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Transforming direct care jobs and stabilizing the workforce will require policy changes and innovative strategies, according to a recent study from PHI.

Despite decades of research, advocacy and incremental policy and practice reform, direct care workers are poorly compensated, supported and respected, according to a paper published in JAMDA, the journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine.

The PHI researchers make the case for transforming direct care jobs and stabilizing the workforce as a centerpiece of efforts to reimagine long-term services and supports. 

There are 4.6 million direct care workers — including personal care aides, nursing assistants and home health aides  — in the United States. From 2000 to 2019, the direct care workforce increased by 52%, and almost 1.3 million new jobs will be added by 2029.

The pandemic, however, spotlighted long-standing concerns about job quality, which is linked to high turnover and job vacancy rates. That, the authors said, compromises the availability and quality of care for older adults and people with disabilities.

A strong, stable direct care workforce requires several changes and innovations, starting with competitive wages and adequate employment benefits, updated training standards and delivery systems that prepare workers to meet increasingly complex care needs across settings, and enhanced career mobility and workforce flexibility, according to author Kezia Scales, Ph.D., PHI director of policy research. 

Investments in well-trained frontline supervisors and peer mentors to help workers navigate their roles, along with an elevated position for frontline workers in relation to the interdisciplinary care team, also are key, they said.

“Reimagining LTSS requires a broad-based commitment to improving the quality of direct care jobs,” the authors wrote. “This commitment must be matched by strategies that span across direct care occupations and LTSS settings to the extent possible to achieve a strong, stable workforce that is well prepared to provide competent care where and when needed.”

In addition to legislation that addresses investments in the direct care workforce — such as the American Rescue Plan Act and the Build Back Better reconciliation budget bill — the authors urged more action at the federal level.

An advisory council of government representatives, payers and providers, workforce development experts, consumers and family members, and direct care workers themselves, could develop recommendations on wages, standards, career pathways, supervision, team integration and gaps in data collection, she said.

Changes within Medicare are needed to support the provision of long-term care across settings, whereas changes in state licensure and other regulations are necessary to address assisted living and other settings and services that fall outside the public payment system. 

“Now is the time for a national direct care workforce strategy,” they concluded. “A fully reimagined LTSS system will require a transformative financing approach that ensures coverage for eligible individuals, builds in job quality for direct care workers, and enhances equity and social justice.”

PHI recently announced the launch of the Direct Care Worker Equity Institute to address issues of racism and gender injustice in long-term care.