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PHI Releases New Report on California’s Direct Care Workforce

March 9, 2021

NEW YORK — As California begins implementing a bold, new Master Plan for Aging, a new report from PHI provides a detailed overview of the state’s direct care workforce and examines how this plan can improve jobs for this rapidly growing workforce.

Released in January 2021, California’s Master Plan for Aging offers a comprehensive 10-year blueprint designed “to ensure all people in California are engaged, valued, and afforded equitable opportunities to thrive as we go through different ages and stages of life.”

As part of a multi-year process to create the Master Plan, the state convened an LTSS Subcommittee (among other steps) to issue recommendations on long-term services and supports, including various proposals on the direct care workforce.

PHI’s new report, Quality Jobs Are Essential: California’s Direct Care Workforce and the Master Plan for Aging, describes how the Master Plan supports this workforce, highlights where it incorporated the LTSS Subcommittee’s recommendations, and proposes where and how the Master Plan can be strengthened. PHI’s report also includes various stories from direct care workers in the state to inform future advocacy.

“We commend California’s leaders for creating a bold and expansive plan on aging and for including direct care workers in the core framework of the plan,” said Jodi M. Sturgeon, president of PHI, a national research, advocacy, and workforce innovations organization widely considered the nation’s leading expert on the direct care workforce.

“Direct care workers are essential to the lives of older adults and people with disabilities throughout California, and our new report offers a variety of ideas for ensuring that the state’s Master Plan strengthens these jobs, improving the critical services and supports they deliver,” added Sturgeon.


Because of growing demand, the direct care workforce has expanded significantly in California in recent years—from more than 203,000 workers in 2009 to nearly 696,000 workers in 2019. Today, the direct care workforce in California outnumbers every other occupation in the state.

Quality Jobs Are Essential describes how, despite their growing numbers and enormous value, direct care workers continue to struggle with a variety of challenges, including inadequate compensation.

According to the report, the median hourly wage for direct care workers in California is $13.18, and the annual median income for these workers is just $17,200. In turn, 44 percent of the state’s direct care workforce lives in or near poverty, nearly half (49 percent) access some form of public assistance, and 19 percent do not have health coverage.

Direct care workers also struggle with insufficient training, limited career advancement training, and a general lack of appreciation that leaves these jobs without proper protections and support.

COVID-19 has brought these job quality concerns to light and made it even more difficult to recruit and retain direct care workers even as their services are needed more than ever.

Quality Jobs Are Essential notes that California’s long-term care sector will need to fill more than 1.2 million job openings in direct care between 2018 and 2028, including more than 199,000 new jobs and just over one million separations caused by workers who leave this occupation or the labor force.

“California’s Master Plan for Aging has arrived at the right time as the state navigates and learns from COVID-19, and as it imagines a bold future in which older adults, people with disabilities, and direct care workers can all thrive together,” said Robert Espinoza, vice president of policy at PHI and author of Quality Jobs Are Essential.


As described in Quality Jobs Are Essential, California’s new Master Plan for Aging rightfully elevates the direct care workforce, establishing “Caregiving That Works” as one of the five primary goals of the Master Plan and “direct care job creation” as one of the primary strategies under this goal.

Beyond this primary goal, the plan contains other opportunities to improve direct care jobs and strengthen the workforce, including various ideas related to training, advanced roles, recruitment and retention, COVID-19, stakeholder groups and task forces, dementia care competency, data collection, and inclusion and equity, among others.

Quality Jobs Are Essential examines each of these goals, strategies, and initiatives in the Master Plan for Aging that pertain to the direct care workforce and compares these ideas against the recommendations offered in the LTSS Subcommittee report.

“The Master Plan for Aging and the LTSS Subcommittee have spelled out the right framework and policy measures, and we look forward to working with California advocates and officials as they build on these ideas,” added Espinoza.

Read the full report here.

This report is made possible through generous support from the Arthur N. Rupe Foundation.


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