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We Cannot Wait to Strengthen Michigan’s Direct Care Workforce

By Emily Dieppa Colo (she/her) | July 26, 2021

Michigan’s direct care workforce is critical to the state’s long-term services and supports sector, ensuring that older adults and people with disabilities can live and thrive in their homes and communities and across congregate settings.

Unfortunately, as the COVID-19 crisis has reinforced, these workers remain undervalued and woefully lacking in support. For example, Michigan’s direct care workers earn a median wage of less than $13.00 per hour, and half the workforce lives in or near poverty. Because of poor job conditions, many direct care workers are forced to leave this sector for other fields (such as fast food and retail), which profoundly affects the individuals who rely on their support.

Did you know? PHI’s research shows that from 2018 to 2028, Michigan’s long-term care sector will need to fill 178,000 job openings in direct care, including 17,500 new jobs to meet rising demand and nearly 161,000 job openings caused by workers who transfer to other occupations or exit the labor force altogether.

Yet, there is some encouraging news and a sense of promise in the air. A wave of recent federal proposals—including the American Rescue Plan and the American Jobs Plan, as two notable examples—signal a shift in how the federal government is supporting states to strengthen this workforce. At the state level, Michigan continues to identify the best ways to improve jobs for the state’s 120,000 home care workers, residential care aides, and nursing assistants.


In this climate, as part of our Essential Jobs, Essential Care initiative, PHI has been working with IMPART Alliance and its broad coalition of leaders to identify the primary policy barriers facing direct care workers and to co-create an advocacy roadmap in response.

In February of this year, we co-hosted a statewide virtual gathering where 200 participants reviewed the latest data on this workforce, heard from direct care workers and other experts in the state about the policy landscape for this workforce, and identified the policy areas central to the future of these workers. Here is a summary of the three most pressing policy needs that this initiative will drive forward.


Michigan’s direct care workers deserve a living wage and comprehensive benefits. Now  more than ever, it is clear just how essential direct care workers are to the well-being of older adults and persons living with disabilities, yet these workers struggle with poverty wages and inadequate access to benefits. As one immediate solution, state policymakers in Michigan should make permanent the $2.00 hourly wage premium that has been paid to direct care workers during the COVID-19 pandemic. They should also expand this premium to all direct care workers, include an adequate administrative increase for providers, and build in an annual cost of living increase tied to inflation. With additional federal funding, Michigan could also strengthen access to critical employment supports for direct care workers (among other low-wage workers), including paid leave and affordable childcare.

Improving training standards for direct care workers in Michigan will strengthen the workforce and increase access to care. Research and examples from other states clearly show that investments in training lead to better workforce retention, improved care outcomes, and cost savings for the state—but Michigan’s current training landscape is inconsistent and inadequate. State policymakers should overhaul Michigan’s training standards and infrastructure, using as a benchmark the direct care competencies set that has already been developed by the Michigan Direct Care Worker Professional Association and the Direct Care Workforce Advisory Committee at the Michigan Department of Health and Human Services. Federal funding could help further develop a training and credentialing system in Michigan that ensures quality entry-level training for all direct care workers as well as offering career pathways into advanced specialties and certifications.

Michigan needs better direct care workforce data to help address the root causes of poor job quality. Without a robust system for collecting and tracking data related to Michigan’s direct care workforce, it is difficult to accurately describe workforce challenges, let alone incentivize employers to create good jobs. The state should adopt quality improvement measures directly tied to direct care jobs and use federal funding to invest in upgrading technology and data systems so that workforce information can be gathered and made accessible to policymakers, legislators, advocates, and others.


For years, PHI and IMPART Alliance have led critical advocacy on the direct care workforce. Yet we have never experienced the type of widespread policy interest at the state and federal levels that we are currently witnessing. Together, we must capitalize on this moment, transforming jobs for direct care workers and care for older adults and people living with disabilities.

Learn more about Essential Jobs, Essential Care in Michigan >>

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

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