Financing, compensation, training, workforce interventions, data collection, direct care worker leadership, equity and public narrative are the most significant issues for the federal government to address to strengthen the workforce for the 4.6 million residential care aides, nursing assistants and home care workers in the United States, according to a new report from PHI.

The organization shared 47 policy recommendations in eight key areas for the White House, Congress and federal departments and agencies to consider to bolster the direct care workforce in the report, released Wednesday.

PHI calls for financing policy changes in the elder care market, including Medicaid reform and alternative financing models. Further, the report calls for the Centers for Medicare & Medicaid Services to “incentivize states to build minimum standards for direct care jobs into their contracts with providers and managed care plans.”

Low pay is another area of concern mentioned in the report. The median salary for U.S. direct care workers is $20,300, and almost 15% of those workers have no health insurance, the authors said.

According to PHI, wages for direct care workers have hardly increased over the past 10 years. The organization urged Congress to take steps to address the issue through legislation, and  it called on the Department of Labor and other federal departments to “work together to develop a national compensation strategy that addresses direct care workforce concerns.”

Additionally, the government should strengthen training standards for direct care workers, PHI said.

“Training requirements for direct care workers are uneven and insufficient throughout the country, with federal mandates applicable only to some workers and state-level training regulations varying widely across states, long-term care settings and job titles,” the report authors stated.

Workforce interventions are another area of concern mentioned in the report, with a focus on recruitment and retention.

“Congress should enact and fully fund the Direct Creation, Advancement, and Retention of Employment (CARE) Opportunity Act, which would invest more than $1 billion over five years in workforce interventions that improve training, recruitment, retention, and advancement opportunities in the direct care workforce,” the report authors said.

Better data collection is needed for long-term care leaders to keep apprised of the size, stability, credentials and compensation of the direct care workforce and on direct care job quality, PHI said.

The organization recommended that the federal government give more attention and support to women, people of color and immigrants in the direct care workforce.

“Policy and practice interventions aimed at direct care workers do not often account for the unique structural barriers and inequalities they face on the job and in their daily lives, limiting the evidence base on race and gender-explicit workforce interventions in this sector,” the report authors stated. 

Lastly, PHI called on the government to use its communications platforms to shift the public narrative about direct care workers through education campaigns to show members of the workforce in a more positive light than they often are portrayed.