training and care delivery, reduce turnover, and ultimately improve the quality, efficiency, and continuity of care.”
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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.
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