Direct Care Workforce Policy and Action Guide

Focus Area:
The Health of Aging Populations
Health Equity


The Direct Care Workforce Policy and Action Guide examines the challenges direct care workers (DCWs) face and outlines administrative, funding, policy, and regulatory levers that states can use to offer them better support. This Guide is designed to help states understand the complexity of the issues regarding the current direct care workforce shortage, and the role states can play in strengthening and improving this critical workforce. In particular, the Guide offers concrete examples of thoughtful and innovative ways states are working to overcome the challenges that have long plagued the workforce.

The Guide provides:

  • An overview of the direct care workforce crisis and the challenges DCWs face;
  • The levers state leaders have to strengthen the direct care workforce;
  • The actions needed to make meaningful change across sectors;
  • Examples of state innovations and strategies to better support the direct care workforce; and
  • Steps states are taking to address the long-standing racial and economic disparities that have affected both the direct care workforce as a profession and DCWs themselves.

States understand the importance of meaningfully supporting DCWs but struggle to identify how to tackle the problem in a systematic, effective way. There is significant variance, for example, among states in availability of data on the direct care workforce, mechanisms for consistently engaging stakeholders, wage scales, and the use of collective bargaining. Thus, states vary widely in their levels of capacity and readiness for taking on this issue. This Guide is intentionally meant to meet states wherever they are on the continuum of readiness to strengthen DCW opportunities.

Read the Guide

Watch a recording of the May 20 webinar


Roman C., Luz, C.,  Graham C.,  Joseph N., and McEvoy K. Direct Care Workforce Policy and Action Guide. The Milbank Memorial Fund, May 18, 2022.


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