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Centers for Medicare & Medicaid Services


In 2006, the Centers for Medicare and Medicaid Services created the National Direct Service Workforce Resource Center (WRC) as a response to the growing U.S. shortage in direct care workers. PHI served as a technical assistance provider to the WRC.

Through that role, PHI published a white paper outlining detailed recommendations for improving data collection on the direct care workforce. Released in 2009, The Need for Monitoring the Long-Term Care Direct Service Workforce and Recommendations for Data Collection proposed a framework for state-level data collection that included three basic elements: workforce volume, which includes the number of full-time and part-time workers; workforce stability, which includes turnover rates and vacancy rates; and worker compensation, which includes average hourly wages, annual income, and benefits such as health insurance and paid time-off. Today, this framework serves as a blueprint for strengthening data collection on this workforce.

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