[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-160181-en":3,"doc-seo-160181-105":30,"detail-sidebar-cat-0-en-105":91},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":27,"seo_description":14,"update_tm":28,"read_time":29},160181,1374402524268,"Berry Peter","https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2",8,"Research & Report","Strengthening the Direct Care Workforce - Scan of State Strategies","Strengthening the Direct Care Workforce outlines why direct care workers (DCWs) are vital to hands-on support for older adults and people with disabilities, especially when family caregivers are unavailable. It analyzes key barriers including low Medicaid reimbursement, underpricing of the role, turnover driven by wages and hours, limited federal training requirements, and unequal access to affordable training. The report highlights how the COVID-19 pandemic and ARPA funding increased state activity, and provides state strategy examples spanning legislation and training models.","Strengthening the Direct Care Workforce: Scan of State Strategies  \nBy Hannah Ward, Matthew Ralls, Courtney Roman, and Diana Crumley, Center for Health Care Strategies  \nA  \ncross the U.S., direct care workers (DCWs) are responsible for a majority of the hands-on care for older adults and people with disabilities, including those who require personal assistance services. DCWs work in a variety of settings, including nursing homes and individuals’ own homes, and  \nperform tasks such as bathing, dressing, housekeeping, meal preparation, and medication management as well as more intensive medical care and assistance. This critical workforce provides essential support for older adults and people with disabilities who may not have family or informal caregivers to provide the dayto-day care they need.  \nThe challenges DCWs face are significant. First, DCWs are highly underpaid—in part due to low Medicaid reimbursement rates—but also because of a deeply rooted undervaluing of the work within the larger healthcare system.1 Due to low wages, long hours, and the demanding nature of the work, there is a high rate of DCW turnover, with many moving to jobs with fewer hours and higher pay in other industries such as hospitals, retail, and fast food.2 Furthermore, while some employers require a certain number of hours for basic certification, there are few federal training requirements and DCWs often perform tasks outside their limited training3 and struggle to find affordable and accessible training opportunities. Finally, DCWs and the work they provide is essential—but are not always viewed as such by society.4 A concerted culture shift is still needed across the broader health care system and the public in general, where DCWs are valued for the skilled work they perform as health care professionals.  \nThe COVID-19 pandemic only heightened the urgency to develop strategies that attract new workers to the field and strengthen the direct care workforce, especially as more older adults and people with disabilities seek to avoid institutions and to live in home-and community-based settings. Coupled with the unique opportunity presented by the availability of American Rescue Plan Act (ARPA) funds, states across the country are creating legislation and other supports to bolster this critical workforce.  \nThe following scan was designed to highlight state examples of strategies aimed at strengthening the direct care workforce. The scan includes examples from the following states: Colorado, Iowa, Illinois, Indiana, Massachusetts, Minnesota, Nevada, New Jersey, Tennessee, Washington State, and Wisconsin.  \nThe following sections highlight states’: (1) legislative language supporting DCWs, including related to ARPA investments; and (2) direct care workforce training models, including how states fund training, when available.  \nThis scan was developed for the Michigan Department of Health and Human Services, Bureau of Aging, Community Living, and Supports with funding from the Michigan Health Endowment Fund. Although it was prepared to inform the Michigan landscape, the lessons herein can apply to any state interested in strengthening the direct care workforce.  \nSection 1. Examples of State Legislation Supporting DCWs  \n\n| LEGISLATIVE LANGUAGE | CONSIDERATIONS |\n| --- | --- |\n| COLORADO |  |\n| In 2019, Colorado passed SB19-238 (Improve Wages and Accountability Home Care Workers), which requires that the state:\u003Cbr>• [25.5-6-1602] Requests an 8.1% increase in reimbursements from the federal government for services paid for through the home and communitybased waivers.