Top 5 Latest Resources on the Direct Care Workforce

We recently updated PHI’s National Direct Care Workforce Resource Center—the nation’s premier online library for information on the direct care workforce—to include recent key publications from the field. Below are five highlighted resources from around the country—namely, New York City, Oregon, Maine, and Michigan—that provide snapshots of regional and state efforts at elevating the direct care workforce.

To Care for Them, We Need to Take Care of Ourselves: A Qualitative Study on the Health of Home Health Aides

This research article describes a study undertaken by New York City-based researchers in collaboration with the 1199 SEIU Training and Employment Fund. Researchers interviewed 28 English- and Spanish-speaking home health aides in New York City about their physical health status and how their employment impacts their health. Findings revealed five major themes: home health aides manage their own ongoing health issues while working to care for others; home health aides have high motivation to be healthy, partly stemming from their caregiving role; working with sick and disabled individuals affects home health aides’ views on health; the home health aide job offers both challenges and opportunities for maintaining health; and home health aides seek out support and information to benefit their health. The authors of this paper emphasize that home health aides must receive accurate and reliable information about maintaining their health, as well as related support and training from their employers. This study has implications for workplace training and benefits that could improve the health of home health aides and lead to longer-term sustainability of the home health aide workforce in New York City.

The Benefits Cliff Dilemma: Navigating Wage Increases and Public Benefits

This research brief summarizes the findings from a case study on the impact of a $2 minimum wage increase for New York City home care workers on their access to public benefits. The “benefits cliff” occurs when individuals who use public benefits get a raise or otherwise increase their incomes, such as by working more hours, and no longer qualify for benefits but remain in financially precarious situations. To conduct this research, the Financial Health Network (a nonprofit devoted to building financial health and stability for all, with a focus on vulnerable populations) worked with three organizations that serve low-income workers in New York City: The Leap Fund, Neighborhood Trust Financial Partners, and The ICA Group. The majority of the home care workers in the study used at least two forms of public benefits to supplement their incomes. Many of the participating home care workers were unaware of benefits cliffs and how their higher wages would put them at risk of reaching them. The brief emphasizes that more awareness and financial education is needed for workers alongside any wage increases they may receive.

Direct Care Staff Experiences in Oregon Assisted Living, Residential Care and Memory Care Communities

This report discusses the experiences of resident care assistants in Oregon in 2022, based on the findings from a qualitative research study that involved focus groups and interviews with resident care assistants and other experts with experience in hiring, training, and supervising resident care assistants. Key themes emerging from the interviews touched on resident care assistants’ identities and meaning-making; the challenges and burnout faced by resident care assistants and the coping strategies they use; the variation in management of and resources offered to resident care assistants; and barriers and facilitators to improving the residential care workplace. This report emphasizes that a multi-level systems approach—including resident care assistants, their employers, policymakers, and advocates—is needed to best address the challenges that Oregon faces regarding this critical segment of the direct care workforce.

The High Cost of Devaluing Direct Care Work

This report, written by the Maine Center for Economic Policy, highlights the issues facing direct care workers in Maine and their negative impacts on direct care workers themselves and on consumers, families, the healthcare system, and the state economy (including through reduced tax revenue and heightened health care expenditures). Because of a shortage of direct care workers in Maine, many people have had to leave the workforce to care for their loved ones. This report recommends public policy strategies, as well as private and social sector approaches. From a policy standpoint, the state could raise Medicaid reimbursement rates for direct care workers. Private companies could invest in workplace policies that support care provision. The general public can change the traditionally negative and disparaging narrative on direct care work in verbal and written communications by lauding the accomplishments and hard work that direct care workers do.

Forging a Path Forward to Strengthen Michigan’s Direct Care Workforce

This report, authored by the Center for Health Care Strategies, summarizes the direct care workforce landscape in Michigan. The report was informed by state policy research, participation in Direct Care Workforce Advisory Committee Meetings, and interviews with direct care workforce experts, home care organizations, long-term care companies, direct care workers, and consumers in Michigan. Findings reveal that, like many states, Michigan is facing a shortage of direct care workers, which was worsened by the COVID-19 pandemic—with the vital contribution of direct care workers often overlooked within the health care system. The report emphasizes steps that could improve the workforce, such as investment in platforms that connect direct care workers with consumers, developing a state direct care work taskforce to keep focus on the issues, and funneling Medicaid funds towards skills enhancement and training for workers.

PHI’s National Direct Care Workforce Resource Center includes a searchable database of academic and applied research publications and policy resources, including those highlighted here. PHI also tracks state policy developments, conducts original research on the direct care workforce, and issues studies, reports, and multimedia resources.