The Value of Statewide Direct Care Worker Training and Credentialing Systems – PHI

Nationwide, the direct care workforce is expected to have more than 9 million job openings between 2021 and 2031 created both by new jobs due to growing demand and job vacancies due to workers leaving the field or exiting the labor force. Yet, low pay, limited benefits, inadequate support and supervision, and few training and career development opportunities mean long-term care providers nationwide struggle to attract and retain workers in these essential roles. Many states are taking notice and investing in the direct care workforce to address these issues, especially through catalyst funding made available through the American Rescue Plan Act.

Recently, at ADvancing States’ HCBS Conference, PHI gathered experts from Wisconsin, North Carolina, and Michigan to highlight their work developing statewide direct care workforce training and credentialing systems. These centralized systems are intended to enhance the competency of direct care workers, increase their ability to move between settings (and advance their careers), and improve the quality of care these essential workers provide. Here is a quick look at each of these innovative and impactful projects.


Facing a dire shortage of home care workers and nursing assistants, Wisconsin began in 2018 to comprehensively reevaluate its training and credentialing system. Through a dynamic partnership between the Wisconsin Department of Health Services and the University of Wisconsin-Green Bay, the state has created a voluntary Certified Direct Care Professional (CDCP) training and credentialing system. Once trained and certified, these professionals can work in a variety of home and community-based settings, such as in-home care, adult family homes and residential care facilities, and they can work for both home care agencies and consumer-directed programs. The program builds on the remarkable success of the WisCaregiver Careers program’s initial focus on nursing assistants.

Launched in mid-July, this training and credentialing system takes a multifaceted approach, including:

  • An online, competency-based training program that is free for workers;
  • Sign-on/stay-on and retention bonuses for new and current workers;
  • A statewide workforce portal connecting workers to jobs and employers to workers; and
  • Public outreach activities and a marketing campaign, including a partnership with the Green Bay Packers, to help spread the word about these offerings.

Early results from this program are promising, with the state making strides towards its goal of training 10,000 new home care workers.


The WECARE (Workforce Engagement with Care Workers to Assist, Recognize, and Educate) project aims to develop a training, credentialing, and job quality model for the direct care workforce in North Carolina. Funded by Money Follows the Person federal funds and led by Duke University, in partnership with the North Carolina Coalition on Aging, PHI, the National Domestic Workers Alliance North Carolina Chapter, and Appalachian State University, the project has several goals, including to:

  • Analyze training content and requirements across direct care roles and settings;
  • Identify core competencies that all direct care workers need;
  • Optimize training approaches to teach these core competencies; and
  • Support high-road employers who are excelling at recruiting and retaining a professional direct care staff.

Through extensive research on the current training landscape in partnership with a range of experts across the state—including those with lived experience of providing and receiving care—the WECARE team has generated several key findings to inform their work. These findings show current direct care training systems are complex with minimal portability across settings. They have also found that relational skills, often left out of traditional training programs, are viewed as top training priorities by both workers and the people they support. WECARE’s research will inform the development of a pilot program to improve training and enhance the quality of direct care jobs across North Carolina.


Through the advocacy of the IMPART Alliance, Michigan’s Direct Care Workforce Advisory Committee is working to establish a competency-based credentialing system for direct care workers across long-term care settings. The Committee—convened by the Michigan Bureau of Aging, Community Living, and Supports— is a group of state agency representatives, researchers, advocacy organizations, and long-term care providers. This cross-sector, inclusive committee has a few key goals, including establishing the following:

  • Statewide competency guidelines for all direct care workers;
  • New credentials in stackable levels to provide portability and career advancement opportunities;
  • Competency assessments to ensure quality care is being provided; and
  • Well-defined career pathways to attract workers to the field and help retain them.

The committee’s strong, careful collaboration across many different partners is leading to concrete progress. The first steps have included identifying and endorsing competencies, expanding training, and determining the best home for the new credentialing system. Throughout this work, the committee has been careful to articulate a common definition of “direct care worker” while ensuring they advocate for the entire direct care workforce, rather than one segment over another.

All three of these states showcase that investments in training, credentialing, and collaboration can make significant progress toward transforming direct care jobs. These examples also highlight the importance of collaboration and practical solutions to strengthen this workforce and address its staffing crisis.  Direct care workers deserve strong statewide training and credentialing systems, and these state-level efforts take us one step closer to that ideal.

With special thanks to Kevin Coughlin, Policy Initiatives Advisor – Executive, Department of Health Services, Division of Medicaid Services; Trish Farnham, Interim Executive Director, NC Coalition on Aging; and Clare C. Luz, PhD, Associate Professor, Michigan State University/College of Osteopathic Medicine and Director, IMPART Alliance for sharing insight on each of their state’s efforts.

Source: The Value of Statewide Direct Care Worker Training and Credentialing Systems – PHI

You may also like...