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Direct Care Work is Real Work: Elevating the Role of the Direct Care Worker (Section 3)

This report describes the roles and responsibilities of direct care workers, with an eye towards training, advanced roles, and care integration.

Despite their value, direct care workers are severely limited by insufficient training, underappreciation, and few career advancement opportunities.

Direct Care Work Is Real Work: Elevating the Role of the Direct Care Worker examines the current training landscape for direct care workers. This irregular and under-resourced system fails to prepare workers to succeed and threatens quality of care for older adults and people with disabilities.

The report takes a closer look at the aspects of direct care work that are often unseen or underestimated, including its physical demands, social and emotional complexity, and growing contributions to consumers’ health management. It also proposes ways to maximize the role of the direct care worker in care delivery through upskilling, integration into care teams, and advanced roles, reviewing the evidence on such interventions to date.

Direct Care Work Is Real Work is the third installment in a year-long series of reports examining the importance and impact of the direct care workforce. The final, comprehensive report—Caring for the Future—will be released in January 2021. This report series was made possible through generous support from the W. K. Kellogg Foundation and the Woodcock Foundation.


To inform the dialogue on direct care jobs, PHI spoke with workers in different parts of the country to hear their stories and ideas.

" need to understand that being a home health aide is work. It’s a challenging job, both physically and mentally."
"If I could make a change, it would be for this field to show more appreciation for what we do because we are the main backbone of this work."
"I think the role of the home health aide should be considered just as important as any other health care role."

Key Takeaways

The training landscape for this workforce is fragmented and outdated, with inconsistent rules and regulations across states, occupational categories and job titles, and payment programs.
There is a need to understand the considerable skill level required of direct care workers and the value their work offers to consumers, employers, and society at large.
Measuring the impact of well-trained and supported direct care workers on consumer outcomes, payers’ bottom lines, and public health will help us better appreciate the value of direct care work.

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.