Home caregiver helping senior woman walking at home
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The top five states for direct care workers are Washington (No. 1), Rhode Island, Washington, DC, Maine and New Jersey, whereas the states with the “most opportunity for improvement” are Texas (No. 51), Mississippi, Louisiana, Alabama and North Carolina.

That’s according to a new online tool, the Direct Care Workforce State Index, launched by PHI to share a picture of how states’ public policies support direct care workers — and where they can improve. The interactive, data-driven tool shows how states’ public policies support direct care workers and how those workers are faring financially. 

Users can rank and compare states based on policies enacted to support workers — including wags, training requirements, Medicaid expansion, paid leave, “Right to Work” laws, LGBTQ+ protections and state-level earned income tax credits. The ranking also examines the economic status of the nation’s 4.7 million direct care workers — residential care aides, nursing assistants and home care workers — through median wage, wage competitiveness, median annual personal earnings, poverty, affordable housing and health insurance coverage.

Kezia Scales, PhD, PHI vice president of research and evaluation, said that the index provides “much-needed analysis” for state and national leaders. 

“This index is the beginning of a vital state-to-state assessment of direct care workforce policy issues, and we hope to continue evolving it over time to ensure that it benefits everyone,” Scales said. 

Advocates working with states to improve job quality

Alyse Meyer, LeadingAge Texas vice president of advocacy, told McKnight’s Senior Living that she is optimistic that the Texas Legislature will prioritize policies that support the long-term care workforce this session. Texas ranked last on the index. 

“The staffing shortage in long-term care, which was already growing, has been accelerated by the COVID-19 pandemic,” Meyer said. “Our organization is supporting various proposals to help strengthen the long-term care workforce, including student loan repayment assistance and increased Medicaid funding to improve staff wages and benefits in nursing homes.”

Georgia Health Care Association / Georgia Center for Assisted Living Director of Communications Devon Barill told McKnight’s Senior Living that the association recognizes the “urgent need” for policymakers, regulators, providers and advocates to engage in “intentional dialogue and efforts to confront the workforce crisis threatening the viability of our healthcare infrastructure and access to care.” The Peach State ranked No. 46 on the index.

“We owe it to these workers and the vulnerable individuals they serve to do the hard work of designing policy and payment systems that ensure a competent workforce that benefits from a quality work-life balance,” Barill told McKnight’s Senior Living

Calling the direct care workforce “foundational to care delivery,” Barill said the association looks forward to working with state legislators to increase the available pool of healthcare workers and ensure providers have resources to recruit and retain additional caregivers. At the federal level, GHCA implored lawmakers to balance staffing and workforce recommendations or requirements with funding resources.

While Maine comes in at No. 4 on the list, Angela Westhoff, Maine Health Care Association president and CEO, told McKnight’s Senior Living that many facilities remain “critically understaffed.”

“The PHI study notes that similarly skilled jobs in other industries pay an average of almost $2 an hour more than our direct care workers,” Westhoff said. “These caregivers are essential to the healthcare system, and we need more funding to close the wage gap and address the workforce shortage.”

Growing demand means more open jobs

PHI estimates that the long-term care sector will need to fill 7.9 million job openings in direct care between 2020 and 2030 — including new jobs created by growing demand, as well as filling openings left when workers exit the workforce or transfer to other occupations.

PHI said workers often leave the field because direct care jobs “impoverish workers” and offer poor job quality. The index provides data and information on successful initiatives some states adopted to help policymakers and other stakeholders improve direct care jobs.

“States are critical actors in job quality for direct care workers, and we hope this new online tool provides state leaders with insightful data and information to improve these jobs for the benefit of workers, consumers and employers,” PHI President and CEO Jodi M. Sturgeon said.