Frequently Asked Questions

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Answers to your frequently asked questions about the DSW Resource Center and direct service workforce.

Why is there concern about the direct service workforce?

Two demographic trends could combine to create a severe shortage of direct service workers in the coming years: the increasing number of people who need long-term services and supports and the decreasing number of workers available to provide these services. Driven by the aging of the “Baby Boom” generation, the demand for long term services and supports in the aging population will grow much faster than the supply of caregivers, either paid or unpaid. While not everyone age 65 years and older needs long term care services, the number of older people who do need assistance will nearly double between 2000 and 2040. At the same time, divorce rates, smaller family size, and the way families are spread out across the country will result in a larger number of older people with no access to family support.

In addition to older Americans, millions of individuals below the age of 65 have some type of permanent or long lasting disability. The fact that most individuals with disabilities prefer to live in the community, rather than in nursing facilities and institutions, and the Supreme Court’s Olmstead decision, which requires states to offer the option of community-based services make it likely that the demand for long-term services and supports will increase in the disability community as well as in the aging community.

These two trends will drive an increasing demand for direct service workers. The Bureau of Labor Statistics projects demand for health care support to grow 33.3 percent between 2004 and 2014, faster than any other sector of labor force demand. To meet this demand, the direct service industry will be competing for available workers with other industries that offer better wages, better benefits and better working conditions. At the same time, the the overall labor supply is growing much more slowly than demand. It will require the commitment of government agencies and private employers to improve the recruitment and retention of direct service workers.

Why should state Medicaid agencies get involved with DSW initiatives?

Medicaid is the single largest source of funding for long-term services and supports, accounting for 47% of long term care spending in 2002. Medicaid long term care spending doubled between 1987 and 1997, and is expected to continue to increase dramatically along with the number of older Americans. Long term care spending, including both institutional and home and community based services, accounted for an average of 35% of state Medicaid budgets, with some states spending 50-60% of their Medicaid budgets on long term services and supports. Provision of services in the community holds the potential to both increase the quality of life for Medicaid recipients and save Medicaid dollars. Appropriate and timely provision of home and community based services can delay or prevent institutionalization, keeping long term care costs lower.Inadequate or unsuitable home and community based services, or a lack of access to the services, can lead to inappropriate institutionalization, more visits to the emergency room, and an increased need for expensive acute care. Access to adequate community based supports depends on the availability of a well trained workforce of sufficient size. Obstacles to achieving such a workforce – including worker shortages, lack of training, lack of supervision, and high turnover – exist in many regions. The impact of workforce issues on the quality of service is direct and immediate. For example, turnover of direct service workers reduces continuity of care for the consumer as the new service provider establishes a relationship and climbs the learning curve. Workforce issues also increase costs for providers, who in turn pass them on to third party payers like state Medicaid Agencies. For example, researchers estimate the cost of turnover in long term care for government payers at roughly $2.5 billion, not including the increased health care costs created by lower quality care for consumers and increased injuries among workers. State Medicaid agencies play a key role in quality assurance, worker and supervisor education, wages and benefits, and provider reimbursement. Their interventions in this area can have a real impact on both Medicaid spending and the quality of care.

What’s the advantage of collaboration with other organizations?

Direct service workforce issues affect and are affected by Medicaid policy, labor policy, community demographics, disability policy, aging policy, and local labor markets. Collaboration allows for a more comprehensive, more sustainable, and therefore more effective approach to workforce issues. An initiative that brings together different types of organizations and partners will be stronger, have more support in the community, and will be more likely to succeed.In addition, both government and private funders frequently require evidence of collaboration and actively encourage grantees to partner with the public and private sectors.


What kind of assistance is available to me through the Resource Center?

The Resource Center provides general technical assistance (TA) to state and local governments, non-profit organizations, employers, and professionals who want to pursue initiatives to improve the recruitment and retention of direct care workers in their state.

In addition to our comprehensive on-line database and targeted search engine that finds relevant resources quickly and easily, Resource Center staff are available by phone (1-877-822-2647) or email to guide you through referrals to resources on other websites, and provide quick answers to your information needs. When you call or email the DSW Resource Center, staff will respond to your inquiry within two business days. If further assistance is necessary, your question will be referred to an appropriate expert from our diverse and experienced team of direct service workforce policy experts. From November 2008 through September 2010, 16 selected Money Follows the Person grantees and their designees are also eligible for individualized, in-depth technical assistance. From 2006 to 2008, Intensive TA was awarded to state Medicaid agencies, through a competitive application process.

The Resource Center will also provide, with CMS approval, individualized short-term TA to approximately 2-3 non-MFP states or organizations. This will involve between 10-40 hours of TA, providing assistance with strengthening the workforce to support individuals transitioning from institutional settings.


I'm a consumer looking for a direct service worker. Where should I start?

This website is not meant to provide assistance in finding direct service workers, but if you need someone to provide direct support or personal assistance at home or in the community for yourself or for someone else with long term support needs, the following resources may be helpful.

Information, Assistance and Resources

Eldercare Locator

1-800-677-1116

State Worker Registries

If you suspect that someone you know is being abused, exploited, or neglected, report it immediately. In an emergency, call 911.

State Elder Abuse Hotlines

State Long-Term Care Ombudsmen

National Domestic Violence Hotline 1-800-799-SAFE (7233), 1-800-787-3224 (TTY)

State Medicaid Fraud Control Units

For more information: National Center on Elder Abuse

What’s the difference between a direct service worker, a direct care worker, a direct support worker, and a direct support professional?

All those terms (and more) are used by various groups to describe individuals who provide direct care and personal assistance to individuals with disabilities and older adults. The "direct service workforce" is a broad and inclusive phrase that encompasses all the individuals who provide hands-on supports and services to individuals with different types of disabilities of all ages. Our website includes materials that use a variety of terms that describe individuals in this workforce, including direct service worker, direct support professional, frontline worker, personal care attendant, personal assistance provider, home care aide, direct care worker, and individual provider. The mission of the DSW Resource Center is to assist in improving and strengthening all segments of the home and community-based workforce, regardless of the title they use or the populations they serve.

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