Gloved healthcare worker holding someone's hand

As nursing homes, assisted living communities and home care agencies recover from the COVID-19 pandemic, they continue to face another daunting challenge: the ongoing low supply of direct care workers to assist the growing numbers of aging Americans. To help the industry build a stronger, more equitable workforce, long-term care workers should receive a family-sustaining wage, full-time hours for those who want them, as well as paid leave, health insurance and retirement benefits, among other things.

That’s according to a new report from nonprofit research and consulting group Altarum and national research, advocacy and workforce innovations organization PHI.  

Although the report examines the state of the long-term care workforce in the state of Michigan in particular, the recommendations are likely to help strengthen direct care workers throughout the nation. 

The report noted that the most important step in strengthening the state’s long-term care workforce is improving compensation. Direct care workers in Michigan earn a median wage of $12.49 per hour, and their median annual earnings are $16,600 per year. 

“Not only does poor compensation weaken direct care workers’ economic security, but it also contributes to high turnover in the workforce and undermines recruitment efforts,” the report authors wrote. They suggest that new and existing long-term care financing programs in Michigan should ensure that direct care workers are sufficiently compensated to support themselves and their families without public assistance. Wage floors or wage passthroughs should be structured to account for variation in cost of living across regions of the state and over time, they said.

The authors also recommended full-time scheduling for those who want it, to help increase

direct workers’ annual compensation and optimize scheduling and deployment of the

workforce. Factoring health insurance, paid leave and retirement contributions into reimbursement rates would help workers transition off public supports — without fear of sudden disruption to their benefits — and achieve economic self-sufficiency, they said.

Taking steps to improve workforce recruitment and retention across occupational roles and care settings also would help strengthen the long-term care workforce, the authors concluded. Strategies could include establishing a state program to fund innovative projects that strengthen direct care workforce recruitment and retention, a matching service registry as well as a workforce development program aimed at recruiting, training and deploying new direct care workers where they are most needed.

Similar to many states, Michigan has inconsistent training standards across settings, wide variation in training quality among employers, and limited portability of training credentials for workers, the authors noted. These shortfalls compromise care quality, workers’ skills and confidence, and overall workforce capacity. To help strengthen training for direct care workers across long-term care settings, they recommended that the state mandate the use of high-quality, direct care training curricula. Enacting a stackable, portable credentialing system for direct care workers is also critical, they noted.

“Enabling workers to carry recognized training credentials across employers and settings would help optimize the existing direct care workforce and maximize training resources,” the authors wrote, adding that training records for credentialed workers should be housed in a searchable online registry.