Direct care workers (DCWs) such as nursing assistants, home health aides, and personal care assistants play an essential role in the health and well-being of over 20 million Americans. Yet DCW wages are not enough to make jobs competitive with entry level positions in other industries with similar job requirements which exacerbates the challenges in recruitment and retention of these workers. Many DCWs are lost to other sectors that offer similar wages but more flexible schedules, more hours, and other benefits. Some states have tried to address these issues by implementing policies aimed at improving DCW wages. The purpose of this study was to explore state policies for improving compensation for DCWs, the key elements of policies, and the results of those policies.
This research was conducted under contract #HHSP233201500039I between HHS/ASPE’s Office of Behavioral Health, Disability, and Aging Policy (BHDAP) and Research Triangle Institute. Additional research in this area is available at the ASPE Long-Term Services & Supports/Long-Term Care page.
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Available Reports:
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- Direct Care Workforce Experienced Limited Wage Improvements Despite State Policy Efforts Issue Brief (2024)
- State Efforts to Improve Direct Care Workforce Wages: State Case Studies (2024)
- Wages of Direct Care Workers Lower Than Other Entry-Level Jobs in Most States Issue Brief (2023)
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- Mitigating Direct Care Workforce Injuries in Homecare: A Summary of the Evidence (2022)
- Direct Care Workforce: An Integral Part of Long-Term Services and Supports Issue Brief (2013) [HTML version also available]
- Understanding Direct Care Workers: A Snapshot of Two of America’s Most Important Jobs -- Certified Nursing Assistants and Home Health Aides (2011) [HTML version also available]
- Measuring Long-Term Care Work: A Guide to Selected Instruments to Examine Direct Care Worker Experiences and Outcomes (2005) [HTML version, with PDF links, available]
- Federal Workforce Development Programs: A New Opportunity for Recruiting and Retaining Direct Care Workers in the Long-Term Care Field (2003) [HTML version also available]