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Center Direct Care Workers in Leadership Roles and Public Policy

Direct care workers are experts on their jobs and care delivery, and they should help define the future of this workforce.

As the paid frontline of long-term care for older adults and people with disabilities, direct care workers possess unique insights on how to improve the quality of their jobs and the delivery of care. Unfortunately, their experiences and wisdom are often left out of the critical discussions and initiatives shaping policy and practice in this rapidly growing job sector. To address these problems, a variety of mechanisms exist to center direct care workers in leadership roles and public policy. States could create workgroups to develop action plans to improve these jobs and include workers front and center in these groups. Divisions of paid care could be instituted at various levels of government with the remit of supporting direct care workers, childcare workers, and housekeepers to access their rights and benefits, among other offerings. Finally, direct care workers could be tapped for key advisory roles and leadership positions across the public and private sector.


To ensure that direct care workers’ voices are heard and that that their concerns are directly addressed in policy and practice, we recommend the following:

Establish a statewide workgroup to create recommendations for advancing policies that improve direct care jobs. For many states, the growing workforce shortage in direct care can seem insurmountable, given the entrenched challenges facing this job sector and the unique—and sometimes conflicting—interests of stakeholders. States should form and properly resource state-level workgroups comprised of leaders from different sectors to identify and promote an expansive set of policy recommendations that strengthen this critical workforce.

Create a division of paid care that supports direct care workers with accessing their employment rights and resources. Many direct care workers navigate their jobs without a strong understanding of their legal rights or the job-related resources that are available in their communities. States and localities should create paid care divisions to assist all types of direct care workers (as well as childcare workers and housekeepers) with legal and employment concerns while also monitoring relevant workforce-related trends.

Integrate direct care workers into key advisory roles and leadership positions throughout the public and private spheres. For too long, direct care workers have been virtually shut out of these spheres of influence, despite their experiences and profound insights on this field. Actualizing the recommendations outlined in this section will require that direct care workers be centered as experts across organizations, long-term care businesses, government bodies, and the advocacy space. These workers must be empowered to help define the policies and programs that impact their jobs and lives.

Key Takeaways

The profound wisdom and experience of direct care workers should be tapped to inform policy and practice interventions for this workforce.
States should create direct care workforce workgroups that include direct care workers to advance statewide policy reforms.
Direct care workers should be integrated into key advisory roles and leadership positions throughout the public and private spheres.

By the Numbers: Direct Care Workers


Number of statewide direct care workgroups that have been convened since 2003. Source: PHI, 2019


Number of divisions of paid care that have been created at either the local, state, or federal level (New York City's Division of Paid Care)


Turnover rate in worker-owned home care cooperatives, compared to the turnover rate of 60 percent or higher in the broader direct care field. Source: ICA Group

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