The U.S. is facing a dire shortage of direct care workers (DCW), who provide essential services to older adults and people with disabilities. Although state officials understand the importance of meaningfully supporting the direct care workforce, they often struggle to identify how to tackle the problem in a systematic, effective way.

The Direct Care Workforce Policy and Action Guide, a new Milbank Memorial Fund resource for state officials examines the challenges that direct care workers face — and the administrative, funding, policy, and regulatory levers that states can use to better support this critical workforce. The guide, coauthored by the Center for Health Care Strategies, IMPART Alliance/Michigan State University, and the Milbank Memorial Fund, underscores that simply raising wages or requiring more training hours is not sufficient. The guide outlines — with action steps and examples — how officials can build a statewide, coordinated plan that is tailored to state needs and responsive to drivers of the DCW shortage. The authors also illustrate how some states are addressing long-standing racial and economic disparities that have affected both the direct care workforce as a profession and DCWs themselves.

View the guide at