This report examines Iowa’s direct care workforce challenges and presents six comprehensive recommendations based on national best practices to address growing demand for personal care aides, home health aides, and nursing assistants. With nearly 86,000 projected job openings between 2022 and 2032 and persistent issues of low wages, high turnover, and limited advancement opportunities, Iowa faces significant workforce pressures. Still, Iowa has meaningful opportunities to build on a strong foundation of policy innovation and data collection efforts—strengthening job quality and ensuring a more stable, skilled workforce for the future.
Key Takeaways
Iowa needs to fill nearly 86,000 direct care job openings by 2032, but low wages are driving workers away—70% cite better pay as their top reason to leave the field.
Nearly 11,700 Iowans were enrolled in self-direction programs in 2023 (up from 9,700 in 2019), but both independent providers and consumers struggle to find each other—Iowa previously explored but didn't implement a matching platform that could solve this.
The six recommendations (training, wages, benefits, pipeline, self-direction, data/voice) reinforce each other and require collaboration across state agencies to be most effective.
Contributing Authors
Sarah Angell, MSc, Stephen McCall, MPA, and Kezia Scales, PhD
