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PHI Launches Institute to Address Inequities in the Direct Care Workforce

February 8, 2022

NEW YORK — For a workforce comprised largely of women, people of color, and immigrants, systemic racism and gender injustice—among other inequities—are at the core of poor direct care job quality.

Today, PHI launched an institute—and released new data—dedicated to tackling these challenges and creating a stronger long-term care sector.

The Direct Care Worker Equity Institute aims to address the systemic inequities and profound disparities facing direct care workers by compiling resources and publications, producing original studies, developing advocacy tools, designing workforce interventions, and convening workforce experts—all with a clear focus on equity.

“For too long, direct care workers have faced a range of systemic inequities that harm their quality of life and devalue the direct care job,” said Jodi M. Sturgeon, president of PHI, a national organization focused on strengthening the direct care workforce through research, advocacy, and workforce innovation.

“The Direct Care Worker Equity Institute further cements equity in all of PHI’s strategies to transform this job and strengthen long-term services and supports for everyone,” added Sturgeon.


PHI’s data shows that 87 percent of direct care workers are women, 61 percent are people of color, 27 percent are immigrants, and 44 percent live in or near poverty.

A new research brief from PHI released today shows that although these segments of the direct care workforce are pivotal to the future of long-term care, they face a range of disparities that undermine their financial security.

According to this new research, women of color are a growing segment of the direct care workforce, increasing from 1.4 million workers in 2009 to 2.4 million workers in 2019—and from 45 percent to 53 percent of this workforce.

Immigrants are also a significant part of the direct care workforce, especially considering the intersection of immigration and race/ethnicity. Compared to just 6 percent of white direct care workers who are immigrants, 89 percent (nearly 9 in 10) of Asian/Pacific Islander workers are immigrants, as well as 46 percent of Hispanic/Latino workers, 29 percent of Black/African American workers, and 18 percent of workers of another race/ethnicity.

Despite comprising the majority of the direct care workforce, women and people of color in this job sector are financially less stable than their male and white counterparts, as evidenced by notable disparities in family income, poverty status, and public assistance access.

For example, 48 percent of Hispanic/Latino workers and 47 percent of Black/African American direct care workers live in low-income households, compared to 41 percent of white workers. Similarly, 40 percent of women live in low-income households, compared to 38 percent of men.

PHI’s research brief recommends five key strategies for addressing these disparities: closing compensation gaps, enhancing employment benefits, adopting equity-focused direct care workforce interventions, collecting and disaggregating direct care workforce data, and setting goals for increasing diversity at every level of long-term care staffing and leadership.

“It’s clear that in an already marginalized workforce, women, people of color, and immigrants generally fare worse than their counterparts, which means that we must focus significant support on these critical populations,” said Robert Espinoza, vice president of policy at PHI.


The disparities outlined in PHI’s new brief are rooted in a long history of systemic racial and gender inequities.

From the exclusion of home care workers and other domestic workers from important New Deal protections in the 1930s to the gradual erosion of Medicaid, to the ongoing onslaught of anti-immigrant policies—and much more—racist government decisions have long harmed the health and financial security of direct care workers and other workers of color.

For centuries, systemic racism has also concentrated people of color into poor-quality, low-paying occupations, including direct care.

Gender injustice also undermines direct care jobs. Specifically, caregiving has historically been defined as “women’s work” and is still often dismissed as a labor of love that requires only minimal compensation, training, and support, perpetuating poor job quality in this sector.

“To transform the entire direct care workforce, our country must confront its long and troubled history of systemic injustice that has impoverished various marginalized groups,” said Espinoza.

The launch of this institute was made possible through generous funding from the Woodcock Foundation.

To learn more about the Direct Care Worker Equity Institute, click here.

Join our February 14 webinar on equity and the direct care workforce.


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