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— Offers examples of state strategies for increasing HCBS workforce capacity (Medicaid and CHIP Payment and Access Commission, 2022)
- Direct Service Workforce Learning Collaborative Summary Report— Summarizes themes, challenges, and strategies from state Medicaid and partner agencies participating in CMS’ 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— Provides information on the amount of planned and reported state spending on activities to enhance, expand, or strengthen home and community-based services (Centers for Medicare & Medicaid Services, 2024)
Other Resources
- Financial Worries of Diverse Californians With Needs for Long-Term Services and Supports— Fact sheet that explores the financial struggles of California’s older adults and adults with disabilities who require long-term services and supports, highlighting disparities in financial worries and their impact on health outcomes (University of California, Los Angeles, Center for Health Policy Research, 2024)
- 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 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 address the DCW crisis by enhancing pay, benefits, and job conditions for HCBS workers, aiming to create a more sustainable and equitable care system (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 that 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 DCWs 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)
- State Language Access Initiatives Are Helping to Serve an Increasingly Diverse Workforce and Aging Population— Article that highlights various state initiatives across the U.S. aimed at improving language access for DCWs, particularly immigrants, to meet the growing needs of an aging and diverse population (PHI, 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)
- The Future of HCBS: A Report From the HCBS Sustainability Summit— Findings from the HCBS Sustainability Summit, focusing on sustaining ARPA-funded improvements in HCBS and supporting the direct care workforce (ADvancing States, 2023)
- 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 for the Direct Care Health Workforce— Brief provides a series of multi-sector state and employer strategies to address recruitment and health sector retention of direct care professionals (National Governors Association, 2021)
- State Implementation of American Rescue Plan Act Initiatives to Increase Wages and Expand Career Opportunities for Direct Service Workers— Summarizes the work of the Affinity Group to strengthen the direct service workforce (ADvancing States, 2022)
- States Use American Rescue Plan Act Funds To Strengthen Home and Community-Based Service (HCBS) Workforce— Explores how states propose using these one-time funds to bolster the workforce that provides HCBS (National Academy for State Health Policy, 2022)
- Strengthening the Direct Care Workforce (DCW)— Provides a 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— Helps states understand 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— Examines 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— Examines 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— Summarizes a 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— Summarizes the 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)— Outlines considerations and action 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— Provides a 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— Provides a statistical snapshot of direct care professionals in WI and considerations for strengthening this workforce (PHI, 2019)
- State Policies to Strengthen the Direct Care Workforce (DCW)— Webinar provides an overview of state policies in two states to improve the quality and supply of the DCW and innovations (National Academy for State Health Policy, 2022)
- Unlocking the Future of Homecare: California’s IHSS Career Pathways Program and PHI’s Contributions— Summarizes 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— Highlights 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— Spans 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— Provides information about states’ efforts to understand the impact of their ARPA home and community-based services initiatives and investments (ADvancing States, 2024)
- American Rescue Plan Act Workforce Topical Analysis— Proposed state initiatives that will influence workforce expansion in home and community-based services (National Association of State Directors of Developmental Disabilities Service, 2019)