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Would You Stay? Rethinking Direct Care Job Quality (Sect. 4)

This report takes an in-depth look at job quality in the direct care workforce and proposes a new framework to improve these jobs in the years ahead.

The COVID-19 crisis has amplified the many long-standing challenges facing the direct care workforce—our new job quality framework aims to address these inequities.

Would You Stay? Rethinking Direct Care Job Quality examines how poor job quality has defined the direct care job for decades, negatively impacting workers, long-term care employers, consumers, and the economy. The report also reviews how the COVID-19 pandemic has endangered the lives of these essential workers and left them unprepared to manage the crisis.

To improve these jobs, this report delineates PHI’s new framework for quality jobs in direct care, which spans five pillars: quality training, fair compensation, quality supervision and support, respect and recognition, and real opportunity.

This report is the fourth 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: The Power and Potential of America’s Direct Care Workforce—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.

"I think isolation in general is a challenge for caregivers, but with the risk of COVID added, it has really been very taxing. I’d say that’s the hardest part of the job for me."
"I will always say that this job is not about money—it’s about you working with your heart. But you also have to pay your bills."
"We aren’t hearing as much about home health aides in the news, but we are dealing with our own crises during this coronavirus pandemic. It’s a scary time right now for us, as well as for our clients and their families."

Key Takeaways

Direct care workers have been hindered by poor job quality for decades, as evidenced by low compensation, inadequate training, and much more.
The COVID-19 crisis has amplified both the visibility of direct care workers and their many deep-seated challenges.
To guide our industry, this report delineates PHI’s new framework for job quality in direct care, which includes five pillars and 28 elements.
Private: Robert Espinoza (he/him)
About The Author

Robert Espinoza (he/him)

Former Executive Vice President of Policy
Robert Espinoza oversees PHI's national advocacy and public education division on the direct care workforce, and contributes vision and leadership to the organization's strategies.

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