PHI

02/21/2026

On , and every day, PHI honors and celebrates caregivers across the United States. Whether you are a PCA, home health aide, a CNA, residential care aide, or a family caregiver, know that your contributions to the lives of older adults and people with disabilities are seen. Know that they are valued. Know that they are recognized. Thank you for all that you support and all that you make possible.

02/10/2026

A workgroup led by the New Jersey Department of Human Services has released a comprehensive strategic plan to support the essential workers who provide daily care to older adults, people with disabilities, and individuals with behavioral health needs.

Developed through an intensive, PHI-facilitated interagency process, the plan outlines more than 40 strategies to address recruitment, retention, and job quality for direct care workers across the state. This initiative was heavily informed by collective input, including from the Essential Jobs, Essential Care New Jersey coalition, and serves as a blueprint for how the state can tackle the direct care workforce crisis as Governor Mikie Sherrill begins her term.

The plan acknowledges the scale of the challenge—noting that while home health and personal care aide employment grew 76.8 percent between 2019 and 2023, the median annual income remains just $27,889. To address this, the strategy focuses on gathering better workforce data, creating a universal training and certification system with stackable credentials, and improving compensation and benefits to create a sustainable workplace.

Read the full analysis by PHI Senior Policy Advocacy Specialist Jake McDonald here:

A workgroup led by the New Jersey Department of Human Services has released a comprehensive strategic plan to strengthen the state’s direct care workforce—the essential workers who provide daily support and care to older adults, people with disabilities, and individuals with behavioral health ne...

02/04/2026

The Centers for Medicare & Medicaid Services (CMS) has struck down the only federal policy to establish a baseline for nursing home staffing levels. This move effectively removes a critical lever for workforce improvements and puts nursing home residents at greater risk.

This week, PHI submitted formal comments strongly opposing this change.

A Misdiagnosis of the Crisis: CMS justifies this rollback by citing workforce shortages. However, this rationale fundamentally misinterprets the nature of the crisis. The challenge is not a shortage of workers but a recruitment and retention crisis driven by inadequate wages, unsustainable workloads, and poor job quality.

Risk for Residents: The standards CMS just repealed would have saved approximately 13,000 lives annually. Moving to repeal these protections without a replacement will result in the preventable deaths of thousands of nursing home residents every year.

Job Quality, Not Repeal: Eliminating minimum standards effectively guarantees that the cycle of understaffing, burnout, and attrition will continue unabated. Instead of abandoning worker protections, CMS should be leading a coordinated effort to improve job quality.

To erase minimum staffing standards without a viable alternative is to accept an unacceptable status quo.

Read our full comments to CMS here:

The Centers for Medicare & Medicaid Services (CMS) has struck down the only federal policy to establish a baseline for nursing home staffing levels, effectively removing a critical lever for workforce improvements, compounding the challenges already facing the direct care workforce, and putting nurs...

01/31/2026

With demand projected to add 681,000 home care jobs in the next decade, we need to invest in this workforce—not dismantle their labor protections. Quality care depends on quality jobs.

"They should not carry this affordability problem on their own backs."

The Labor Department has proposed rescinding an Obama-era rule that gave home care workers the right to overtime pay and other wage protections. The administration says the rule made care too costly.

01/29/2026

The Department of Labor has proposed rolling back wage protections that home care workers have held for nearly a decade. PHI’s Vice President of Research and Evaluation, Kezia Scales, PhD, spoke with NPR's Morning Edition about what this would mean:

"We are talking about stripping back hard-won employment rights from our country's largest workforce and one that is providing arguably some of the most essential services for ourselves and our loved ones."

The data is clear: since a rule extending these protections to home care workers took effect in 2015, home care agencies have paid workers nearly $158 million in back wages, with countless more benefiting from employers' proactive compliance. In short: These protections work.

Quality care depends on quality jobs. With demand for home care projected to add 681,000 jobs in the next decade, we need more investment in this workforce—not less. As Kezia told NPR: "Further marginalizing and devaluing the workforce that provides the services—that is simply not the answer. They should not carry this affordability problem on their own backs."

Listen to the full story: https://www.npr.org/2026/01/29/nx-s1-5626767/home-care-seniors-trump-labor-overtime

01/21/2026

The direct care workforce is the backbone of Maine’s healthcare system. Yet, echoing a nationwide crisis, this workforce faces daunting systemic challenges—including low pay, poor job quality, and outdated training—that have created a staggeringly large care gap.

In response, Maine’s Essential Care & Support Workforce Partnership brought experts together to develop targeted recommendations. These recommendations have informed the Maine Essential Care & Support Workforce Enhancement Act, an omnibus bill championed by Speaker Ryan Fecteau that is being taken up in Maine's legislative session.

If enacted, this bill would take significant steps toward closing Maine’s care gap by budgeting for all care needs, raising wages, developing a universal training and credentialing system, and creating a plan to harness technological advancements to support direct care workers and improve service delivery.

As federal shifts threaten the stability of the direct care workforce nationwide, this bill offers a clear framework for recruiting and retaining the workforce Maine’s people and economy desperately need.

Read a full analysis by PHI's Senior Policy Advocacy Specialist, Jake McDonald, here:

The direct care workforce is the backbone of Maine’s healthcare and support system, providing essential services to older adults, people with disabilities, and individuals with behavioral health challenges across the state. Yet, this workforce faces daunting systemic challenges, including low pay,...

01/19/2026

On this day, as we honor the life and legacy of Dr. Martin Luther King Jr., we reflect on what he called “the most persistent and urgent question”: What are you doing for others?

Every day, 5.4 million direct care workers answer that question. They support older adults and people with disabilities, strengthening families and economies in every U.S. state.

