Direct Care Workforce State Resources

In general, the following resources are intended for state staff working on direct care workforce issues. Resources include initiatives led by ADvancing States, as well as information from various partners.

If you would like to learn more about the State of the Workforce Survey – Aging & Disabilities, Direct Care Careers, or any other ADvancing States resources, please email April Young at

State Implementation of American Rescue Plan Act Initiatives to Increase Wages and Expand Career Opportunities for Direct Service Workers: Summary of a State Affinity Group

 ADvancing States and our partners with the ARPA HCBS Technical Assistance Collective are proud to release two papers that provide information about state efforts and activities under their American Rescue Plan Act (ARPA) HCBS spending plans. Through the generous support of The SCAN Foundation, The John A. Hartford Foundation, The Milbank Memorial Fund, and Arnold Ventures, the TA Collective operated two Affinity Groups (AG) to support states, facilitate information exchange, and share innovations, promising practices, and other strategies to expand and enhance their HCBS programs. One AG focused on HCBS Workforce Shortages and state efforts to increase worker compensation and to improve training and education activities while the other AG was dedicated to incorporating enabling technology into state HCBS programs. Each paper provides an overview of the issue, a summary of the discussions and ideas presented, examples of state innovations, and a discussion of future activities, challenges, and considerations as states continue to address these issues.

Click here to read the report.

Addressing Wages of the Direct Care Workforce through Medicaid Policies

 This paper provides a summary of state approaches to increase direct care worker wages, with a focus on those that have reporting requirements, enforcement vehicles or other mechanisms to help ensure funds go to intended recipients working in facility and HCBS settings.

Click here to read the paper.

Direct Care Workforce Scan of State Strategies (CHCS)

 This scan highlights examples of strategies in 11 states ― Colorado, Iowa, Illinois, Indiana, Massachusetts, Minnesota, Nevada, New Jersey, Tennessee, Washington State, and Wisconsin ― aimed at strengthening the direct care workforce through legislation, American Rescue Plan Act funding, and training.

Click here to read the scan.

ADvancing States and NASHP webinar on DCW

 Direct care workforce strategies from Indiana and Missouri are featured in this webinar cohosted by ADvancing States and NASHP.

Click here to view the webinar.

Updated Analysis of State HCBS Spending Plans

ADvancing States released an analysis of states’ initial spending plan submissions in September 2021, grouping activities into tables focusing on ten areas.  Each table provides information on a specific category of activities, including:

  • Service Expansions
  • Eligibility and Enrollment Activities
  • Provider Payment Increases
  • Direct Care Worker Recruitment, Retention, and Training
  • Technology for Providers
  • Technology for State Agencies
  • Capital/Structural Improvements
  • Quality Initiatives
  • Strengthening State Administration
  • Other Activities (not captured elsewhere)

We have updated these tables using the states’ most recent spending plan updates to CMS (either October 2022 or January 2023). We indicate removal of an initiative in a table by striking through the X, and new initiatives by a new X in green.  Notes indicating more nuanced changes can be found in the ‘other’ column.

Click here to view the analysis. 

Dementia Capable Caregiver Course Materials

Among other topics, the dementia capable curriculum for caregivers includes an introduction to dementia, working through hallucinations and delusions, working with families, how to approach activities of daily living, medications/therapies, and challenging behaviors. This training was developed with feedback and input gathered from stakeholders across the state of Washington. Primary stakeholder groups included facility owners/providers, managers, supervisors, caregivers, trainers, families, clients/residents, DSHS staff, long term care ombudsman and advocacy group representatives. The Washinton Aging and Long-Term Support Administration has graciously made all course materials publicly available.

Click here to view the course materials.

Direct Care Careers

 Direct Care Careers Center is a free, national website that provides individuals (1) access to jobs with potential employers, (2) access to resources to develop their skills, and (3) access to trainings to increase competence. The job matching tool uses a matching algorithm to pair licensed and/or trained workers with healthcare and LTSS employers that need their specific skills. This website was created by ADvancing States and Altarum, in partnership with participating States/Territories.

Learn more about Direct Care Careers here.

Click here to visit the Direct Care Careers website. 

State of the Workforce Survey

 A first of its kind for the aging and disabilities field, this new effort, co-managed by ADvancing States and HSRI, collects and aggregates statewide information about demographics, wages, benefits, and turnover of the direct service workforce—as reported by the agencies that employ them. NCI-AD began piloting a ‘State of the Workforce’ survey in 2022 with five states: Missouri, Washington, Colorado, Wisconsin, and Indiana.

 As with the original NCI-IDD State of the Workforce survey, which debuted in 2014, the Aging and Disabilities version collects data about the status of direct service workers (DSWs) from provider organizations. The first round of data collection for the State of the Workforce—Aging and Disabilities began in summer 2023.

Click here to learn more about the State of the Workforce Survey.

CMS Releases New Resources for Strengthening the Direct Service Workforce

The Centers for Medicare & Medicaid Services (CMS) recently released seven new resources focused on strengthening the DSW. The online training, Recruiting, Selecting, and Retaining Direct Service Workers to Provide Self-directed Home and Community-Based Services (HCBS), provides guidance and information for people who self-direct, or wish to self-direct, their HCBS, as well as others interested in information on finding, hiring, and retaining direct service workers. You can access all of these resources from CMS’ Direct Care Workforce page and ADvancing States' HCBS Clearinghouse.

Click here to view the resources.

2023 HCBS Conference Direct Service Workforce Intensive

Several states presented during the DSW Intensive at the 2023 HCBS Conference. The slide deck and recording for the intensive can be found on ADvancing States IQ under “Virtual Meetings, Events, & Conferences” (the DSW intensive was on Thursday, August 31st). Some of what was shared includes:

  • Listening to and incorporating input from direct service workers
    • Indiana Direct Service Workforce Advisory Board
    • Colorado Direct Care Workforce Collaborative
    • Maine Direct Care and Support Professional Advisory Council
  • State Workforce Development Strategies
    • Tennessee – competency-based training and wage incentives, DSP apprenticeship program, career path opportunities, strategic partnerships
    • California – information about CalGrows, a direct care workforce training and retention program. California provides grants to providers with innovative ideas for training DSWs. These have included virtual reality training programs, on the job shadow trainings, and a learn by play training system built with videogame technology

Career Ladder Identifier and Financial Forecaster (CLIFF)

States are paying more and more attention to the impact the benefits cliff has on direct service workers and providers. The Federal Reserve Bank of Atlanta provides state customized Career Ladder Identifier and Financial Forecaster (CLIFF) tools for states and workers to use.

Learning From COVID-19-Related Flexibilities

As policymakers consider which COVID-19-related temporary regulatory flexibilities might improve Medicare and Medicaid programs if continued as permanent policies, they are now faced with complex decisions weighing the impact on consumers and providers, the opportunities for programmatic alignment, the ability of modifications to address risks, and the possibility of additional evaluation before making a final choice.

Manatt Health and HMA conceptualized a person-centered assessment framework to facilitate these decisions. The framework assesses the potential for the regulatory flexibilities to:

  • Advance person- and community-centered care
  • Facilitate care in the least intensive or least restrictive setting
  • Better align Medicare and Medicaid program rules

Access the issue brief here.