Several states around the country are taking unique measures to combat the direct care workforce crisis in home-based care.
And it would benefit other states and agencies to follow suit, according to a new report from PHI.
There are more than 4.6 million direct care workers in the U.S., according to the report. Broadly, “direct care workers” are individuals who provide regular, hands-on assistance to seniors and individuals with disabilities across a variety of settings, including the home.
Direct care workers already comprise the largest workforce in most states. In order to meet the demand for long-term services and support (LTSS), Kezia Scales — director of policy research at PHI — hopes that state leaders take into consideration PHI’s recommendations to “support, strengthen and stabilize the direct care workforce.”
“To tackle the workforce crisis, we must address the problem of persistently low wages for direct care workers. But higher wages won’t be a panacea,” Scales told Home Health Care News in an email. “We also need to strengthen training, create career pathways in direct care and improve support and supervision to create good jobs that attract and retain the workforce we need.”
Currently, the median wage for a direct care worker is $13.56 per hour, though there’s significant variance across states.
The New York-based PHI is a direct care worker advocacy organization. In its report, it used specific examples from over 20 states of how to address the workforce crisis.
Providing better compensation will always be near the top of the list, but as Scales said, it’s not the be-all and end-all. For instance, training is also another key factor.
PHI said the training landscape for direct care workers is often characterized by “inconsistent and insufficient requirements, fragmented delivery systems, and a lack of portability across settings, roles and regions.”
States like New York, Tennessee and Maine have shown examples on how to modernize training standards to better prepare workers to meet the needs of today’s LTSS patients.
New York’s Medicaid Managed Long Term Care Workforce Investment Program distributed about $245 million over a three-year period for initiatives designed to “retrain, recruit and retain health care workers in the long-term care sector.”
In Tennessee, workers can earn stackable training credentials through a value-based payment program. Following the program’s education and career pathway, workers can earn a series of competency-based “micro-credential badges” beyond the requisite entry-level training. For every four badges earned, a worker achieves a higher occupational designation.
Having an open line of communication with workers about training should be a priority for providers, Scales said.
“Asking workers about their training needs accomplishes two goals at once: it helps ensure that new training programs that providers offer will be relevant and appreciated, and it shows workers that they are seen, heard and valued,” she said.
Specialty training standards can also be a pathway for more experienced workers to take care of patients struggling with dementia and other unique diseases.
Another key aspect in retention — especially following the COVID-19 pandemic — is for states to support the “development, testing, dissemination and replication of successful direct care workforce interventions.”
States can build pipelines into direct care jobs in partnership with workforce development experts, training providers and educational institutions, much like Massachusetts did with Northeastern University in the early weeks of the pandemic.
The state government and the University created an employment website that connects nursing homes with potential job candidates. The pilot website was the first of its kind and ushered in ConnectToCareJobs.com, which now operates in seven states.
The scarcity of actual and reliable data on the direct care workforce is also a major issue that needs to be addressed, PHI argued. If states and home-based care agencies want to quantify workforce concerns, identify priorities and implement solutions, then data collection and monitoring has to be better.
For instance, the most recent nationally representative surveys of home health aides was done in 2007, almost 15 years ago, according to PHI.
Texas, on the other hand, has done an admirable job collecting data for a few years now. Since 2018, the state has required LTSS providers to submit data on the size, stability and compensation of the direct care workforce through mandatory cost reports, according to PHI.
The data provides valuable information about workforce variations across LTSS programs and helps shed light on trends over time, like the relationship between changing wage levels and turnover rates.
Scales said states and providers should take advantage of past and future funding for home- and community-based services to begin innovating, if they haven’t already.
“States can use this funding to improve training and credentialing systems, test out new workforce interventions, strengthen data collection on the workforce and more,” she said. “But in parallel, states and providers must focus immediately on developing sustainable job quality solutions, such as a higher wage floor for direct care workers.”
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