Reports Call for Changes for the Direct Care Workforce

The coronavirus pandemic has brought to greater public attention the workers who provide care to older people and people with disabilities and the challenges they face. Two new reports, one by PHI, a national nonprofit organization focused on the direct care workforce, and the other by LeadingAge, the trade association of not-for-profit services providers, call for fundamental changes for direct care workers.

More than 4.6 million direct care workers provide support and care to older adults and people with disabilities in a variety of institutional settings and in homes. PHI describes the direct care workforce:

• 87% | Percentage of direct care workers who are women
• 59% | Percentage of direct care workers who are people of color
• 27% | Percentage of direct care workers who are immigrants
• $12.80 | Median hourly wage for direct care workers
• 45% | Percentage of direct care workers living in or near poverty
• 36% | Percentage of direct care workers who lack affordable housing
• 47% | Percentage of direct care workers accessing some form of public assistance (food and nutrition assistance, Medicaid, and/or cash assistance)
• 7.4 million | Number of job openings in direct care between 2019 and 2029, including 1.3 million new jobs to meet rising demand and 6.9 million openings caused by workers who transfer to other occupations or exit the labor force altogether.[1]

In its new report, Federal Policy Priorities for the Direct Care Workforce, PHI identifies federal policy priorities for the direct care workforce, in the eight areas of

1. financing through Medicaid and alternative financing models 
2. compensation for workers (better wages and benefits)
3. training (national competency-based training standard, training infrastructure)
4. workforce interventions
5. data collection
6. direct care worker leadership
7. equity
8. public narrative 

LeadingAge’s report, “Feeling Valued Because They Are Valued; A Vision for Professionalizing the Caregiving Workforce in the Field of Long-Term Services and Supports,”[2] describes a new vision for direct care workers, whom it renames “professional caregivers” or “direct care professionals.” LeadingAge’s reimagined workforce would

• “Receive high-quality, competency-based training.
• “Earn a living wage and meaningful benefits commensurate with their competency levels.
• “Enjoy good working conditions and skilled supervision. 
• “Have access to a variety of career advancement opportunities. 
• “Be respected and appreciated by their employers, care recipients, and the general public.”[3]

LeadingAge identifies six strategies to improve recruitment of caregivers, reduce turnover, and ensure a stable workforce. These strategies are:

1. Expanding the pipeline of potential caregivers by recruiting nontraditional workers and changing immigration policy
2. Enhancing education and training, with “robust curricula”
3. Facilitating career advancement
4. Increasing compensation so that direct care professionals earn “at least a living wage”[4]
5. Preparing universal workers so that direct care professionals can work across care settings
6. Reforming the long-term services and supports financing system[5]

The similarities in the reports’ recommendations are striking. It is long past time for these recommendations to be implemented.

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[1] PHI, Federal Policy Priorities for the Direct Care Workforce, p. 4 (2021), citing “Workforce Data Center.” Accessed 6/8/2021. https://phinational.org/policy-research/workforce-data-center/.  The report is accessed through a link at http://phinational.org/resource/federal-policy-priorities-for-the-direct-care-workforce/
[2] Robyn I. Stone and Natasha Bryant, Feeling Valued Because They Are Valued; A Vision for Professionalizing the Caregiving Workforce in the Field of Long-Term Services and Supports (Jul. 2021), https://leadingage.org/sites/default/files/Workforce%20Vision%20Paper_FINAL.pdf
[3] Id. 2.
[4] See LeadingAge’s study, Making Care Work Pay: How a Living Wage Benefits Us All (Fall 2020), https://leadingage.org/sites/default/files/Making%20Care%20Work%20Pay%20Report.pdf
[5] Robyn I. Stone and Natasha Bryant, Feeling Valued Because They Are Valued; A Vision for Professionalizing the Caregiving Workforce in the Field of Long-Term Services and Supports, p. 3 (Jul. 2021), https://leadingage.org/sites/default/files/Workforce%20Vision%20Paper_FINAL.pdf