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A Transformative Proposal for Washington, D.C.’s Direct Care Workforce

By Jake McDonald (he/him) | January 30, 2024


Recently, eight members of Washington, D.C.’s Council introduced a groundbreaking bill to address the District’s direct care workforce crisis. This landmark legislation seeks to address the systemic challenges faced by these essential workers, who play a pivotal role in supporting District residents’ independence, health outcomes, and quality of life.   

The Direct Care Worker Amendment Act of 2023 promises substantial improvements in worker’s wages, training, and career opportunities while also bolstering government reimbursements to providers of direct care services. Here’s a summary of its key provisions: 

  • Wage Increase: Direct care workers would receive a minimum wage of no less than 120% of the District’s general minimum wage, while Medicaid reimbursement rates would be raised to meet this new obligation. Although this increase is lower than what is needed to fully address the District’s workforce crisis, it is a positive step that recognizes the value of direct care workers and moves them closer to a livable wage. 
  • More universal credentials: Training and certification for home health aides and nursing assistants—which currently are separate and independent of one another—would be combined into one training curriculum and one certification. This would create a recognized direct care worker certification allowing those with it to work across settings, making the workforce more versatile and the job more appealing. 
  • Removing barriers to training: The bill would require the District to identify and eliminate obstacles that hinder the development and support of on-the-job training programs and registered apprenticeship programs. These initiatives are crucial for expanding access to skills development and career advancement opportunities that improve quality of care while creating career pathways for workers. 
  • Expanding reciprocity: Maryland and Virginia home health aides and nursing assistants would be permitted to work in the District, fostering a more flexible and responsive workforce that can meet the growing demand for direct care services. Similar flexibilities available during the COVID-19 pandemic demonstrated how helpful giving workers the freedom to work across state lines is to the long-term care system.   

While the bill is not perfect, advocates in the District, particularly the DC Coalition for Long Term Care, are working to strengthen the bill’s text while supporting its general thrust and purpose. They are urging District residents to reach out to their council members, testify on the bill’s behalf, and share their stories that underscore the need for this bill.  

The District’s Direct Care Worker Amendment Act is a powerful bill and, if passed, would be a transformative law. In fact, it is one of the strongest proposals to address the direct care workforce crisis in the country and would create a model for other states to follow. Importantly, the passage of the bill is not just a matter of improving the lives of direct care workers; it is an investment in the health and well-being of the entire District community. By prioritizing the economic security and well-being of these essential workers, we can create a more robust and effective long-term care system that benefits all.  


Jake McDonald (he/him)
About The Author

Jake McDonald (he/him)

Senior State Policy Advocacy Specialist
As the Senior State Policy Advocacy Specialist, Jake McDonald improves job quality for direct care workers by deepening and expanding PHI’s state-based advocacy approach.

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