COVID-19 has “ravaged” assisted living and other long-term care settings, with direct care workers on the frontlines struggling to remain in their jobs and provide quality care without sufficient training, support, protection or compensation, according to a new report. 

PHI workforce report cover

Low compensation, inadequate training, limited career advancement, and racial and general inequalities are cited as contributors to poor job quality in “Would You Stay? Rethinking Direct Care Job Quality,” a report from PHI, a national organization widely considered the leading expert on the direct care workforce. The report also looks at how the COVID-19 pandemic has amplified the visibility of direct care workers and the challenges they face. 

It also offers a new framework for elevating job quality among the direct care workforce through quality training, fair compensation, quality supervision and support, respect and recognition, and real opportunity.

“For too long, direct care jobs have suffered from underinvestment and profound challenges that make it nearly impossible for workers to stay in these roles, much less thrive,” PHI President Jodi M. Sturgeon said. “At a devastating cost, COVID-19 has made painfully clear that we must transform job quality in this sector once and for all.”

Even before the pandemic, long-term care employers struggled to recruit and retain workers. Low wages that can’t compete with other occupations are contributing to the 8.2 million estimated job openings that will occur between 2019 and 2028, according to the report authors. Recent data show that the number of direct care workers dropped by 280,000 during the first three months of the pandemic, with 50,000 of those departures in assisted living communities and nursing homes. 

New data from PHI show that in all 50 states and Washington, D.C., the direct care worker median wage is lower than other occupations with similar entry-level requirements, including janitors, retail salespersons and customer service representatives. In many states, direct care worker wages also can’t compete with occupations with lower entry-level requirements.

“Even though direct care workers have been deemed essential during this health crisis, their jobs have never been compensated or supported in a manner commensurate with this designation,” said Robert Espinoza, vice president of policy at PHI and the report’s author.

To begin improving jobs for direct care workers, the report proposes two immediate actions:

  1. Creating more infrastructure at the state level to collect, analyze and report data on direct care workers.
  2. Strengthening the safety net for low-wage workers through paid sick days, comprehensive paid family and medical leave, affordable childcare and long-term care support.

This report is the fourth in a year-long series examining the direct care workforce. The final, comprehensive report — “Caring for the Future: The Power and Potential of America’s Direct Care Workforce” —  will be released in January.