The Direct Care Workforce Crisis
The direct care workforce includes people with various job titles and roles, including personal care attendants, home health aides, direct support professionals, job coaches, and more. Their services can range from helping with personal care and daily living tasks to providing assistance that is essential to someone’s ability to live, work, socialize, volunteer, and participate in their communities. Their services also are an important source of practical support and respite for families and caregivers.
Low wages, lack of benefits, limited opportunities for career growth, and other factors have resulted in a long-standing shortage of these critical professionals. That shortage reached crisis levels during the COVID-19 pandemic and continues today, with more than three-quarters of service providers declining new participants and more than half cutting services.
As a result of the workforce shortage, people who need assistance often have no option except to move to a nursing home or other institution; people who want to leave these facilities cannot; and the health and safety of those who live in the community are put at risk.
As the populations of older adults and people with disabilities grow, so does the demand for home and community-based services. Without urgent action, the problem will only continue to get worse.
We must build the nation’s capacity to support community living by expanding and strengthening the direct care workforce.
Building Capacity to Support Community Living
Created by the Administration for Community Living in 2022, the Direct Care Workforce Strategies Center (Strategies Center) provides technical assistance to states and service providers and facilitates collaboration with stakeholders to improve the recruitment, retention, training, and professional development of members of the direct care workforce.
The Strategies Center will:
- Provide tools and training to assist state systems and service providers and support the development and coordination of policies and programs that contribute to a stable, robust direct care workforce.
- Facilitate peer-to-peer sharing of lessons learned and promising systems-change practices through learning collaboratives between state systems, including Medicaid, aging, disability, and workforce agencies; service providers; and disability, aging, and labor stakeholders.
- Maintain a clearinghouse of resources and promising practices for delivering person-centered support and services for people living in the community.
A multi-agency, multi-sector approach
This initiative builds upon ongoing collaboration between ACL, the U.S. Department of Labor (DOL), the Centers for Medicare & Medicaid Services (CMS), and the Office of the Assistant Secretary for Planning and Evaluation (ASPE).
The Strategies Center is operated by the National Council on Aging (NCOA) in partnership with:
- ADvancing States
- Center for Innovation (CFI)
- Lincoln University Paula J. Carter Center on Minority Health and Aging
- National Alliance for Caregiving (NAC)
- National Association of Councils on Developmental Disabilities (NACDD)
- National Association of Medicaid Directors (NAMD)
- National Association of State Directors of Developmental Disabilities Services (NASDDDS)
- National Council on Independent Living (NCIL)
- PHI
- Social Policy Research Associates
- University of Minnesota Institute on Community Integration
About ACL
The Administration for Community Living is an operating division of the U.S. Department of Health and Human Services. ACL was created based on the fundamental principle that older adults and people of all ages with disabilities should be able to live where they choose, with the people they choose, and with the ability to participate fully in their communities. By funding services and supports provided primarily by networks of community-based organizations and with investments in research, education, and innovation, ACL helps make this principle a reality for millions of Americans.