In a recent White House proclamation on Care Workers Recognition Month, President Biden affirmed the importance of honoring care workers for their “tireless contributions” and noted the steps his administration has taken to improve compensation for home workers and to support the broader care work sector.
The proclamation is profound, and these strategies—along with worker-centered, equity-focused approaches—are essential to improving millions of home care jobs. But, equal attention should be given to other job-quality interventions such as skills training, career pathways and high-quality non-degree credentials that would boost economic mobility for these workers and ensure long-term employers can fill jobs in a tight labor market.
In this context, we’re drawing attention to the workforce development field—entities such as departments of labor and education, workforce and workers’ rights groups, community colleges and short-term training providers—and their critical role in strengthening the nation’s home care workforce.
The Training and Career Landscape
Home care workers in this country—nearly 2.8 million home health aides, personal care aides and independent providers (i.e., direct care workers who are employed directly by consumers, either through Medicaid programs or private-pay arrangements)—are essential to millions of older adults and people with disabilities, assisting them with daily tasks such as dressing, bathing, and eating. In many cases, they take on clinical tasks, such as wound care, blood pressure readings, and help with range-of-motion exercises, under the supervision of a licensed professional. Most of these workers are women and people of color, 1 in 4 is an immigrant, and 30% live in or near poverty.
These workers deserve good jobs, and all U.S. workers need access to quality care. Yet the latter is dependent upon the former. A lack of good jobs in home care—as evidenced by inadequate compensation, limited training and advancement opportunities, a general lack of respect and recognition, and more—impoverishes millions of workers, drives many away from this field, and makes it nearly impossible to support a growing population of older adults and people with disabilities.
New research confirms this challenge will magnify between 2021 and 2031 as long-term care employers will need to fill nearly 9.3 million job openings in direct care, which includes home care workers and nursing assistants supporting older adults and people with disabilities in various settings.
One critical driver of poor job quality in home care is the fractured training landscape. Training requirements and delivery systems for home care and other direct care workers vary considerably from state to state, and most training requirements tend to focus on personal daily tasks, with less attention paid to the physical, social and emotional demands of direct care.
It doesn’t help the situation that many people erroneously think of direct care work as unskilled or low-skilled, and the training infrastructure desperately needs modernization, standardization and more resources.
‘One critical driver of poor job quality in home care is the fractured training landscape.’
In today’s home care sector, workers also have limited advancement opportunities—in both advanced roles that allow workers to remain in direct care, such as dementia specialists, and career ladders that workers can ascend to advance into management roles or healthcare professions, such as LPNs. Undergirding these challenges is the fact that the direct care field lacks a standardized, high-quality credential that would permit workers to carry their training and credentials across settings and states without costly retraining and the unnecessary burden put on the worker to do so.
These dimensions harm workers, their clients and the economy. Today’s typical home care worker earns a poverty-level wage, relies upon public assistance to survive, and leaves the sector within the first 90 days for modestly better-paying work in the retail and fast-food industries. Consider California, in which the median hourly wage for home care workers is $14.95; in Missouri, it’s $12.65. Both wages lead to 38% and 52%, respectively, of these workers living at less than 200% of the federal poverty level (data points from 2022).
Women, people of color, and immigrants comprise this low-income workforce, a reality that underscores how a history of racial discrimination has segregated workers of color into low-wages jobs ripe for exploitation, coupled with a problematic perception of care work as “women’s work” that’s dismissed as a labor of love requiring only minimal compensation and support.
Without a strong and stable workforce, older adults and people with disabilities receive substandard care, and businesses can’t function effectively, or worse, stay afloat.
These issues are relevant to workforce development because many policies that improve training, career pathways and credentials are governed and funded through the labor, education and commerce departments. While many workforce systems use federal Workforce Innovation and Opportunity Act funds to support direct care training, more can be done to boost policies and programs in workforce development and support this beleaguered sector.
Our unfortunate experience also has been that many leaders in workforce development often inadvertently exclude direct care work from their focus because these jobs don’t provide a living wage and a viable career, an important principle. Workforce development leaders also would benefit from joining other leaders like unions and workers’ rights organizations in fighting for better wages, worker protections, and dignity and respect for home care workers. All this means that the workforce development field could be better tapped, recognizing that improving home care training also would enhance job quality, leading to higher wages and a better narrative on the value of the work. Now is the time for change.
A Way Forward
Organizations such as PHI, Caring Across Generations and many others have called on federal policymakers to enact a range of policies that would address the workforce development needs of direct care workers and their employers, which the workforce sector writ large could help advance. For example, federal leaders could establish a national standard for direct care competencies and require states to adopt it with some localized flexibility and guidance. They also could establish minimum federal training standards for personal care aides, help cover training and career advancement costs nationwide for all direct care occupations, and support industry partnerships at the state level that invest in skills training, career pathways, quality non-degree credentials, and other needs for direct care workers.
Policymakers also can draw upon the successes of state policy and practice models in training and advancement, such as those developed by the Center for Caregiver Advancement (CCA), a California-based organization focused on improving and delivering training to the state’s caregivers. Since 2000, CCA has been delivering quality, evidence-informed training programs to direct care workers.
The Center for Caregiver Advancement is building a body of research demonstrating the professional and social value of caregivers.
Recognizing the inequities and structural barriers that this workforce endures, CCA is building a body of research demonstrating the professional and social value of caregivers. Through impact studies conducted by university-affiliated researchers, CCA highlights the effect that multi-week training programs have on caregiver skills and the health outcomes of consumers.
The curriculum offered by CCA is grounded in adult-learning best practices and centers care recipients' needs and desires. Using a rapid cycle feedback process during course development ensures that CCA can offer continuous curriculum improvements that incorporate the voice of workers and those they provide care for. Taught in eight languages, the training programs are aimed at meeting the diverse needs of the California caregiver workforce and consumer population.
Impact studies on their training programs show an increase in retention for those caregivers who have taken training, as well as reductions in consumer hospitalizations and visits to emergency departments. By conducting program analyses, CCA continues to deepen the connection between quality training, care outcomes and cost savings—creating data they use as a powerful tool in shifting the value proposition of this workforce to stakeholders. While the impacts of CCA training have been clear, scaling and sustaining programs has proven difficult. This year, as California offers its first formal paid IHSS training program through the Career Pathways Program (CPP) (which was recommended by the state’s Master Plan on Aging and the Governor’s Alzheimer’s Task Force), federal funding for the program is set to end.
By publicizing the successes of caregiver training like CPP and its impacts on the healthcare system as a whole, the organization is working with stakeholder partners to gain support for ongoing dedicated state funding for quality training programs for caregivers.
Care Workers Recognition Month rightfully acknowledges the contributions of care workers to this country. Ensuring that home care workers can access training, high-quality non-degree credentials, and career pathways will help move our country to a better place—and workers to a better existence.
Robert Espinoza is CEO at the National Skills Coalition, a nonresident senior fellow with Brookings Institution, and chair of ASA’s Board of Directors. Corinne Eldridge is president and CEO of the Center for Caregiver Advancement.
