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, employers, and career pathways for direct care workers through shared standards and sustainable financing.
Together, we can transform the lives of millions of direct care workers, older adults, and people with disabilities.
THE PROBLEM
AN UNSUSTAINABLE STATUS QUO
Direct care work is essential. The system supporting it has not been built to last. Across the country, more than 5.4 million direct care workers help older adults and people with disabilities maintain their health, safety, independence, and wellbeing.
Yet wherever they work —in homes, residential settings, or nursing homes—infrastructure remains fractured and under-resourced. Training requirements vary by occupation and state. Credentials are inconsistent and rarely transferable. Clear pathways to economic mobility are rare. Wages remain poverty-level. Turnover reaches as high as 100 percent in some settings, even as demand continues to rise year after year.
Workers, employers, individuals and families, and communities across our nation deserve a system that works, not a fractured one. Government agencies and payers hold critical responsibility for financing, regulating, and managing care.
We all need sustainable solutions.
DIrect care workers By the numbers
Projected Direct Care Job Openings between 2024 – 2034 ²
Federal training requirement for personal care aides ²
Training standards and credential portability vary widely across state lines¹
Median wage for direct care workers, requiring 49% to rely on public assistance ³
¹ Jessica King et al., Training Standards for Personal Care Aides Across States (San Francisco: UCSF Health Workforce Research Center on Long-Term Care, 2025)
² PHI, Direct Care Workers in the United States: Key Facts 2025 (New York, NY: PHI, 2025)
³ PHI, U.S. Direct Care Workers: Key Facts (New York, NY: PHI, 2025)
CONNECTED BY CARE
A COHERENT DIRECT CARE WORKFORCE ARCHITECTURe
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 futures. In doing so, it sets a new standard for 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 meet their missions and bottom lines. Policymakers gain the tools they need for long-term impact. States and our nation sustain a workforce designed to succeed.
PHI is bringing forward-thinking solutions to address today’s challenges. This is long-term infrastructure—not a short-term fix, but a constellation strong enough to shape 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.