Voices from the field
Direct Care Needs a Constellation
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Direct care workers, consumers, employers, managed care organizations, and state leaders are all navigating the same fragmented system. From the frontlines of long-term care to the offices that finance and regulate it, the message is consistent: the current structure doesn’t work.
Direct care workers tell us they want high-quality jobs and training that counts everywhere. Credentials that travel. Wages that reflect skill. Clear pathways into leadership. In short, they want careers.
Direct Care Workers
Direct care workers tell us they want high-quality jobs and training that counts everywhere. Credentials that travel. Wages that reflect skill. Clear pathways into leadership. In short, they want careers.
Marisol has worked in both home care and assisted living, completing multiple trainings along the way. Each time she changed employers, she was required to repeat coursework and accept lower starting wages despite her years of experience.
“I’ve done this work for 12 years. I know how to care for people safely and with respect. But every time I change jobs, it feels like I have to prove myself all over again. My training should follow me. My experience should count.”
Marisol Rivera
Home Health Aide in Brooklyn, NY
Employers
Employers see the same inefficiencies from another angle.
“We invest in training our aides, but when they leave for another agency, their credentials don’t always carry weight — and when we hire experienced workers, we often have to retrain them from scratch. It’s costly, it’s inefficient, and it makes retention harder than it needs to be. A more aligned system would help everyone.”
Linda Park
Owner, Evergreen Home Care, Columbus, Ohio
Public and private payers
Public and private payers bear the cost of workforce instability — in rising expenses and disrupted care.
“Workforce instability is one of the biggest risks to quality and cost in long-term care. When workers cycle in and out, members experience disruption and plans absorb the expense. A standardized, portable workforce model would help us invest in retention instead of constantly reacting to turnover.”
Carlos Mendoza
CEO, Community-First Managed Care, San Antonio, Texas
State Medicaid leaders
And state Medicaid leaders, who finance, regulate, and oversee long-term services and supports, see the fiscal implications clearly.
“States spend billions on long-term services and supports, yet workforce instability drives up costs year after year. Without shared standards and portable credentials, we’re funding a revolving door. Alignment between training, credentialing, and reimbursement isn’t just good workforce policy — it’s sound fiscal policy.”
Marcus Alvarez
Deputy Director, State Medicaid Agency, New Mexico
Share Your Story
The Universal Direct Care Workforce Initiative replaces fragmentation with alignment, building career pathways where experience compounds, wages reflect skill, and financing supports retention — a constellation designed to hold.