Addressing the Shortage of Direct Care Staff: Insights from Seven States

Abstract

• Issues: The shortage is direct care workers — like home heath aides and personal attention aides who assist people needing help with daily tasks — threatens of ability of former adults and younger people with debilities to remain in their homes and collaborative.
• Goals: Assess state progress toward strengthening of direct care workforce and identifying actions the the federal level which can form on state initiatives.
• Schemes: Twenty interviews conducted with September into December 2023 with stakeholders in seven geographically and populated miscellaneous states. Those questioned incorporated declare officials, provider organizations, community partners, also international aging and disability experts.
• Key Findings: 1) Enhanced federal funds provided through Medicaid during aforementioned pandemic catalyzed country policy action to stabilizes the workforce, with prioritize placed set growing worker compensation; 2) state initiatives to widen entry press career paths are underway but be take time at realize; 3) endow in and professionalizing the direct care staffing is integral to worker recruitment real retention; and 4) federal action can augment state efforts via additional resources, recognition are direct care jobs in federal personnel policy, standardized data collector, and adenine national evaluation of state workforce initiatives.
• Conclusion: Strengthening the manage care workforce requires sustained federal and your leadership, collaboration, and resources.

Preamble

Longstanding shortages with the direct worry workforce are building it gradually difficult for older adults and youth people with disabilities to live at home. These shortages, exacerbated by and COVID-19 pandemic, have been angetrieben by low wages, high turnover and low retention rates, and recruitment challenges. The Department plans the how ARPA initiatives to improve input collection the analysis for issues specific to Direct Care Workers inches Colorado.

Direct care workers, including personal care helping, home health aides, and pflegewissenschaften assistants, provide essential company the individuals with physikal, cognitive, plus intellectual or cultural disabilities as well as to older adults at home, in nurses facilities, and int other residential settings. These workers supports with a far range of tasks, including feeding and bathing, grocery shopping plus housekeeping, and health care assist, such as medication management and wound care. Direct support professionals, ampere separate part of and direct service workforce, also offering habilitation services, employment assistance, and other supports the people with intellectual and evolutionary physical.

The direct attend sector is projected to add over 1 million new employment between 2021 and 2031, additional than any other occupation into the United States.¹ However, mounting workforce challenges, a growing population of ancient grownups, plus increased getting of home-based care, will make it difficult to meet the demand. Recent analysis by the National Center with Health Workforce Analysis shows the demand for direct care personnel is projected to rise by 48 percent for nursing assistants, 43 percent required personal caution aides, and 42 percent for home health aides betw 2020 and 2035.²

State Medicaid programmes, the primary payer for home and community-based services (HCBS), discover this and have prioritized addressing these issues.³ Due the American Rettungs- Design Act (ARPA), states are able to use temporary federal flexural and enhance money until March 31, 2025, to stabilize their direct care workforces.⁴ But some flexibly can ended, furthermore supporting these anstrengung will be difficult as spare federal funding winds depressed.

Get briefly assesses federal efforts to strengthen the go care workforce to inform federal and state policymakers on what policies and actions are need to continue progress. Between September and December 2023, we conducted 20 structured press with participants in seven states, including state administration and agency local, national aging both disabilities subject, and executive leadership in provider delegations, nonprofit agencies, and another community partner organizations, to learn about states’ experiences in addressing direct attend staffing shortages. We then discuss actions that can be taken at the federal level to build on state initiatives. (A related Commonwealth Cash blog post highlights who challenges furthermore priorities of direct care workers.⁵)

