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How Are States Investing in the Direct Care Workforce?

February 27, 2018

Did you know that Wisconsin offers a retention bonus to certified nursing assistants in nursing homes after six months on the job?

Or that Washington, D.C. has created a direct care worker training curriculum that applies across long-term care settings?

Or that a New Mexico taskforce is developing recommendations for stabilizing the direct care workforce?

While you might know what your state is doing to strengthen the direct care workforce, you might be in the dark about other states. To help states learn from one another, PHI teamed up with the Working Poor Families Project last year to release a report on state-level policy developments on the direct care workforce.

States share a range of similar challenges – a shortage of direct care workers, poor job quality in direct care, and limited long-term care funding, among others. State policy actors, including advocates and legislators, can use this report to begin developing a state plan that addresses these challenges.

A better investment in the direct care workforce can improve life for a wide swath of the population. As well as improving job quality for direct care workers, this type of investment can enhance care quality and coverage for older adults and people with disabilities, ease the burden on family caregivers (since direct care workers can take on more of this responsibility), and, in some circumstances, save costs (such as when unnecessary hospitalizations are avoided).

Drawing on examples from 19 states and the District of Columbia, this report offers five general recommendations:

  1. Increase wages, benefits and workforce protections for direct care workers. For example, states like New York require that certain Medicaid-funded home health aides receive a mandated minimum level of compensation in the form of both wages and benefits.
  2. Assess how funding sources can better invest in the direct care workforce. For example, Rhode Island and Montana have implemented Medicaid rate increases that specifically apply to increasing direct care worker wages.
  3. Improve direct care worker training requirements and career advancement opportunities. For example, Washington State has strengthened training requirements for personal care aides.
  4. Establish data systems that track and identify direct care workforce challenges. For example, Iowa issues an annual report on staff turnover in nursing homes.
  5. Create stakeholder engagement opportunities in order to help interpret data that has been collected, identify direct care workforce challenges, and determine solutions. For example, New Mexico, Maine, Iowa, California, and Michigan have all created workgroups to address challenges facing the direct care workforce.

When implemented in a manner that accounts for your state’s unique characteristics and needs, these recommendations can improve the lives of older adults and people with disabilities, family caregivers, and direct care workers – a win for everyone.

This report was released as part of PHI’s #60CaregiverIssues campaign.

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