\u003Cbr>• [25.5-6-1603-2] Implements a minimum wage of $12.41/hour for DCWs.\u003Cbr>• [25.5-6-1603-3&4] Sets up distribution and reporting requirements for how funds are spent.\u003Cbr>• [25.5-6-1604] Creates a process for reviewing and enforcing training for personal care services.\u003Cbr>- Established the Senate Bill 19-238 Training Advisory Committee which produced Senate Bill 19-238: Improve Wages and ","cbCaiq3xUtVF6VqA","https://ap.wps.com/l/cbCaiq3xUtVF6VqA","pdf",254002,1,9,"English","en",105,"# Overview\n## Workforce importance and key challenges\n## COVID-19 and ARPA-driven urgency\n## Purpose and scope of the scan\n# Section 1. Examples of State Legislation Supporting DCWs\n## Colorado\n## Iowa","[{\"question\":\"What roles do direct care workers (DCWs) perform?\",\"answer\":\"DCWs provide hands-on personal assistance such as bathing, dressing, housekeeping, meal preparation, and medication management, and they may also deliver more intensive medical care and assistance. They work in settings such as nursing homes and individuals’ own homes.\"},{\"question\":\"Why does the report say DCWs face major challenges?\",\"answer\":\"The report highlights underpayment partly linked to low Medicaid reimbursement, long hours and demanding work that drive turnover, limited federal training requirements, and difficulty accessing affordable, accessible training opportunities. It also notes that society and the broader health care system do not always value DCWs appropriately.\"},{\"question\":\"What is the focus of the scan across states?\",\"answer\":\"The scan is designed to highlight state examples of strategies to strengthen the direct care workforce. It covers (1) legislative language supporting DCWs, including ARPA-related investments, and (2) direct care workforce training models and how states fund training when available.\"}]","Strengthening the Direct Care Workforce - Scan of State Strategies | PDF",1788051375,23,{"code":4,"msg":31,"data":32},"ok",{"site_id":24,"language":23,"slug":33,"title":13,"keywords":34,"description":14,"schema_data":35,"social_meta":86,"head_meta":88,"extra_data":90,"updated_unix":28},"strengthening-the-direct-care-workforce-scan-of-state-strategies","",{"@graph":36,"@context":85},[37,54,68],{"@type":38,"itemListElement":39},"BreadcrumbList",[40,44,48,51],{"item":41,"name":42,"@type":43,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":45,"name":46,"@type":43,"position":47},"https://docshare.wps.com/document/","Document",2,{"item":49,"name":12,"@type":43,"position":50},"https://docshare.wps.com/document/research-report/",3,{"item":52,"name":13,"@type":43,"position":53},"https://docshare.wps.com/document/strengthening-the-direct-care-workforce-scan-of-state-strategies/160181/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":23,"description":14,"dateModified":62,"datePublished":62,"encodingFormat":61,"isAccessibleForFree":63,"interactionStatistic":64},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":41,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-08-30",true,{"@type":65,"interactionType":66,"userInteractionCount":4},"InteractionCounter",{"@type":67},"ViewAction",{"@type":69,"mainEntity":70},"FAQPage",[71,77,81],{"name":72,"@type":73,"acceptedAnswer":74},"What roles do direct care workers (DCWs) perform?","Question",{"text":75,"@type":76},"DCWs provide hands-on personal assistance such as bathing, dressing, housekeeping, meal preparation, and medication management, and they may also deliver more intensive medical care and assistance. They work in settings such as nursing homes and individuals’ own homes.","Answer",{"name":78,"@type":73,"acceptedAnswer":79},"Why does the report say DCWs face major challenges?",{"text":80,"@type":76},"The report highlights underpayment partly linked to low Medicaid reimbursement, long hours and demanding work that drive turnover, limited federal training requirements, and difficulty accessing affordable, accessible training opportunities. It also notes that society and the broader health care system do not always value DCWs appropriately.",{"name":82,"@type":73,"acceptedAnswer":83},"What is the focus of the scan across states?",{"text":84,"@type":76},"The scan is designed to highlight state examples of strategies to strengthen the direct care workforce. 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