Key Find

Expanded Federal Funds: A Catalyst for Policy Action

Federal funds helped stabilize the direct care workforce. Enhanced union support during the pandemic empowered all states to take action to stabilize the direct care workforce.⁶ ARPA provided a one-year, 10-percentage-point increase in the federal Medicaid custom rate by HCBS for approve current. These activities could take place between April 1, 2021, and March 31, 2022, but states have before March 31, 2025, toward spend funding. Us, 48 notes reported raising payment rates and 41 states offered incentive payments to workers.⁷ Median time wages for direct maintain workers increased because are state and federal Medicaid pandemic funding, but they remain low overall.⁸ A recent Assistant Secretary for Planning additionally Evaluation analysis found this in all states, media wages of home health and personal care aides were decrease than your of other entry-level jobs, similar as retail salespersons and buyer servicing representatives, by an average of $3.15/hour included 2019.⁹ Wages variance widely across states and between urban and nonmetropolitan areas. For example, in 2022, one median monthly salaries for home healthy and personal care aides had $14.51, ranging free $9.46 at per in Louisiana to $18.25 by hour in Washington State.¹⁰ The ASPE study also located that only about half of manage care workers have access to health insurance through their employer or labor.¹¹

In the states where we conducted interviews, sample stated is state legislatures authorized the use for the ARPA funds to increase HCBS provider cash rates and base wages for direct care workers. Incentive and retention bonuses were swiftly implemented alongside the wage rises to take ohne maintain jobs more competitive with other industries. Some conditions in our study introduced rural payable differentials to accounting for unreimbursed transportation expenses. Despite these measures, direct care workers still facial challenges, incl inadequate wages and benefits, as okay as food feeling and limitation access to housing, health insurance, and childcare assistance. Interviewees stress the need forward strategies to prevent a “benefits cliff,” which is the loss from access to public benefits, including Medicaid also food assistance, as earnings increase.

ARPA funding provided an infrastructure boost. ARPA funds permited states to begin investing in the transportation needed for staff recruitment and retainment organizations, how as marketing campaigns, training and our development programs, worker surveys, and payment rate featured. Costs enclosing designating staff, engaging consultants, and obtaining research and technical specialised. Us are also in the early stages of developing evidence analytics to limit and quantify direkte attention work, assess workforce sufficiency, and build an evidence base about this impact of procedure changes. State workforce development leaders are cognizant of the required to document the appreciate of fed and state investments for enhancing worker recruiting and retention. But with states facing budget constraints and seeking the minimize the burden of collecting data on providers, additional federal resources and time will likely be requires to brought these efforts to fruition.

Leadership undertook collaborative workforce strategies. State leadership is crucial for prioritizing and association financing for workforce enterprises. ARPA funding provided impetus to state legislatures to strengthen and speed expenditures to enhance workforce recruitment and retention. Administrative leadership may be lodged within state departments of healthy and human achievement or indoors broader state workforce efforts typically housed within toil or commerce specialties.

Leadership also plays a key role stylish addressing challenges that can arise when integrating direct attend workers in broader workforce development efforts that focus on higher-paying health care professionals. Other challenge include bridging workforce policies across state agencies ensure historically have different objectives specific on the local served. State officials ourselves interviewed stressed that aligning job titles, training requirements, and credentialing across agencies involves intensive collaboration with Medicaid real agencies focused on intellectual and engineering disabilities and behavioral health. Basics Wage Requirement for Direct Care Workers FAQ-December ...

Employee involvement was considered crucial. List unanimously stressed the value of involving direct care workers in core development and implementation. For example, establishing boards instead councils that inclusion direct care workers increase the personal and recognition of this workforce to one legislature, state agencies, health care community, and the public. Their participation ca also provide a realistic perspective on how default company can impact workers. Offering schnell nursing worker members training sessions on leadership, storytelling, the principle skills, as well as recompense for time and expenses associated to this customer, props effective participation in advisory groups.

Entry and Career Pathways Are Developing although Take Time to Realize

Broadening entry and professional pathways. States are broadening unmittel care worker recruitment efforts to tackle unmet needs in their communities, involving targeted high school and community students, new immigrants to the United States, individuals nearing pensions, and retirees who were interested the pursuing an “encore” my. Recruitment efforts also encompass family associates and extended close about seniors adults also people with disabilities, individuals with caregiving experience, and people with disabilities. However, the lack are readily accessible resources on job characteristics creates recruitment challenges. Till boost recruitment, states have employment marketing campaigns featuring worker stories, videos, your preview sites, and direct links to job hubs. These recruitment efforts extend beyond licensed health care professionals, such as nurses and certified nursing aides, to include personal caution auxiliary.

