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Workforce Interventions in Direct Care Could Use a Boost

March 1, 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 fourth in an eight-part series, describes a few critical ideas for funding, implementing, and evaluating workforce interventions in direct care.

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


To strengthen and leverage the direct care workforce while building the evidence base for future investments in this workforce

  • Strengthen the workforce pipeline in direct care. Demographic shifts and persistently poor job quality have created significant workforce shortages in long-term care. To ensure there are enough qualified direct care workers to meet consumer demand, targeted efforts are needed to attract more candidates to these jobs. Recruitment strategies and training programs should be designed to meet the unique demographic, cultural, linguistic, learning, transportation, and care needs of a particular region. Programs should also be designed to recruit new populations for direct care jobs, such as men and workers displaced by COVID-19, as two examples. States should support such efforts, including efforts specifically aimed at independent providers in consumer-directed programs, and ensure that publicly funded job placement services are prepared to connect jobseekers with free direct care training and employment programs.
  • Integrate direct care workers onto the care team. Though direct care workers spend more time with consumers than any other paid provider, they are rarely consulted by—or trained to communicate with—members of the consumer’s interdisciplinary care team. Research shows, however, that bringing direct care workers’ observations about consumers to care teams—either through direct communication pathways between entry-level workers and other care team members, or via advanced direct care workers serving as intermediaries—can maximize the direct care workforce in care coordination and improve consumer outcomes and cost savings. The public and private sectors should invest in implementing, evaluating and scaling-up care team integration initiatives, with attention to the different approaches required for different LTSS service-delivery models and settings.
  • Develop rungs in the career ladder that are accessible to direct care workers and that build on their experience. Today’s direct care workers have few options for advancement within direct care; for example, pursuing the next formally recognized rung on the career ladder, licensed practical nurse (LPN), requires time, resources, and educational credentials that are often inaccessible to direct care workers. With support, employers can take a leadership role in creating and evaluating advanced roles for direct care workers that represent an elevation in title, function, and compensation. States should also establish and fund advanced direct care roles that meet the needs of employers and consumers, such as those specializing in care coordination, worker retention, condition-specific care, and more.

* 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 >>

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.