How states can better care for direct care workers

A new report offers recommendations for state policymakers looking to strengthen the backbone of the care economy - the direct care workers themselves.


As the American population ages, the need for care workers is exploding. Direct care jobs, like home health and personal care aides, are generally predicted to be among the fastest-growing occupations over the next few years. But the quality of these jobs in no way reflects their importance, or the growing need for these workers, who are overwhelmingly women and disproportionately people of color and immigrants. One in six live in poverty, and the median income for direct care workers is under $20,000. 

Those stats come from a new report from PHI and Caring Across Generations, which offers some recommendations for state policymakers looking to strengthen the backbone of the care economy — the direct care workers themselves. Workforce Matters: The Direct Care Workforce and State-Based LTSS Social Insurance Programslooks at the working conditions for the people on “the paid frontline of long-term services and supports.” 

Between workforce attrition and growing need, the report says, the direct care workforce will need to fill nearly 8 million jobs between 2016 and 2026. Building a strong care infrastructure requires ensuring those jobs are good, well-paying jobs.

To accomplish this, the report lays out several suggestions for states looking to strengthen their direct care workforce. Among the most urgent: increasing compensation by setting robust wage floors and providing benefits can help direct care workers, who’ve barely seen their hourly pay go up over the last decade. 

Developing more advanced roles and training for care workers could improve the quality of care. The report authors also suggest states learn more about their care workers by collecting more employer-level data about the size and composition of the direct care workforce and launching workgroups to respond to the needs of both care workers and families. 

Investing in care workers couldn’t be more crucial as families around the country grapple with the high costs of providing quality care. “We cannot make care more accessible or affordable without solving for the crisis that direct care workers face every day,” Josephine Kalipeni, director of policy and federal affairs at Caring Across Generations, said in a statement.

The report comes as states consider how to help their residents cover the cost of long-term care services. Earlier this year, Washington set the bar by adopting a social insurance program for long-term care. In Hawaii, the Kupuna Caregivers program launched in 2017 provides subsidies to help caregivers working at least 30 hours a week outside the home. And a report released earlier this year by the National Academy of Social Insurance offers up blueprints for states looking to implement social insurance programs for universal family care — encompassing long-term care for aging people as well as childcare and paid family and medical leave. 

These bold proposals all require a strong direct care workforce to succeed. “As transformative policy solutions like Universal Family Care emerge, and states design and implement programs to urgently meet the care needs of an aging population,” Kalipeni said, “they must directly invest in and support the dignity of the people doing this vital work.”


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