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States Take on the Workforce Shortage

By Stephen McCall | July 18, 2017

Even as the demand for direct care workers rises around the country, job quality for this workforce remains poor—and this had led to a nationwide shortage of direct care workers. In response to this shortage, groups representing workers, older people, people with disabilities, caregivers, and long-term care providers have come together to achieve policy victories in states across the country over the past year.

In Wisconsin, legislators may soon approve a proposal from Governor Scott Walker (R – WI) to increase Medicaid reimbursement for personal care and nursing home services by 2 percent. Additionally, nursing assistants employed in nursing homes will soon receive a $500 retention bonus after completing six months on the job, thanks to a program at the Wisconsin Department of Health Services. These policies were proposed in response to research by members of the Wisconsin Long-Term Care Workforce Alliance, a coalition of workers, consumer groups, employer associations, and state agencies. Members of the alliance uncovered high turnover and vacancy rates among direct care workers across long-term care settings, which have detrimentally impacted older people and people with disabilities.

The Maine Council on Aging (MCOA) is another diverse coalition that advocates for better jobs among direct care workers. In early 2016, they successfully lobbied for a government-sponsored, statewide study to determine an appropriate reimbursement rate for personal care services. Later that year, MCOA leveraged the results of this study to pass a law that increased funding for personal care services by $4 million – half of the adjustment recommended by the study. Legislators are now considering a second bill (L.D. 643) that would appropriate the remaining $4 million.

Unlike the unrestricted rate increases in Wisconsin and Maine, recently proposed rate increases in Rhode Island and Montana would be tied directly to worker wages. Governor Gina Raimondo (D – RI) proposed a budget that would raise home health aide wages to $12.30 an hour—a 7 percent increase. If enacted, this law would also effect a 5 percent raise to $11.18 an hour for workers who serve people with intellectual and developmental disabilities. In Montana, Senator Mary Caferro (D – Helena) proposed a bill to raise wages to $13.80 an hour for all Medicaid-funded direct care workers by 2018, using revenue from a new tobacco tax.

In addition to substantive changes to state financing, states have been addressing job quality through state-sponsored workgroups. Legislators in New Mexico recently passed a memorial (Senate Joint Memorial 6) which directs the New Mexico Direct Caregivers Alliance to convene a task force on the direct care workforce. In October 2017, they will issue recommendations on implementation of minimum wage and overtime protections for home care workers. One year later, they will release broader recommendations on how to stabilize the direct care workforce.

While these policies alone will not fix the direct care workforce shortage, advocates view them as positive developments. The successful advocacy campaigns behind these changes demonstrate the importance of collaboration among various types of stakeholders.

Stephen McCall
About The Author

Stephen McCall

Data and Policy Analyst
Stephen McCall is a Data and Policy Analyst at PHI. In this capacity, he studies and writes about a variety of issues facing the direct care workforce–with the goal of reforming state and national policies.
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