Capitol Correspondence - 07.06.21

Commonwealth Fund Examines Direct Care Workforce Crisis and Potential Solutions

Share this page

To help our members stay abreast of how issues surrounding the direct care workforce are being discussed in policy circles, we excerpt the article below by the Commonwealth Fund. We encourage our members to read the full article, as it contains graphics that could be useful for their advocacy and shares four case studies on improving recruitment and retention.

“During the pandemic, people began paying attention to the essential work done by Americans who can’t work from home. This includes the 4.6 million direct care workers who provide caregiving services to people with chronic conditions or disabilities, both in homes and residential facilities. This workforce is primarily made up of women, the majority women of color, many of whom are immigrants to the U.S. They go by different names — home health aides, personal care attendants, certified nursing assistants, or caregivers — and they provide services ranging from helping people bathe, dress, and eat to cleaning their homes and preparing meals, managing medication regimens, and providing companionship. Some are drawn to the field because of their experiences caring for family members and by the low barrier to entry; unlike some other entry-level careers in health care, direct care workers may not need training or certifications before finding work.

Still, employers struggle to recruit and retain direct care workers, in large part because median wages are only $12.27 an hour, on par with entry-level positions in retail or other fields that are much less demanding. Also, direct care jobs often don’t provide opportunities for advancement. ‘You go in as a home care worker earning a certain wage. You develop all that rich experience and knowledge and skills, and you are still a homecare worker earning pretty much the same wage 20 years later,’ says Kezia Scales, Ph.D., director of policy research at PHI, a research and consulting nonprofit focused on the direct care workforce.


Some employers gave direct care workers bonuses or hazard pay as they continued to show up for work during the pandemic, but there is growing consensus that policymakers and health care payers need to do more to recognize and reward the vital role direct care workers play in the health care continuum. Citing the need to bolster the “care infrastructure,” the Biden administration and Democratic members of Congress have called for a $400 billion investment to expand access to LTSS and increase wages and benefits for direct care workers. This issue of Transforming Care profiles efforts by employers and states to document direct care workers’ contributions and create new career pathways by offering them training and opportunities for advancement.”