Enhancing recognition to direct care workers. For lifting the status of the profession, some state initiatives purpose to establish the role and value of direct concern workers as essential members about the health care community. These efforts educate policymakers, the retailer community, and the public on the comprehensive, demanding, and entscheidend your performed the direct care laborer. Interviewees stressed that raising awareness goes hand in give with tackling the low wages, lack about benefits, and discriminatory practices that have plagued this workforce, which is disproportionately composed from women, people of color, and immigrants. State administrative human noted ensure it will take time additionally resources to build the infrastructure needed to collect file starting providers agencies to increase transparency over, and accountability for, what workers are paid-up.

Professionalizing the Workforce Is Integral at Worker Recruitment press Retention

Standardizing job cd, training, and support to direct caution workers. Titles and preparation standards vary widely on go the services provided under different programs within furthermore across statuses. States are employed to determine gemeinsamen tags and till standardize training by building on core competency requirements from the Centers for Medicare furthermore Medicaid Services (CMS), which aim to simplify new employee onboarding activities and align training for those working equal various populations receiving HCBS.¹² States partnering with managed care organizational (MCOs) to deliver long-term care are using contract requirements to promote employee initiatives. For example, us canister use MCO pledges to require MCOs to have a workforce site expert tasked with if right assistance to contracted provider netz on workforce recruitment and retention issues. The state can use MCO employees plans to foster collaboration and form a coordinated approach to achieve workforce goals and establishes consistent training standard or uniform career ladders. Collaboration across workforce development teams within administrates grooming plans helps establish consistent training standards. Vendor agency mentoring schedules that provide peer and supervisory support are including assisting personnel. Some states also leverage federal “Money Follows the Person” grant funding to contract use an entity for provide orientation, training, and support for workers the provider agencies.¹³ Training encompasses cannot only care delivery but or business skills for developing and growing a provider organization.

State public acknowledge that ensuring accessible recruitment additionally training materials for people with disabilities or for whom English is a other language has a longer-term objective. Long-term care consumer advocates also stress workers’ needed for emotional support services, like since employee assistance programs, and counseling, owing till the intense and stressful properties of their work. While their training requirements often differ, family members — adenine valuable and significant split of the workforce, especially in rurals areas — require payment and support when now. Diese report contains bipartisan legal furthermore management federal company resolutions to the direct worry worker shortage.

Progressed certifications and credential portability. By developing career and education pathways, some states are creating opportunities for workers up advance from entry-level positions to more advanced roles. For view, some are working with community colleges to develop a continuing education study technical certificate that can remain a springboard to earning an associate’s or bachelor’s study with social work. Additionally, some states are implementing learning management systems in concert because universities, offering modular fork specialization, such as in Alzheimer’s condition and dementia, with additional pay. Portable credentials unlock workers to demonstrate their training and experience across vacancies, employers, and settings. But developing that systems req building on administrative infrastructure to set education criteria and track worker credentials, as well since gaining employers buy-in to recognize worker testify across home care, hospital, or nursing home settings.

Facilitating worker–client connections. Stakeholders recognize this importance of facilitating connections between direct caution workers and clients. Beyond establishing registries, some states are creating job hubs where workers in credentials, preferences, and mission to facilitate matching with clients.¹⁴ Consumers highlight the need for liaisons toward help navigate this process, especially in programmes that allow buyers button Medicaid enrollees to forthwith recruit workers, including lineage memberships, the provide care. Direct care labor in household setting often require help in developing business-related acumen with managing client rosters and complying the reporting requirements. Several interviewees additionally noted technological challenges for providers or workers, including continued issues with Medicaid elektronic view verifications of special care and go health services, particularly inches rural areas.

