A UNIVERSAL WORKFORCE FOR A UNIVERSAL NEED
Direct care workers deserve a system they can navigate.
Where training counts, credentials travel, and careers can grow.
PHI’s Universal Direct Care Workforce Initiative™ is connecting the dots, aligning states, providers, and career pathways for direct care workers through shared standards and sustainable financing. Together, we can transform the lives of millions of workers and families.
THE PROBLEM
AN UNSUSTAINABLE STATUS QUO
Direct care work is essential. The system supporting it has not been built to last. More than 5.4 million direct care workers help older adults and people with disabilities remain safe and independent — at home, in residential settings, and in nursing homes.
Yet the infrastructure surrounding them remains fractured and under-resourced. Training requirements vary widely by occupation and state. Credentials are inconsistent and rarely transferable. Clear advancement pathways are scarce. Wages remain poverty-level. Turnover remains high, even as demand rises. Long-term care remains chronically underfinanced.
Workers, employers, individuals and families, advocates, and communities across our nation deserve a system that works. Government agencies and payers hold critical responsibility for financing, regulating, and managing care.
We need sustainable solutions.
By the numbers
Projected Direct Care Job Openings between 2024 – 2034 *
Federal training requirement for personal care aides*
Training standards and credential portability vary widely across state lines**
Median wage for direct care workers, requiring 49% to rely on public assistance*
* PHI, Direct Care Workers in the United States: Key Facts 2025 (New York, NY: PHI, 2025)
** PHI, Direct Care Workforce State Index (New York, NY: PHI, 2026).
A COHERENT DIRECT CARE WORKFORCE ARCHITECTURe
CONNECTED BY
CARE
The PHI Universal Direct Care Workforce Model™ connects direct care roles into coherent state and national frameworks built on universal entry-level competencies, stackable and portable credentials, integrated career pathways, and financing structures that support wage progression and retention. It sets a new standard for how workers navigate their careers—and how employers and states sustain high-quality care.
With this aligned approach, fragmentation gives way to connection and stability. Workers build real careers and prosper financially. Individuals and families receive consistent, skilled care. Employers reduce costly turnover and fulfill both mission and margin.Policymakers gain the tools they need for long-term impact. States and our nation sustain a workforce designed to succeed.
A stronger care workforce cannot be built through short-term fixes, but by designing a constellation strong enough to anchor the future of long-term care.
Get CONNECTED
Connect with PHI to learn more about the Universal Direct Care Workforce Initiative. Together, we can solve today’s care challenges—and build a sustainable care system.