Professional caregivers in long-term care settings often face flat organizational structures that offer limited career advancement. Promoting advancement opportunities could allow workers to take on advanced caregiving roles, become mentors for newer workers, serve as part of effective integrated care teams and perform supervised health maintenance tasks. Direct care professionals in particular need access to career ladders — formal processes that outline how employees may advance to higher salaries and levels of responsibility. On-the-job training through apprenticeship programs offer another way for professional caregivers to demonstrate the aptitude to advance professionally.

Career advancement and career ladders allow direct care workers to take on advanced roles on care teams and become specialists in dementia care, chronic condition management, behavioral health, and medication and pain management. Federal and state policymakers could work with providers to create meaningful career lattices through competency-based job descriptions and work with educational institutions to create training programs.


2023-24 Updates

Facilitating Career Advancement

Florida provided a path for CNAs to become Qualified Medication Aides in nursing homes. RNs are allowed to delegate a QMA to dispense medications to nursing home patients. This will address workforce shortages by freeing up RNs to provide care in other ways and add career paths for CNAs.

Hawaii created a “glidepath” earn-and-learn cross-sector collaboration that allows working individuals to maintain their jobs while advancing health education credentials.

Washington reduced barriers to those seeking a home care aide certification by allowing remote testing, expanding testing sites, allowing tests to be administered at the location people are trained, and exploring travel stipends.

Wisconsin launched the Certified Direct Care Professional (CDCP) program in July 2023 to train 10,000 direct care workers in collaboration with the University of Wisconsin-Green Bay. The CDCP program is a free online and asynchronous training with 14 competencies that prepares workers for positions in various home and community-based settings (HCBS). After completing the program, CDCPs may complete microcredentials to increase their knowledge and skill in specific areas of care, including dementia care, trauma-informed care, supporting youth and children with special health care needs, and more. The Wisconsin Department of Health Services is also collaborating with technical colleges to develop a Certified Nursing Assistant (CNA) ladder program for CDCPs.