January 2024 Long Term Care Direct Care Workforce Survey –  For the fourth year, the DC Coalition on Long Term Care has surveyed long-term care providers regarding workforce issues.  This year’s survey reveals a deepening crisis due to a severe shortage of workers causing more seniors and people with disabilities to go without needed care.  The crisis continues to be driven by a lack of competitive wages.  The Coalition is calling upon the Mayor to use her emergency authority to allow Maryland and Virginia aides to work in DC and to allow DC CNAs to work in home health settings.  The Coalition also calls upon the DC Council to enact comprehensive reforms by passing and funding the Direct Care Worker Amendment Act of 2023.


Recording: Senior Village Town Hall on the Direct Care Workforce Crisis in DC (December 18, 2023)- Today, many DC seniors and people with disabilities are going without needed care and assistance due to a severe shortage of trained and qualified direct care workers. Without caregivers, older adults and people with disabilities cannot age with dignity in their own homes or get quality care if they need in-patient rehabilitation or need to go to assisted living.

  • Get the facts. Hear from seniors directed affected by the crisis
  • Learn about root causes and effective solutions.
  • Support the Direct Care Worker Amendment Act!
  • Be an agent for change! Watch the townhall here.

Presentation on Health Occupations Regulations Act (HORA ) Amendments (November 13, 2023)- Mayor Bower has proposed legislation that would amend the Health Occupations Regulations Act. There is little in these amendments to alleviate the current healthcare workforce crisis and some provisions could actually make it worse but imposing new restrictions and more regulation on direct care workers and home health agency administrators. Among other things, the proposed amendments would:

  • Create new authority for the Board of Nursing to license and regulate  Home Health Care Administrators.   
  • Prohibits HHAs and CNAs from reinstating their certification if they fail to renew on time.
  • Eliminate the ability of HHAs and CNAs to place their certification on inactive status.
  • Not change approach to reciprocity but opens the door (slightly) to allow endorsement when standards of foreign jurisdiction are not comparable to DC.
  • Lower age of CNAs/HHAs to 16 but only under a new “temporary” certification that is not defined and would require a new rulemaking.  Those temporarily certified would need to meet full certification standards by age 18 to continue practice.

A virtual hearing is scheduled before the Committee on Health on December 7 at 11:00 am.   To learn more about all the proposed changes and what you can do, read the Coalition’s slides here.  


Letter to the Committee on Health Medication Aide Training, HORA Amendments and the Mayor’s HealthCare Workforce Task Force Recommendations (July 25, 2023)-The Coalition on Long Term Care’s letter to the Committee on Health seeks the Council’s assistance to move the District forward on several key initiatives to help alleviate the direct care workforce shortage:

  1. The failure of DC Health to approve medication aide training programs, an advanced credential for CNAs and HHA that represents a real steps in a career ladder and higer pay for direct care workers. This credential has been “on the books” since 2019, but despite employer demand, the DC government has failed to approve any training programs.’long delays in approved training programs.
  2. The failure of DC Health to bring forward legislative reforms to update certification requirements and processes for CNAs and HHAs. THe Coalition supports lowering the age of aides to 16, creating a universal credential and making it easier for out-of-District aides to work in DC, among others.
  3. The failure of the Mayor to release or act upon the recommendations of the DC Health Care Workforce Task Force, which she appointed in 2023. Among recommendations unanimously approved by Task Force Members is a recommendation calling for establishing a minimum wage for direct care workers that is at least 120% of the minimum wage/living wage whichever is greater.


2023 Long Term Care Direct Workforce Survey (Feb. 14, 2023)- The DC Coalition on Long Term Care’s 2023 Long Term Care Direct Care Workforce Survey shows that the direct care workforce crisis has not abated. Providers are still struggling to recruit and retain workers. The dire shortage of workers is driving up costs and reducing access to care for seniors and people with disabilities. The survey makes clear that the driving force that is fueling the crisis is the lack of ability to pay competitive wages. There are simply not enough qualified candidates who want to take these essential jobs. Providers face fierce competition from other sectors that offer higher pay for less stress, less demanding jobs with similar or lower entry level requirements. The survey underscores the importance of raising the wages paid to direct care workers across the long-term care spectrum. The LTC Coalition endorses raising the minimum wage of all direct care workers to $24/hour.

