States have adopted numerous approaches to strengthen the direct care workforce and long-term services and supports. These reports offer examples of state strategies to address workforce needs, job quality, and wages.
Federal Resources
- Living Well Grants — Grants that help develop and test model approaches for enhancing the quality, effectiveness, and monitoring of home- and community-based services for people with intellectual and developmental disabilities (Administration for Community Living)
- Blazing New Trails for Community-Based Direct Support Professional (DSP) Prize Challenge — Winner’s interactive map identifies where self-directed employees and DSPs are located so that clients can contact them about their services (Administration for Community Living, 2021)
- Direct Service Workforce Learning Collaborative Summary Report— Summarizes themes, challenges, and strategies from state Medicaid and partner agencies participating in CMS’ 2021 DSW State Medicaid Learning Collaborative (Centers for Medicare & Medicaid Services)
- State Efforts To Address Medicaid Home- and Community-Based Services (HCBS) Workforce Shortages— Offers examples of state strategies for increasing HCBS workforce capacity (Medicaid and CHIP Payment and Access Commission, 2022)
Other Resources
- Supporting Direct Care Workers through Training and Stipends: Insights for California Stakeholders— Insights from interviews and research to outline what would be beneficial in a California DCW Training and Stipend Program (Center for Health Care Strategies, April 2022)
- American Rescue Plan Act Workforce Topical Analysis— Proposed state initiatives that will influence workforce expansion in home and community-based services (National Association of State Directors of Developmental Disabilities Service, 2019)
- Strengthening and Stabilizing the Direct Care Workforce in Oregon— Analysis of Oregon’s direct care workforce policies and programs with recommendations to strengthen direct care workforce recruitment and retention (PHI, 2022)
- State Strategies for Sector Growth and Retention for the Direct Care Health Workforce— Brief provides a series of multi-sector state and employer strategies to address recruitment and health sector retention of direct care professionals (National Governors Association, 2021)
- State Implementation of American Rescue Plan Act Initiatives to Increase Wages and Expand Career Opportunities for Direct Service Workers— Summarizes the work of the Affinity Group to strengthen the direct service workforce (ADvancing States, 2022)
- States Use American Rescue Plan Act Funds To Strengthen Home and Community-Based Service (HCBS) Workforce— Explores how states propose using these one-time funds to bolster the workforce that provides HCBS (National Academy for State Health Policy, 2022)
- Strengthening the Direct Care Workforce (DCW)— Provides a broad overview of the DCW and highlights state actions and strategies to strengthen the workforce (National Conference of State Legislatures, 2023)
- The Direct Care Workforce Policy and Action Guide— Helps states understand the complexity of issues regarding the current direct care professional shortage and the role states can play in strengthening and improving this critical infrastructure (Milbank Memorial Fund)
- Long-Term Care Policy Guide— Examines strategies that eight states are deploying to regulate long-term services and supports, invest in home- and community-based services, and meet the needs of the direct care workforce (Council of State Governments, 2022)
- Medicaid Structured Family Caregiving (SFC): Enabling Family Members to Make Caregiving Their Primary Focus— Examines how three states are using Medicaid-funded SFC services to help older adults remain in the homes they share with their loved ones (National Academy for State Health Policy, 2022)
- A Practical Resource Guide for Direct Care Workforce State Advocacy— Spans 20 strategic areas with 60 actionable steps, aiming to facilitate policy advancement for thriving direct care jobs and improved access to vital services (PHI, 2023)
- Building the Direct Care Workforce (DCW) Movement: The Essential Jobs, Essential Care Multi-State Initiative Final Report— Summarizes a multi-state advocacy initiative focused on the DCW in three states (PHI, 2023)
- State Policy Strategies for Strengthening the Direct Care Workforce (DCW)— Brief outlining several state policy initiatives to improve the DCW (PHI, 2022)
- Direct Care Worker Survey and Focus Group Report— Summarizes the findings from a survey and focus group done with California in-home support services workers about challenges, interests, and preferences related to training and incentives (California Department of Aging)
- Direct Care Workforce 2020: Solutions to Direct Care Workforce Crisis— Summarizes listening sessions findings, subsequent actions, and advocacy status around direct care professionals in Iowa (Iowa CareGivers, 2018)
- Forging a Path Forward to Strengthen Michigan’s Direct Care Workforce (DCW)— Outlines considerations and action to support the state of MI in expanding and strengthening its DCW (Center for Health Care Strategies, 2021)
- Spotlight on Minnesota: Direct Care Workers and Quality Jobs— Provides a statistical snapshot of direct care professionals in MN and considerations for strengthening this workforce (PHI, 2019)
- Spotlight on Wisconsin: Direct Care Workers and Quality Jobs— Provides a statistical snapshot of direct care professionals in WI and considerations for strengthening this workforce (PHI, 2019)
- State Policies to Strengthen the Direct Care Workforce (DCW)— Webinar provides an overview of state policies in two states to improve the quality and supply of the DCW and innovations (National Academy for State Health Policy, 2022)
- Unlocking the Future of Homecare: California’s IHSS Career Pathways Program and PHI’s Contributions— Summarizes in-home supportive services program and efforts to create 39 training modules and high-quality, skills-based training videos (PHI, 2023)
- Making the Math Work: Supporting Direct Care Workers in Maine— Highlights Maine's Essential Care & Support Workforce Partnership and positive differences made for direct care workers (PHI, 2023)
- Efforts to Evaluate the Impact of American Rescue Plan Act (ARPA) HCBS Investments— Provides information about states’ efforts to understand the impact of their ARPA home and community-based services initiatives and investments (ADvancing States, 2024)