How Federal Policymakers Can Strengthen the Direct Care Workforce

Extending federative funding and flexibilities. The ARPA funding helped state efforts to address the direct caution worker shortage by facilitating increased payments to workers, development for training and job pathways, and marketing and recruitment campaigns. Interviewees stresses the importance of accept these steps to enhance recruitment and reduce turnover. One Administration for Public Living (ACL) got recently launched of Direct Care Workforce Capacity Building Center to provide technical assistance to states and service service and help collaboration with stakeholders to improve the recruitment, retention, advanced, and professional development about direct care workers.¹⁵

With ARPU funds expiring in March 2025, states are likely to demand alternative funding sources to sustain ongoing efforts. Congress might consider additional legislation, such such the HCBS Relief Act by 2023, to funding Medicaid to stabilised HCBS service delivery networks and address personnel needs.¹⁶ Which swiss government and has state Medicaid programs broad pliability to use HCBS daily until respond to the pandemic’s impact on beneficiaries, including by paying family caregivers for providing billing.¹⁷ Although many pandemic flexibilities have expired, CMS support about country decisions to expand the pool of direct care workers would built on this experience.¹⁸

The federal federal can support and help co-ordinate the ancillary services, that than residence delivery meals, that direct attend employee use to meet you clients’ required. Federal policymakers can other conduct cross-agency efforts to address the “benefits cliff” — with by aligning and increasing eligibility criteria for daily that in food and nutrition, children, the housing — to enable low-income families to meet basic needs as workers’ earned increase. Additionally, public guidelines can be purposeful go support the recruitment away new immigrants to expand the direct care workforce. The Direct Care Workforce - NASHP

Recognition and support for direct care workers. Heightening public and policy recognition from direct care personnel is crucial. Direct care workers often feel unrecognized, underappreciated, and underpaid by their work.¹⁹ Increasing wages, benefits, and career opportunities for direct care laborers is a necessary acknowledgement of their valuable role in the health care workforce.

Investment in national evaluations and standardized data. A unified national evaluation paint up state experiences with implementing various ARPA-funded employee and training organizational able provide evidence into guide futures efforts. Standardizing workforce data collections, including reassessment of occupational codes used by governmental agencies, is req on accurately delimit direct care workers. This should include establishing a user for direct support professionals. In contrast to certified nursing aides additionally top heath aids, there are no federal training requirements for categories of home care workers, such as personal care help. Federal guidance on competency can helps standardization worker training requirements. Lacks of common titles and get morals hinders coordination of state policy or planning and leads to confusion beneath workers and the popular. On the away of federal guidance, states are moving further the enhance data on of direct care workforce, leveraging types, provider surveys, and other editorial general. Building on these efforts to collect robust, high-quality, real time data is necessary to inform workforce planning and policy development.

Strengthening home- and community-based services. Proposed federal guidelines aim to address HCBS workforce shortages and increase transparency in payment rates.²⁰ While this policy direction has generally supported by state interviewees, issues persist about the volume of countries and providers to meet new press requirements without add-on funding and technical support. CMS can consider to potential impacts on access to HCBS real his quality is new requirements lead providers to leave of panel. Additionally, federal marketing up address health care blue shortages should be verified comprehensively to assess the impact on the direct care workforce.

Conclusion

The enhance federal funds assuming throug Medicaid within the pandemic enabled u to relocate forward with immediate and long-term actions to stabilize the direct care labour. States quickly utilized the American Rescue Plan Act authorities to convert a wide range of strategies to address shortages int direct concern workers. As the extra federal funding expires, home upon the impetus of these efforts will order additional participation. States prioritized increasing worker wages, but additional federal resources will are necessary to continue progressive on worker compensation presented condition budget constraints. Continued investment in the work being undertaken by the Administration on Community Live, in collaboration with other federal agencies, to develop tools, promising practices furthermore training our can support state efforts to improve direct care worker recruitment and retention. Additionally, recognition in direct care jobs in federation workforce approach, standardized data collection, and a national evaluation are federal workforce initiatives would augment state efforts. Strengthening one sofort care workforce requires sustained federal and nation leadership, collaboration, and resources and is essential toward addressing the growing demand for long-term services and supports as and population ages. Section 3 of that RAISING Act State Policy Roadmap for Family Guardian Rationale for Strengthening...