Letter on Home Health Aide Parking Permits (Feb. 8, 2023)- The DC Coalition on Long Term Care is calling on the DC Department of Transportation to reengineer ParkDC, a system to issue free parking permits to home health aides via an on-line portal. The system is supposed to help HHAs avoid parking tickets when they are working in residential neighborhoods with parking restrictions. But the system is hopelessly complex and burdensome. Even with assistance, aides and seniors are unable to navigate the twelve step process. Our letter identifies the problems and offers workable solutions. 

DC Coalition on Long Term Care 2023 Legislative Priorities– This document outlines the Action Steps that the DC Long Term Care Coalition Workforce Subcommittee is asking the Council to take in the year ahead to increase the size of a trained, credentialed and competent Direct Care workforce.


Survey of HCBS Providers: Workforce Retention, Recruitment, Conversion, & Vaccine Bonuses (Oct. 2022) – On September 30, the Department of Health Care Finance (DCHF) published three separate notices that outline its approach to paying out more than $17 million in ARPA funds for direct care worker retention, recruitment, conversion and vaccine bonus payments. The DC Coalition for Long Term Care, the DC Coalition of Disability Service Providers, 1199SEIU United HealthCare Workers East, DCHCA, and LeadingAge DC wanted to better understand which providers and workers would be eligible for and benefit from these grants and from the employer’s perspective, whether these grants will alleviate the workforce crisis or might hasten the exit of more workers. This survey was sent to all 70 Medicaid HCBS Providers.

Questions regarding DHCF’s RFA for Recruitment and Conversion Bonus Payments (Oct. 2022)- Questions submitted to the the Department of Health Care Finance (DCHF) by the Coalition on Long Term Care, Workforce Development Subcommittee on October 21, 2022.

Questions Regarding Retention Bonus Payments (Oct. 2022) – Questions submitted to the the Department of Health Care Finance (DCHF) by the Coalition on Long Term Care, Workforce Development Subcommittee on October 21, 2022.

HCBS 2022 Workforce Survey (July 2022)- In June 2022, the Subcommittee fielded a new survey of Home and Community-based Providers to better understand the current workforce situation impacting HCBS providers and their clients. We adapted the questions used by AHCA/NCAL for its June 2022 survey on the State of the Long-Term Care Industry released on June 6, 2022

22 in 22 White Paper: Proposals to Address the Direct Care Workforce Staffing Crisis (Feb. 2022)- Across all sectors in Long-term Care, providers are facing staff shortages and are challenged to find new workers to replace those who are leaving. This White Paper discusses the challenges and solutions identified by the Coalition.

Bullet Points on Workforce Wages (Jan. 7, 2022)-Interventions are needed NOW to address the direct care workforce crisis!



Medication Aide Survey – In 2019, the DC Board of Nursing approved new certification standards for medication aides (MA-C). MA-Cs are CNAs and HHAs who have received additional training and have been certified to administer medications under the supervision of an RN or LPN. The DC Coalition for Long-term Care, Subcommittee on Workforce Development surveyed providers across the LTSS spectrum to better understand the need for certified medication aides in DC.

Action Alert for Preserve Our Healthcare Workforce Emergency Amendment Act – The DC Council has introduced Emergency Legislation called the “Preserve Our Healthcare Workforce Emergency Amendment Act of 2021. This bill amends the DC Health Occupations Revision Act (HORA) to allow individuals who are not licensed or certified in the District of Columbia to continue to engage in the proactive of providing healthcare in the District of Columbia until August 10, 2022.

Survey Regarding Loss of Waivers and Vaccine Mandate on LTSS Staffing– During the Public Health Emergency, DC Health granted waivers allowing DC Health Care Providers to hire nurses, certified nursing assistances and home health aides who were not licensed or certified in DC to work in DC health care facilities to address critical staffing shortages. Those waivers have now expired. The DC Coalition for Long Term Care, working in partnership with the DC Health Care Association, Leading Age DC, the DC Home Health Association and the Maryland National Capital Home Care Association, sent out a short survey to understand the impact. 



CNA Needs Assessment Survey– LeadingAge DC, in partnership with the DC Health Care Association, and the DC Coalition on Long Term Care, fielded this survey to better understand the short and long-term staffing needs of long-term care providers that hire certified nursing assistants (CNAs). 

COVID-19 Impact on HHA’s Survey– The D.C. Coalition on Long Term Care and D.C. Appleseed conducted a survey of home health agencies to assess the impact of COVID-19 on the homecare workforce, particularly during the stay-at-home period of the pandemic.

Workforce Fact SheetThis 4-page document provides an overview and talking points covering the reasons behind the shortage of Home Health Aides (HHAs) and other direct care workers in DC. Created by the DC Coalition on Long Term Care Workforce Subgroup.