States have adopted numerous approaches to strengthen the direct care workforce and long-term services and supports. These reports offer examples of state strategies to address workforce needs, job quality, and wages.
Federal Resources
- State Efforts to Address Medicaid Home- and Community-Based Services (HCBS) Workforce Shortages— Issue brief that describes current issues facing the HCBS workforce and the Medicaid levers available to address them (Medicaid and CHIP Payment and Access Commission, 2022)
- Direct Service Workforce Learning Collaborative Summary Report— Themes, challenges, and strategies from state Medicaid and partner agencies participating in CMS’s 2021 DSW State Medicaid Learning Collaborative (Centers for Medicare & Medicaid Services)
- Living Well Grants — Grants that help develop and test model approaches for enhancing the quality, effectiveness, and monitoring of home and community-based services for people with intellectual and developmental disabilities (Administration for Community Living)
- Blazing New Trails for Community-Based Direct Support Professional (DSP) Prize Challenge — Winner’s interactive map identifies where self-directed employees and DSPs are located so that clients can contact them about their services (Administration for Community Living, 2021)
- American Rescue Plan Act of 2021 Section 9817 National Overview and State Spending Plan Summaries— Information on the amount of planned and reported state spending on activities to enhance, expand, or strengthen HCBS (Centers for Medicare & Medicaid Services, 2024)
Other Resources
- Direct Care Workforce State Index: Mapping Workforce Policies and Outcomes— Report that assesses state policies affecting direct care workers, highlighting demographics, wages, and training to guide improvements in workforce strategies and service quality for individuals with disabilities and older adults (PHI, 2024)
- WisCaregiver Careers— Marketing campaign tool utilized in the state of Wisconsin to provide free training for aspiring CNAs, offering a $500 bonus and pathways for career advancement in the DCW field (WisCaregiver Careers, 2024)
- State Best Practices To Improve Pay for Direct Care Workers & Help Solve the HCBS Workforce Crisis— Brief that outlines state-level strategies to improve wages for direct care workers in Medicaid-funded HCBS programs and help solve the workforce crisis (Georgetown Law Center on Poverty and Inequality, 2024)
- Established Solutions for Issues Affecting DSPs— State-level strategies and initiatives to tackle challenges faced by DSPs through mentorship programs, career ladder models, and collaborative advocacy to strengthen the workforce (The Council on Quality and Leadership, 2024)
- Low Tech, High Potential: Using Technology To Improve Communication Across Home Care Workers— Article examines current and potential uses of technology in home care through a scoping review, home care worker interviews, and stakeholder input (Journal of Applied Gerontology, 2023)
- Worker Well-Being Is Community Well-Being: Why the Human Service Workforce Needs a Living Wage— Findings from a survey of frontline human service workers earnings in the state of Illinois and the recommended improvements (Illinois Partners for Human Service, 2024)
- Closing the Gap: Maine’s Direct Care Shortage and Solutions To Fix It— Report that highlights challenges faced by DSPs in Maine, impacting both workforce stability and economic vitality in the state, and shares recommendations to solve these issues (Maine Center for Economic Policy, 2024)
- California’s Care Workforce: An Overview of Needs, Opportunities, and Challenges— Report that discusses California's critical care sector challenges and plans, emphasizing the need to meet growing demand for services for children, older adults, and people with disabilities (Public Policy Institute of California, 2024)
- Supporting Direct Care Workers through Training and Stipends: Insights for California Stakeholders— Insights from interviews and research to outline what would be beneficial in a California DCW Training and Stipend Program (Center for Health Care Strategies, 2022)
- Strengthening and Stabilizing the Direct Care Workforce in Oregon— Analysis of Oregon’s direct care workforce policies and programs with recommendations to strengthen direct care workforce recruitment and retention (PHI, 2022)
- State Strategies for Sector Growth and Retention of the Direct Care Health Workforce— Issue brief provides a series of multi-sector state and employer strategies to address recruitment and health sector retention (National Governors Association, 2021)
- States Use American Rescue Plan Act Funds To Strengthen Home- and Community-Based Service (HCBS) Workforce— Interactive map explores how states proposed using one-time funds to bolster the workforce that provides HCBS (National Academy for State Health Policy, 2022)
- Strengthening the Direct Care Workforce (DCW)— Broad overview of the DCW and highlights state actions and strategies to strengthen the workforce (National Conference of State Legislatures, 2023)
- The Direct Care Workforce Policy and Action Guide— Support for states in understanding the complexity of issues regarding the current direct care professional shortage and the role states can play in strengthening and improving this critical infrastructure (Milbank Memorial Fund)
- Long-Term Care Policy Guide— Strategies that eight states are deploying to regulate long-term services and supports, invest in home and community-based services, and meet the needs of the direct care workforce (Council of State Governments, 2022)
- Medicaid Structured Family Caregiving (SFC): Enabling Family Members to Make Caregiving Their Primary Focus— How three states are using Medicaid-funded SFC services to help older adults remain in the homes they share with their loved ones (National Academy for State Health Policy, 2022)
- Building the Direct Care Workforce (DCW) Movement: The Essential Jobs, Essential Care Multi-State Initiative Final Report— Multi-state advocacy initiative focused on the DCW in three states (PHI, 2023)
- State Policy Strategies for Strengthening the Direct Care Workforce (DCW)— Brief outlining several state policy initiatives to improve the DCW (PHI, 2022)
- Direct Care Worker Survey and Focus Group Report— Findings from a survey and focus group done with California in-home support services workers about challenges, interests, and preferences related to training and incentives (California Department of Aging)
- Forging a Path Forward to Strengthen Michigan’s Direct Care Workforce (DCW)— Outline of considerations and actions to support the state of MI in expanding and strengthening its DCW (Center for Health Care Strategies, 2021)
- Spotlight on Minnesota: Direct Care Workers and Quality Jobs— Statistical snapshot of direct care professionals in MN and considerations for strengthening this workforce (PHI, 2019)
- Spotlight on Wisconsin: Direct Care Workers and Quality Jobs— Statistical snapshot of direct care professionals in WI and considerations for strengthening this workforce (PHI, 2019)
- State Policies To Strengthen the Direct Care Workforce— Webinar provides an overview of the policies in two states that improve the quality and supply of the direct care workforce and innovations (National Academy for State Health Policy, 2021)
- Unlocking the Future of Homecare: California’s IHSS Career Pathways Program and PHI’s Contributions— Article on in-home supportive services program and efforts to create 39 training modules and high-quality, skills-based training videos (PHI, 2023)
- Making the Math Work: Supporting Direct Care Workers in Maine— Highlight of Maine's Essential Care & Support Workforce Partnership and positive differences made for direct care workers (PHI, 2023)
- A Practical Resource Guide for Direct Care Workforce State Advocacy— 20 strategic areas with 60 actionable steps, aiming to facilitate policy advancement for thriving direct care jobs and improved access to vital services (PHI, 2023)
- Efforts to Evaluate the Impact of American Rescue Plan Act (ARPA) HCBS Investments— Information about states’ efforts to understand the impact of their ARPA home and community-based services initiatives and investments (ADvancing States, 2024)