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PHI Launches State Advocacy Initiative to Strengthen the Direct Care Workforce

September 29, 2020

NEW YORK —PHI and its coalition partners in three states announced today the launch of a multi-year advocacy initiative that aims to improve jobs for direct care workers at the state level—building on a growing wave of states that are increasingly supporting this critical yet undervalued workforce.

The “Essential Jobs, Essential Care” multi-state advocacy initiative will be based in Michigan, New Mexico, and North Carolina. It will focus on advancing policy solutions for direct care workers across three areas: increasing wages and reimbursement rates, promoting workforce innovations, and improving data collection.

The three coalitions participating in this initiative are IMPART Alliance (Michigan), the New Mexico Caregivers Coalition, and the North Carolina Coalition on Aging.

“We are thrilled and inspired to partner with these impressive coalitions to push for policy solutions and innovations that strengthen the direct care workforce,” said Jodi M. Sturgeon, president of PHI, a national organization widely considered the leading expert on the direct care workforce.

“More than ever, as COVID-19 has emphasized, direct care workers are critical to the lives of older adults and people with disabilities, and states should ensure that these workers are fully supported through high-quality jobs,” added Sturgeon.

Recognizing the longstanding challenges facing these workers and their growing demand, PHI will provide strategic advocacy guidance, coordination, and technical assistance to its coalition partners to ensure that strengthening the direct care workforce is central to their policy agendas.

These coalition partners will advocate for policy reforms over the next two years that stabilize these jobs, improve care for consumers, and help employers better recruit and retain a workforce characterized by high turnover.

PHI estimates that between 2018 and 2028, the long-term care sector will need to fill 8.2 million job openings in direct care, including 1.3 million new jobs and 6.9 million openings spurred by workers who leave this sector or exit the labor force altogether. The COVID-19 crisis has deepened this monumental challenge.


In a variety of long-term care settings, direct care workers support older people and people with disabilities with activities of daily living, among other responsibilities.

Recent research from PHI shows that 4.6 million home care workers, residential care aides, and nursing assistants in nursing homes make up the direct care workforce. Because of its significant growth over the last decade, the direct care workforce is now larger than any single U.S. occupation.

Yet despite their enormous value, direct care workers struggle with a range of economic barriers that force workers into poverty and drive many of them out of this sector.

As one example, nearly half (47 percent) of home care workers live in low-income households and over half (54 percent) rely on some form of public assistance.

PHI and its three coalition partners aim to improve these conditions by focusing on three key policy goals: lifting workers from poverty by increasing compensation and state funding for this sector; investing in workforce innovations such as training and advanced roles, among others; and improving data on this workforce to help states identify where workforce shortages exist and track urgent trends over time.

COVID-19 has both amplified the barriers facing this workforce and strained state budgets across the country—a challenge that this initiative will navigate as it proposes key policy reforms.

“For the direct care workforce, most of this country’s advocacy energy is at the state level, where states are increasingly crafting home-grown solutions to transform a troubled long-term care sector that isn’t meeting the full needs of either workers or consumers,” said Robert Espinoza, vice president of policy at PHI.

This initiative also acknowledges how a history of systemic racism has long harmed the lives and jobs of people of color in direct care—from the creation of these jobs, through the exclusion of home care workers (and other domestic workers) from federal wage and overtime protections, to the widespread racial discrimination that people of color continue to face in regard to employment, housing, education, and access to health care, among others.

PHI and the three coalitions will deliberately identify racial justice strategies that center and uplift women, people of color, and immigrants throughout the life of the initiative.


In the absence of strong direct care proposals at the federal level, states have increasingly enacted laws and regulations to improve jobs for direct care workers, including policies that raise hourly wages and strengthen training requirements, among other measures.

Additionally, since 2003, at least 16 states have created workgroups to develop statewide reports and recommendations for transforming the direct care job with a primary focus on increasing compensation, improving training, boosting public awareness, developing career advancement opportunities, and establishing workforce data systems.

The “Essential Jobs, Essential Care” advocacy initiative builds on this state-level momentum and the energy and expertise of statewide coalitions to move the needle on direct care policy reform.

In addition to the advocacy activities that will take place in each state, this initiative will release a digital advocacy toolkit at the end of 2022 that guide advocates in other states on effectively advancing measures that support and stabilize this critical workforce, reflecting best practices from this multi-state work.

“Now is the time to bolster a national, state-by-state political movement in support of direct care workers and the people they support,” said Espinoza.


“IMPART Alliance is excited to work with PHI on transforming direct care jobs in Michigan through meaningful policy change. Now, more than ever, we see just how essential direct care workers are to our collective health and well-being. It’s time we create the quality jobs this critical workforce deserves.” ~ Clare Luz, PhD, IMPART Alliance Director, Department of Family and Community Medicine, Michigan State University

“New Mexico’s direct care workers deserve great jobs, and we’re aiming to achieve this ideal and create a real impact through this initiative. We’re looking forward to partnering with PHI, given its long history of high-quality policy advocacy and research on the direct care workforce.” ~ Adrienne Smith, President and CEO, New Mexico Caregivers Coalition

“We are excited to partner with PHI to co-lead a multi-year initiative which acknowledges the essential role of direct care workers. Over the past months, COVID-19 has magnified the challenges of this critical workforce. Now is the time to support our state’s direct care workforce by working collaboratively to address the many policy barriers they face.” ~ Heather Burkhardt, Executive Director, North Carolina Coalition on Aging

This initiative is made possible through generous support from the W. K. Kellogg Foundation.


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