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A Multi-Pronged Strategy to Strengthen the Direct Care Workforce

March 5, 2024

The U.S. Department of Health and Human Services (HHS), through the Administration for Community Living (ACL), has unveiled a robust series of initiatives aimed at addressing the critical and longstanding shortage of direct care professionals. This workforce, the backbone of support for older adults and people with disabilities, is crucial for enabling millions to live with dignity in their communities rather than in institutional settings. The new measures, part of the Biden-Harris Administration’s broader efforts to bolster the nation’s caregiving infrastructure, promise a significant step forward in ensuring accessible, quality care for some of society’s most vulnerable.

The Growing Crisis in Direct Care

The direct care workforce includes personal care aides, home health aides, direct service workers, and other professionals who perform a vital role in the healthcare system. They provide essential services that allow older adults and people with disabilities to live independently, offering assistance with activities of daily living and supporting social and community engagement.’. Despite their importance, these workers have faced systemic challenges for decades, including low wages, lack of benefits, and limited opportunities for career growth. The COVID-19 pandemic further exacerbated these issues, leading to a crisis-level shortage, with over three-quarters of service providers declining new participants and more than half cutting services.

A Multi-Pronged Approach

The HHS’s response to this crisis is multi-faceted, aiming to tackle the root causes of the workforce shortage while also providing immediate support to those affected. The initiatives include:

  • Technical Assistance Opportunities: States are offered assistance to strengthen their systems for recruiting, retaining, and developing direct care workers. This includes a focus on strategies to sustain direct care workforce initiatives funded through the American Rescue Plan.
  • National Resource Hub: A hub for states, stakeholders, and communities to connect with best practices and resources related to the direct care workforce.
  • Webinar Series: A series focused on a range of direct care workforce topics to educate and inform states and stakeholders.

These measures are designed to build on the $37 billion already invested by states in home and community-based services through the American Rescue Plan and support the comprehensive set of actions outlined in the President’s executive order to improve care services.

Interested states should complete an online Expression of Interest Application by 8:00 p.m. ET on Monday, March 25, 2024.

The Importance of Strengthening the Direct Care Workforce

The direct care workforce is more than just an employment sector within the healthcare system; it is a critical component of the infrastructure that supports community living for older adults and people with disabilities. “Today’s announcement reflects the Biden-Harris Administration’s steadfast commitment to strengthen the caregiving infrastructure and increase the availability of home and community-based services,” said HHS Secretary Xavier Becerra. This initiative is not only about bolstering the workforce but also about enhancing the quality of life for millions of Americans who rely on these services.

Challenges and Opportunities

The shortage of direct care professionals presents a complex challenge that requires a nuanced approach. Low wages and lack of benefits contribute to high turnover rates, while the lack of career advancement opportunities limits the attraction of the field to new entrants. By addressing these issues directly, the HHS initiatives aim to make the direct care profession more attractive and sustainable.

However, the success of these initiatives will require collaboration across various sectors. State agencies, including Medicaid, aging, disability, labor, and workforce development systems, must work together with direct care professionals, service recipients, and other stakeholders. This collaborative approach is at the heart of the technical assistance opportunities and the peer-learning collaboratives being offered as part of the HHS’s strategy.

Looking Forward

As the population of older adults and people with disabilities continues to grow, so too does the demand for home and community-based services. Without significant and sustained efforts to address the direct care workforce shortage, the problem will only worsen, with severe consequences for individuals and the healthcare system as a whole.

The initiatives announced by the HHS represent a significant investment in the future of healthcare in the United States. By strengthening the direct care workforce, the administration aims to ensure that older adults and people with disabilities can continue to live in their communities, receiving the care and support they need. This not only benefits those directly affected but also contributes to the health and well-being of society as a whole.

The HHS’s announcement is a promising step forward in the effort to address one of the most pressing challenges facing the American healthcare system. By providing states with the resources and support they need to strengthen their direct care workforces, the administration is laying the groundwork for a more sustainable, equitable, and compassionate healthcare system. As these initiatives unfold, the hope is that they will not only alleviate the current crisis but also pave the way for a future in which all Americans have access to the care and support they need to live with dignity and independence.

More information can be found at

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