LTC News Release: District Leaders Must Address the Growing Shortage of Direct Care Workers for Residents in Need of Long-Term Care









January 28, 2021

District Leaders Must Address the Growing Shortage of Direct Care Workers for Residents in Need of Long-Term Care

A broad coalition of providers, advocates and consumers led by LeadingAgeDC, the DC HealthCare Association (DCHCA), the DC Home Health Association, DC Appleseed, the DC Coalition on Long Term Care and Capitol Hill Village is calling on District leaders to focus attention on the growing shortage of Direct Care Workers to serve older adults and residents with disabilities who need long-term services and supports.  According to the Coalition’s Fact Sheet on Workforce Issues, the ratio of residents needing Long Term Services and Supports (LTSS) to available caregivers is 3 to 1, a ratio predicted to worsen if current demographic and workforce trends continue.  Mary Proctor, a member of Capitol Hill Village, calls the short fall alarming.

Two recent surveys, one focused on home health agencies and a second survey focused on facility-based providers fielded by the Coalition shed light on the challenges of meeting the current and future direct care workforce needs.  These challenges have been exacerbated by COVID 19.

Across all care settings, survey respondents expressed serious concerns about their ability to hire all the direct care staff they need to meet clients’ needs.  The surveys found:

  • Over 50 percent of home health agency respondents stated they did not have enough Home Health Aides to staff all of their clients on every shift.
  • Institutional providers reported that approximately 1/5 of CNA positions are vacant.
  • Virtual schooling and childcare issues are contributing to staff recruitment and retention.
  • Across all care settings, providers reported that direct care staff are leaving the workforce or not reporting to work.
  • An important finding from the survey showed that the vast majority of CNAs who care for District residents do not live in DC.

The vast majority of Direct Care Workers in DC are women and people of color who struggle financially to meet basic needs.  They are engaged in challenging work that requires special skills and training and are caring for our most vulnerable residents.  Yet, they are often paid no more than a fast-food worker.  “If we are serious about addressing racial and economic disparities and serious about meeting the needs of seniors, then we must ensure that direct care workers are paid a real living wage that takes into consideration the training and skills needed to do this work” states Ijeoma Arungwa, President of the DC Home Health Association.

Coalition members applaud recent efforts by District agencies to address some of the short-term issues they face due to COVID.  “DC Health, the Board of Nursing and the Department of Health Care Finance have all taken positive steps to reduce some regulatory barriers, grant waivers and increase provider payment rates to help with the immediate crisis during the public health emergency,” notes Veronica Sharpe, Executive Director of the DC Health Care Association that represents nursing facilities and assisted living providers.  “But” notes Sharpe, “absent systemic changes and comprehensive planning and engagement across health care sectors and across the DMV, the crisis we face in meeting our direct care workforce needs will continue to deepen.

Importantly, notes Ilana Xuman, Executive Directive of LeadingAgeDC, which represents a broad spectrum of aging services providers, “we need to value these workers and the work they do.”  Too often, the job of a Home Health Aide or Certified Nursing Assistance is not considered a “good” job and therefore, we have failed to invest sufficiently to promote these jobs as part of a broader workforce development strategy.

Xuman points to the recently enacted HealthCare Workforce Partnership Establishment Act of 2020 enacted at part of the 2020 Budget support Act.  This legislation has established a new Healthcare Sector Partnership to provide guidance to the District, particularly to the Workforce Investment Council (WIC), about healthcare training. The DC Hospital Association has been chosen to lead this new Partnership.

The Coalition members applaud the formation of the Healthcare Partnership and look forward to working with the DC Hospital Association. “We understand the importance of staffing our hospitals, “notes Judith Levy, Director of the DC Long Term Care Coalition, “but we must work together to ensure adequate staffing across all sectors or we simply exacerbate the crisis.”

The Coalition seeks to raise awareness of the workforce needs of long-term care service providers and to educate District leaders and the WIC about innovative approaches to increase recruitment and retention of direct care workers.  According to Eric Walcott, Executive Director of DCHHA, “COVID-19 has elevated our collective understanding of how important health care workers are to maintaining the health status of our most vulnerable populations and in order for us to meaningfully resolve the existing staffing issues in the District of Columbia, we must work collaboratively across all sectors.  Hence, the Coalition is well placed to inform the work of the Healthcare Partnership.  The grant awarded to the DC Hospital Association could not have happened at a better time.”

Copies of the Surveys can be found at:

COVID 19 Impact on Home Health Aides Survey

CNA Needs Assessment Survey



Judith Levy

DC Long Term Care Coalition