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We Must Position Direct Care Workers as Experts on This Sector

By Robert Espinoza (he/him) | May 17, 2021

The Biden-Harris administration is exciting news for direct care workers and the long-term care field.

As the COVID-19 pandemic has reinforced, direct care workers are essential to the health and survival of millions of older adults and people with disabilities. Yet the poor quality of direct care jobs—as evidenced by low compensation, inadequate training, limited career paths, and much more—harms workers’ financial security, hinders quality care, and drives many workers out of this sector, a costly and unsustainable trend.

How should President Biden transform the direct care workforce?

Our new report—Caring for the Future: The Power and Potential of America’s Direct Care Workforce—provides a blueprint for this transformation. This report offers a comprehensive, current-day analysis of the direct care workforce and its critical role in the long-term care system. It also provides an extensive list of recommendations across eight key areas, all of which present federal policy opportunities, as well as options for state and local officials. This article, the sixth in an eight-part series, describes a few critical ideas for centering direct care workers in policy and practice interventions.

Now is the time for federal leaders to strengthen direct care jobs—and here’s one place to start.


To ensure that direct care workers’ voices are heard and that that their concerns are directly addressed in policy and practice

  • Establish a statewide workgroup to create recommendations for advancing policies that improve direct care jobs. For many states, the growing workforce shortage in direct care can seem insurmountable, given the entrenched challenges facing this job sector and the unique—and sometimes conflicting—interests of stakeholders. States should form and properly resource state-level workgroups comprised of leaders from different sectors to identify and promote an expansive set of policy recommendations that strengthen this critical workforce.
  • Create a division of paid care that supports direct care workers access their employment rights and resources. Many direct care workers navigate their jobs without a strong understanding of their legal rights or the job-related resources that are available in their communities. States and localities should create paid care divisions to assist all types of direct care workers (as well as childcare workers and housekeepers) with legal and employment concerns while monitoring relevant workforce-related trends.
  • Integrate direct care workers into key advisory roles and leadership positions throughout the public and private spheres. For too long, direct care workers have been virtually shut out of these spheres of influence, despite their experiences and profound insights on this field. Actualizing the recommendations outlined in this section will require that direct care workers be centered as experts across organizations, long-term care businesses, government bodies, and the advocacy space. These workers must be empowered to help define the policies and programs that impact their jobs and lives.

 * The recommendations above are taken from Caring for the Future: The Power and Potential of America’s Direct Care Workforce.

Read the executive summary of Caring for the Future >>

Download The 5 Pillars of Direct Care Job Quality >>

Private: Robert Espinoza (he/him)
About The Author

Robert Espinoza (he/him)

Former Executive Vice President of Policy
Robert Espinoza oversees PHI's national advocacy and public education division on the direct care workforce, and contributes vision and leadership to the organization's strategies.

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.