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Giving Thanks to America’s Direct Care Workers

November 20, 2023

This Thanksgiving, as we reflect on the many aspects of our lives for which we are grateful, it’s important to turn our attention to a group of professionals whose contributions are vital yet often overlooked: America’s direct care workers. This workforce, 4.8 million strong, deserves our deepest gratitude and recognition.

Every day, direct care workers leave their homes to ensure that older adults and individuals with disabilities receive the essential care and support they need. These workers are the frontline of support for consumers and their families, a workforce that is growing annually as our population ages and the demand for care surges. They work tirelessly in private homes, nursing homes, and residential care settings, such as assisted living facilities, playing a pivotal role in our long-term care system.

A Diverse and Essential Workforce

This workforce is predominantly comprised of women, people of color, and immigrants, representing a diverse and consistently marginalized group. Despite their critical role, these workers often face challenges in being valued, compensated, and supported at the level they deserve.

The COVID-19 pandemic has further highlighted the vulnerabilities of our long-term care system, with direct care workers and their employers often lacking sufficient resources to deliver quality care. This crisis has disproportionately impacted older adults, people with disabilities, and people of color – the very populations that make up most of their clients and residents.

Moreover, the systemic racism deeply embedded in our long-term care system has disproportionately impacted direct care workers, who are primarily women and people of color. The national reckoning on racial injustice has underscored the need for a commitment to gender and racial justice for the direct care workforce.

A Path Forward

Despite these challenges, there is a path forward. PHI’s report, Caring for the Future: The Power and Potential of America’s Direct Care Workforce, offers concrete recommendations for policymakers, employers, advocates, and other long-term care leaders. It proposes a framework for creating quality jobs in direct care and looks forward to where this workforce and industry are heading.

Additionally, PHI commends the federal government’s recent steps in recognizing the essential role of direct care workers. This acknowledgment, particularly in the context of patient safety and healthcare quality, marks a significant shift in how these workers are perceived and valued. While the new focus aligns with the long-standing views of experts in the field, it also highlights that there is still much work to be done. The pandemic has laid bare the staffing vulnerabilities in our healthcare system, making the need for action more urgent than ever.

Addressing Challenges

The recent proposed regulations have shone a spotlight on the compensation challenges facing direct care workers. For too long, the issue of inadequate wages and benefits has plagued this sector, impacting the ability to attract and retain skilled workers. PHI strongly advocates for higher wages and essential benefits for these workers. Improving compensation is not just a matter of fairness; it’s a crucial step towards ensuring quality care and promoting equity in our healthcare system.

The federal government’s recognition should act as a catalyst, spurring collective action among all stakeholders to enhance job quality and conditions for direct care workers. PHI stresses the importance of rigorous implementation and enforcement of these new rules. We encourage active participation in the rule refinement process, ensuring that the voices of those most affected are heard and considered.

Effective implementation will also require addressing the unique needs and challenges faced by frontline staff. This includes not only better compensation but also a supportive work environment, opportunities for professional development, and a culture that values their contributions.

As we enjoy the warmth of our families and the comfort of our homes, let’s remember the direct care workers who make such moments possible for millions of Americans. Their dedication, resilience, and compassion are what truly embody the spirit of Thanksgiving.


Contributing Authors

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.