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Strengthening the Direct Care Workforce

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The ability of older adults and people with disabilities to live in their own home and communities and to participate fully in all aspects of community life is often dependent upon the availability of services and supports provided by a workforce of direct care workers (DCWs). This direct care workforce includes people with various job titles, including personal care attendants, job coaches, home health aides, residential workers, and more. DCWs may also be referred to as direct support professionals (DSPs) or direct service workers (DSWs).

There is currently a shortage of DCWs. That shortage, coupled with high employee turnover rates in the workforce, can compromise the health and safety of older adults and people with disabilities, as well as their ability to live in the community. 

As the populations of older adults and people with disabilities grow, so does the demand for home and community-based services (HCBS). More than 1.3 million new DCWs will be needed by 2030. A coordinated effort to improve our national capacity to recruit, train, and retain a high-quality, competent, and effective workforce has never been more critical. To address the growing crisis, the federal government is engaged in several initiatives.

Direct Care Workforce Federal Initiatives

Administration for Community Living (ACL)

  • Direct Care Workforce Strategies Center: In October 2022, ACL awarded a five-year grant totaling over $6 million to establish a national center to expand and strengthen the direct care workforce across the country. The center provides technical assistance to states and service providers. It also facilitates collaboration with stakeholders to improve the recruitment, retention, training, and professional development of DCWs, and serve as a national hub of resources and best practices.
    • Led by the National Council on Aging, Center partners include the National Association of Councils on Developmental Disabilities, ADvancing States, Paraprofessional Healthcare Institute (PHI), the University of Minnesota’s Institute on Community Integration, the National Alliance for Caregiving, Lincoln University’s Paula J. Carter Center on Minority Health and Aging, the Green House Project, and Social Policy Research Associates. This initiative builds upon the ongoing collaboration to strengthen the direct care workforce 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).
  • Direct Support Professional Prize Challenge: In 2021, ACL launched this challenge to seek innovative solutions that strengthen the workforce and increase the overall stability of HCBS for people with intellectual and developmental disabilities (I/DD).
  • Living Well Grants: In 2017 and 2018, ACL awarded grants to help develop and test model approaches for enhancing the quality, effectiveness, and monitoring of HCBS for people with I/DD. A focus of these grants includes building the capacity of direct service and HCBS providers.
  • Special Projects Promoting Best Practices, Building State Capacity: This project began in 2020 with funding to the National Academy for State Health Policy. A part of ACL’s longstanding Lifespan Respite Care Program, it supports state and national efforts to promote access to respite for family caregivers, including strengthening the direct care workforce. To make this vision a reality, the project is developing, testing, and scaling a respite workforce recruitment, training, and retention program.

The U.S. Department of Labor (DOL)

Centers for Medicare & Medicaid Services (CMS)

Office of the Assistant Secretary for Planning and Evaluation (ASPE)

Last modified on 04/12/2024

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