Stabilizing the Direct Care Workforce: Challenges and Progress

Abstract

The pandemic intensified a 25-year direct care worker (DCW) crisis in the United States. COVID-19 along with preexisting recruitment and retention challenges have pushed many workers to leave their positions caring for some of the most vulnerable of our society when economic challenges, illness, fear, and family responsibilities became too much to handle (Johnson et al., 2021). Projections predict an additional 1.2 million new positions are needed by 2030, predominately in home- and community-based services (HCBS), leading some experts to recast this situation from workforce crisis to systemic failure (Johnson et al., 2021; Paraprofessional Healthcare Institute, 2022). However, collaborative work among researchers, advocates, and politicians at the state and federal level in a variety of states has led to actionable plans poised to make meaningful progress toward righting the complex and cumbersome ship that is the long-term services and supports (LTSS) system here in the United States and the workforce that is its “backbone” (Bogenschutz et al., 2014).