[Excerpt] Direct care workers (DCWs) provide care to older adults and those with disabilities. The term “DCWs” can be used to refer to different types of healthcare workers in different contexts. For this piece we use the US Department of Labor’s definition of DCWs, which includes home health aides, attendants, personal care aides, and nursing assistants. Despite variations in their care settings—long-term care (LTC), community-based settings, etc.—DCWs typically ensure personal and medical care on a daily or near-daily basis.

With an aging population and a push for shorter hospital stays, demand for DCWs has surged. In the United States, there are currently 4.8 million DCWs; estimates suggest that an additional 9.3 million more workers will be needed by 2031. Yet, the supply remains low, partly due to poor job quality, structural inequities, and challenging working conditions. DCWs are predominantly middle-aged women and people of color, and they often face low wages (median $13.56/hour), irregular hours, and inadequate benefits (about half of DCWs have access to health insurance through the workplace). All of this contributes to high turnover rates. Why are direct care workers so crucial, and what can be done to improve their working conditions?