Crisis in Direct Care ‘Will Explode’ Without Immediate Government Support, PHI Warns

From low wages to a lack of career advancement opportunities, there are a number of issues that plague the caregiver workforce.

Under the current presidential administration, however, there’s a chance to reexamine the state of the caregiver workforce and implement several changes that could improve the profession, thus ensuring care for seniors.

PHI, a New York-based advocacy organization for direct care workers, offered nearly 50 federal policy recommendations as part of a new report released on Wednesday. The recommendations speak to the White House, Congress and various government agencies.


“Our country is at a critical point regarding this workforce,” Robert Espinoza, vice president of policy at PHI, told Home Health Care News. “The pandemic reinforced the enormous value of these workers, the challenges they continue to face, and how those problems endanger the lives of both workers and the people they support.”

Overall, there are an estimated 4.6 million direct care workers in the U.S. Generally, this includes personal care aides, home health aides and nursing assistants.

An increasing number of seniors rely on caregivers to remain independent at home. When looking at the aging population, roughly 70% of individuals have severe needs for long-term services and support, according to the Global Coalition on Aging.


Despite the increased need for caregivers, almost half of workers live in or near poverty. 

In fact, the median wage for caregivers is comparably lower than the median wage for other jobs with similar entry-level requirements, such as janitors, retail salespersons and customer service representatives, according to PHI.

This contributes to people leaving the field, in turn making it difficult for home-based care providers to recruit and retain caregivers.

“We’re hopeful that a new presidential administration that has already put forth an ambitious plan to increase wages for home care workers will continue to advance measures that address the many issues facing this workforce,” Espinoza said.

As part of its report, PHI is calling on Congress to enact and fund legislation that would set up a federal social insurance program in long-term care and fund states to enhance their home- and community-based services (HCBS) infrastructure.

Other long-term care financing efforts include: supporting alternative financing models, Medicaid reform and creating an “HCBS workforce plan” that lays out the costs of supporting home-based care workers.

The report also recommends measures that would implement a national strategy to improve wages and benefits for caregivers, foster financial support programs and fund the creation of state or regional public authorities in order to improve job quality.

In terms of a national compensation strategy, PHI suggests that the Centers for Medicare & Medicaid Services (CMS), the Administration for Community Living, the U.S. Health Resources and Services Administration and the U.S. Department of Labor should collaborate on a plan that addresses workforce concerns. This includes developing specific recommendations on states’ Medicaid rates to ensure competitive wages and benefits.

PHI also is suggesting the establishment of a national competency-based training standard. Plus, CMS should create minimum federal training standards for personal care aides, the advocacy organization believes.

“One recommendation that stands out in the report is for various federal agencies to work together with stakeholders in the field to establish a national standard for direct care competencies that applies to everyone in this workforce, which would enhance the quality and consistency of training across these workers,” Espinoza told HHCN.

Additionally, PHI highlighted various recommendations in relation to caregiver advancement opportunities, data collection and monitoring for this job sector, as well as leadership opportunities for caregivers.

Looking ahead, there will be stark consequences if the U.S. is unable to advance on some of PHI’s recommendations, Espinoza cautioned.

“If the federal government doesn’t immediately prioritize this workforce, the crisis in direct care will explode — millions of workers will continue to suffer financially, employers won’t be able to fill the 7.4 million job openings in direct care that our research estimates will occur between 2019 and 2029, and older adults and people with disabilities won’t receive the care they deserve,” he said.

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