January 30, 2020
7 Reasons We Need the ‘Caring for the Future’ Report Series
By: Robert Espinoza

Last week, PHI released an urgent, new report on the direct care workforce. It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce provides a thorough overview of the direct care workforce (including key concepts and definitions), an analysis of how the direct care role has evolved, and a statistical profile of the workforce with key demographics, socio-economic characteristics, and future projections.

But It’s Time to Care not a stand-alone report. It’s the first installment in a yearlong series of reports that will examine the importance and impact of the direct care workforce. The final report— Caring for the Future: The Power and Potential of America’s Direct Care Workforce—will be released in January 2021 and combine the four previous reports, adding an introduction and an extensive set of recommendations for both policy and practice. (Each report in the series will provide original data, in-depth analyses, and immediate opportunities for action, as well as feature the stories of individual direct care workers from around the country.)

Here are seven reasons we need a current-day, comprehensive analysis—and a yearlong report release and online dialogue—on the direct care workforce.

Because direct care jobs are persistently poor in quality, direct care workers struggle to stay afloat–and within the sector.

A variety of challenges plague direct care jobs: low compensation, substandard training, few career paths, and limited job supports, among other challenges. Moreover, in many states, long-term care employers can’t effectively compete with industries such as fast food and retail, which are offering higher wages and more stable schedules. In turn, direct care workers routinely cycle out of these roles, compelling a turnover rate of 40-60 percent or higher.

The demand for direct care workers will increase exponentially in the coming decades as more people turn 65 and live longer.

Two factors are driving much of the demand for direct care workers over the next few decades: the projected growth in the number of older people and increased longevity. As evidence of the growing demand these two demographic shifts are inciting, PHI recently released new data showing that from 2018 to 2028, the direct care workforce will add 1.3 million jobs, and an additional 6.9 million jobs will become vacant as existing workers leave the field or exit the labor force. In turn, we ask: how will we ever meet this demand unless we improve these jobs?

Advocates across the country are creating blueprints for change and demanding a transformation in the direct care sector.

One of the most promising developments in recent years is the rise in state workgroups that are crafting plans to transform this workforce. A recent analysis from PHI examined the formal direct care workforce plans of 16 state workgroups and found remarkable agreement in their priorities: increasing compensation, improving training, boosting public awareness, developing advancement opportunities, and establishing data systems—as the five most commonly cited recommendations. A state-by-state direct care workforce movement is rapidly forming.

Local, state, and federal lawmakers are increasingly prioritizing direct care workforce reforms that illustrate what’s possible—and what’s still needed.

Policymakers at various levels are gradually improving jobs for direct care workers. Wisconsin launched a program to recruit and train thousands of nursing assistants, incentivizing them to remain in the field. New York City created the Paid Care Division, a public advocate for home care, childcare, and housecleaning workers. And a new federal bill was recently proposed to improve recruitment, retention, and advancement among direct care workers nationwide. While this trend is promising, governments in all parts of the country will need to follow suit because the need for direct care workforce reforms across issues and geographic areas is enormous.

The press has begun improving its coverage on the direct care workforce, investigating the variety of issues shaping the lives of these workers.

The press coverage on direct care workforce issues in 2019 has been impressive (though the direct care workforce arguably remains an under-reported topic across the media). Last year, reporters covered the round-the-clock realities of home care workers, the relationships between home care workers and consumers in various states, the acute challenges facing a largely rural population in Maine, and the growing role of men in caregiving roles, among many other important angles. Yet given the many barriers they encounter, these workers merit a heightened level of media interest.

Policy reports and public education campaigns are boosting this groundswell, generating practical, data-driven analysis that creates real change.

In the last few years, PHI has had remarkable success in shaping the policy discourse through our policy reports and public education campaigns. From 2017 to 2019, PHI produced 60 original publications as part of its #60CaregiverIssues campaign, which sought to solve the workforce shortage in home care—sparking media coverage, inquiries from industry leaders, and policy action in different parts of the country. We’ve also launched social media campaigns in Minnesota and Wisconsin (and other areas) that educated and engaged tens of thousands of online users in those states, raising the profile of direct care workers. With new knowledge and smart educational tools, we can build the support needed to elevate these workers.

‘Caring for the Future’ responds to a tipping point: the acute need to improve the quality of care in this country by transforming the direct care job.

Our new report speaks to the urgency of this moment—the changing demographics, the inadequacy of our long-term care system, and the needs and aspirations of direct care workers and their clients. It builds on the foundation and legacy established by our seminal 2011 report on the home care industry, Caring in America, while responding to the policy gains and growing momentum for direct care workforce policy reforms and innovations nationwide. And tactically, it recognizes that reports often fade away soon after their release, which is the primary reason we’re issuing Caring for the Future in five installments over the next 12 months. We want a yearlong, national conversation on the value of direct care workforce, and what’s needed to transform their jobs and improve care for all individuals who need it.

Together, we can create the workforce we need and the caregiving system we deserve.



The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.