Between 2018 and 2028, a projected 8.2 million jobs in the direct care workforce will open. The home care workforce is projected to add one million jobs by the end of the decade, more than any other occupation in the U.S. Four and a half million job openings will be a result of increased demand, workers moving into other occupations and workers exiting the labor force. Additionally, many states report worsening labor shortages during the pandemic. An estimated 420,000 direct care workers left the nursing home workforce over the last two years. For all direct care workers, the national annual turnover rate is estimated to be between 40 and 60%, with home care agencies reporting even higher rates, from 65-89%. The U.S. could experience a shortage of 151,000 direct care workers by 2030 and a shortage of 355,000 workers by 2040.

Individuals who are not usually attracted to long-term care jobs, such as high school students and displaced and post-retirement age workers, could be encouraged with the right incentives from government and the right messaging from community agencies. For example, a long-term care council in Pennsylvania recommended that the commonwealth implement incentives — such as loan forgiveness, tuition assistance and academic credit — to encourage college students to enter the direct care workforce. Apprenticeships and other paid work-based learning opportunities can recruit workers by removing training costs as a barrier. Such programs create more coordination across state agencies focused on employment, education and workforce development.


  • The Colorado Department of Higher Education partners with institutions on a collegiate apprenticeship program that combines classroom content with paid training opportunities in entry-level health care and direct care jobs.
  • Hawaii’s Hana Career Pathways program employs a grant from the U.S. Department of Education to provide tuition assistance for short-term training in high-demand health care roles including those in long-term care. In recent years, the state has expanded career and technical education career pathways into areas like health services after an alignment study using state economic and workforce data was conducted to determine high-skill, high-wage and high-demand occupations and state economic priorities and initiatives.
  • Massachusetts partnered with Northeastern University to create an employment website to connect nursing homes with potential job candidates.
  • The Michigan Department of Health and Human Services worked with the Department of Labor and Economic Opportunity Career and Technical Institute to adapt a campus-based certified nursing assistant training program to make it more accessible to individuals with disabilities who are receiving Temporary Assistance for Needy Families.
  • The Missouri Apprentice Connect program identifies in-demand occupations and connects potential workers with apprenticeship programs where they can receive training and work experience while earning wages.
  • Rhode Island’s American Rescue Plan Act spending plan directs $6.1 million to an initiative designed to expand career pathways for direct care workers and focuses outreach efforts to increase the diversity of the workforce.

States are also developing additional strategies for recruiting and retaining workers.

  • The Arizona Department of Education has implemented 27 home health aide programs in public high schools. Arizona’s American Rescue Plan Act plan proposed an investment in the Workforce Data Reporting System that will help state agencies monitor trends affecting recruitment and retention in the health care workforce.
  • Arkansas provides $1,000 recruitment and retention bonuses to certified nursing assistants, behavioral health aides, residential care assistants, technicians and supervisors.
  • Hawaii has used state funds from employer contributions to the unemployment insurance fund to offer incentives to employers to train, hire and retain health care workers and others in high-demand industries.
  • Maine tasked a commission with studying ways to support and strengthen the direct care workforce.
  • Maryland established a Direct Care Workforce Innovation Program to award matching grants to create and expand successful recruitment and retention strategies. New York and North Carolina have similar programs.
  • Minnesota launched Direct Support Connect, a statewide job board that helps consumers find direct care workers and workers find employment.
  • North Carolina provides grant funding for job training programs and internships for individuals seeking careers in various direct care roles. Interested workers from historically marginalized populations are a focus.
  • A Michigan statewide direct care workforce advisory committee brings together stakeholders from all care settings, state-funded programs and populations to address the state’s direct care worker shortage and make policy, regulatory and programmatic recommendations.
  • The New Jersey Caregiver Task Force was created to research the availability of caregiver support services in the state and provide recommendations for service improvement and expansion.
  • New Mexico and Texas also had commissions on the direct care workforce in recent years that have issued recommendations.
  • A New York law from 2021 enabled the study, development and implementation of a long-term strategy to support the growth of the caregiving industry in the state. A second law established the “reimagining long-term care task force.”
  • The Tennessee Direct Support Professionals Apprenticeship Program is a public-private partnership to address workforce shortages in the state. The program compensates individuals for on-the-job training, increases wages by $3.50 per hour upon program completion and partners with community colleges and universities to train students in direct care work.
  • Washington invests $450,000 to support an apprenticeship pathway for direct care workers.
  • A Wisconsin task force, created by executive order in 2019, developed a report containing 16 policy proposals. They include creating a tiered career ladder, designing a statewide marketing strategy and developing a pilot program to establish a home care provider registry.

2023-24 Updates

Expanding the Pipeline

Colorado and Texas partnered with ADvancing States and tech firm Altarum to create customizable online platforms for direct care workers to access tailored training, resources, and job matching services.

Massachusetts partnered with Northeastern University to create an employment website to connect nursing homes with potential job candidates.

Minnesota launched Direct Support Connect, a statewide job board that helps consumers find direct care workers and workers find employment.

Minnesota established a long-term care workforce grant program to provide specialized services and supports to new Americans to enter the long-term care workforce. $28,316,000 onetime appropriation available until 2027.

Nebraska (2024) released over $500K in mini-grants to HCBS providers to provide training to enhance the current workforce and expand the availability and quality of services.

New York’s New Jewish Home has a Geriatrics Career Development Program for high school students and a three-month program for disconnected young adults, ages 18-24, who are not enrolled in school and unemployed.

North Dakota allowed the Department of Health and Human Services the ability to employ staff that can be deployed to health care facilities, including long-term facilities, in order to address staffing shortages.

Washington exempted long-term care workers with a certificate expired for less than five years who is seeking to renew it from annual continuing education requirements while the certificate is expired.

Washington joined the Multistate Nurse Licensure Compact, allowing RNs and LPNs with a multistate license to practice in WA or remotely from the provider’s home state or another state within the licensure.

Wisconsin’s Certified Direct Care Professional (CDCP) program includes a job platform, WisCaregiver Connections, that connects community-based employers with CDCPs. CDCPs will be able to display their badge of achievement in resumes, email, and social media platforms to demonstrate their expertise. A CDCP registry has also been created to list all CDCPs and their achievements. The registry will be accessible to employers and colleagues.