Innovative Strategies and Policy Changes Can Help Transform Direct Care Jobs, Stabilize PALTC Workforce

February 10, 2022

February 10, 2022

Contact: Ellen Mullally


Direct care workers play an essential role in the lives and care of older adults receiving post-acute and long-term care (PALTC). Yet, despite decades of research, advocacy, and incremental policy and practice reform, these workers remain inadequately compensated, trained, supervised, mentored, and respected. As a result of these issues and other factors such as the stresses of an ongoing pandemic, turnover and attrition have reached crisis levels, and it’s challenging to attract new people to the field. In an article in the February issue of JAMDA, the authors suggest steps for transforming direct care jobs and stabilizing this workforce.

In Transforming Direct Care Jobs, Reimagining Long-Term Services and Supports (LTSS), the authors determined that a strong, stable direct care workforce requires a number of changes and innovations, starting with competitive wages and adequate employment benefits, updated training standards and delivery systems that prepare these workers to meet increasingly complex care needs across settings, and enhanced career mobility and workforce flexibility. They also suggested a need for investment in well-trained frontline supervisors and peer mentors to help direct care workers navigate their challenging roles, plus an elevated position for frontline workers in relation to the interdisciplinary care team.

“Reimagining LTSS requires a broad-based commitment to improving the quality of direct care jobs. This commitment must be matched by strategies that span across direct care occupations and LTSS settings to the extent possible to achieve a strong stable workforce that is well prepared to provide competent care where and when needed,” the authors said. They noted that policy and other changes are necessary for these innovations to happen.

However, they also reported that there is already positive action in some areas, stating that innovative efforts to empower and integrate direct care workers already exist. For example, they said, “The nursing home culture change movement has produced several team-based models that elevate nursing assistants’ status.” They added that the evidence from the national Nursing Home Culture Change Survey “shows a link between nursing assistant empowerment and retention,” as nursing homes with medium and high levels of empowerment had a 44% and 64% greater likelihood of having high retention, compared to those in the low-empowerment category.

In addition to legislation currently before Congress, the authors urged more action on the federal level. For instance, they suggested that the U.S. Department of Health and Human Services could convene an advisory council comprising representatives from relevant federal agencies and departments, as well as LTSS payers, providers, workforce development experts, worker advocates, consumers and family members, and direct care workers themselves. Among its efforts, the authors proposed, the council could develop recommendations for improving direct care workers’ compensation, raising standards across settings and occupations, establishing recognized career pathways, strengthening supervision, enhancing team integration, and overcoming gaps in direct care workforce data collection. They concluded, “Now is the time for a national direct care workforce strategy.”

This study was conducted by researchers at PHI, Bronx, NY.

The February 2022 issue of JAMDA is entirely devoted to evidence-based papers and recommendations to guide reimagination of the long-term care workforce, societal issues, models of care, financing, payment, regulation, and services. Read more about the issue.

Go here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.


About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.