We observe this MLK Day amid a surge in harmful rhetoric that questions the belonging of immigrants and seeks to divide communities based on origin and background. But this rhetoric, which deals in abstractions and fear, ignores the reality of care in this country.

The real experience inside American homes is one of trust and connection. Every day, families across the political spectrum entrust their loved ones to direct care workers from different backgrounds, cultures, and countries of origin. In these intimate moments, our shared humanity outweighs our differences.

Dr. King understood that economic justice and civil rights are inseparable. Yet, direct care workers continue to face systemic barriers rooted in the same racism and sexism he spent his life confronting.

𝗧𝗼𝗱𝗮𝘆, 𝗣𝗛𝗜 𝗰𝗮𝗹𝗹𝘀 𝗳𝗼𝗿 𝗮𝗰𝘁𝗶𝗼𝗻:

𝗣𝗼𝗹𝗶𝗰𝘆𝗺𝗮𝗸𝗲𝗿𝘀: Safeguard and strengthen labor protections for direct care workers.

𝗘𝗺𝗽𝗹𝗼𝘆𝗲𝗿𝘀: Invest in wages, training, and career pathways.

𝗔𝗹𝗹 𝗔𝗺𝗲𝗿𝗶𝗰𝗮𝗻𝘀: Recognize the contributions of the workforce that makes all other work possible.

We cannot build a strong care economy by alienating the very workers who sustain it.

Read our full statement here:

On this day, as we honor the life and legacy of Dr. Martin Luther King Jr., we reflect on what he called “the most persistent and urgent question”: What are you doing for others? Across the nation, nearly 5.4 million direct care workers answer that question every day. They are home care workers ...

01/17/2026

Paula Span (The New York Times) writes on the Trump administration's decision to rescind federal labor protections for home care workers—protections that were in place successfully for over a decade.

After nearly 40 years of advocacy, the 2013 rule brought home care workers under the Fair Labor Standards Act, ensuring minimum wage, overtime pay, and compensation for travel time between clients. Since then, agencies have paid approximately $158 million in back wages to workers who had been denied fair compensation.

Now, the Department of Labor is on course to return to 1975 regulations, once again excluding home care workers—a workforce made up primarily of women, minorities, and immigrants—from basic federal labor protections that are afforded to all other professions.

As PHI's Vice President of Research & Evaluation, Kezia Scales, states, this is "a shocking step backward."

Home care workers deserve dignity, fair wages, and the labor protections afforded to all other workers. This work is not "casual" or "nonskilled"—it's essential, professional care that supports millions of older Americans and people with disabilities.

Read the full article:

Two regulatory rollbacks, along with a new A.I. experiment in Medicare, raise some worrisome questions.

01/12/2026

A proposed Department of Homeland Security (DHS) regulation is likely to bring significant challenges to immigrants, the direct care workforce, and our nation’s care systems.

Immigrants constitute at least 29 percent of the direct care workforce. Nearly half of direct care workers rely on some form of public assistance to meet their basic needs. By injecting immigration risk into any decision to use benefits for which they are lawfully eligible, this rule will force many immigrant direct care workers to forego necessary food, shelter, and health care.

The predictable result is a chilling effect that will lead to higher stress, greater instability, and increased difficulty in meeting basic needs, which, in turn, will translate into increased absenteeism, turnover, and burnout.

PHI strongly urges DHS to withdraw this proposal, which will have devastating consequences for the nation's direct care workforce and for the older adults and people with disabilities who rely on direct care workers for daily care and support.

Read our full comments to the DHS here:

A proposed Department of Homeland Security (DHS) regulation is likely to bring significant challenges to immigrants, the direct care workforce, our nation’s care systems, and state and local economies. To gain admission to the United States, immigrants are subjected to a public charge test, which ...

01/09/2026

"For decades, surveys have shown that they [older adults] prefer to remain in their homes for as long as possible.

That means they need home care, either from family and friends, paid caregivers, or both. But paid home care represents an especially strained sector of the long-term care system, which is experiencing an intensifying labor shortage even as an aging population creates surging demand."

The New York Times
KFF

Paid home care is buckling under the surging demands of an aging population. But there are alternatives that could upgrade jobs and improve patient care.

12/24/2025

As we mark the holiday season, we share warm wishes and gratitude with all who engage in PHI’s efforts to advance quality care through quality jobs.

While this past year has brought significant change—and cascading challenges—to the landscape around us, PHI’s guiding focus remains unchanged. We step into 2026 steadfast in our resolve to build a future where direct care workers hold jobs anchored in respect, recognition, and real opportunity. Only by investing in this workforce can we ensure that older adults, people with disabilities, and family caregivers benefit from high-quality care, rooted in principles of dignity and independence.

Note: Our office will be closed from Thursday, December 25, 2025, until Monday, January 5, 2026.

12/09/2025

Effective care delivery requires a stabilized, empowered workforce. With essential support from Margaret A. Cargill Philanthropies (MACP), PHI is advancing the Universal Direct Care Workforce™ (UW) Initiative, a comprehensive approach to direct care workforce training, credentialing, and employment that seeks to transform job quality at every level, in Wisconsin.

MACP has now released a new profile and video documenting the impact of PHI's efforts in rural Wisconsin. Through a story written by PHI's Grant Writer Tasha Beauchesne and a video produced by PHI with MACP and videographer Page Stephenson (and special thanks to GT Independence), we examine the Care Integration Senior Aide (CISA) role, a key component of PHI's UW model.

Drawing from a 2023-24 PHI evaluation, the footage demonstrates how the CISA role elevates direct care workforce contributions, while expanding quality of life for older adults living at home—as reflected in the experience of Tomahawk resident Gloria Walbeck.

Watch the video & read the full profile here:

For the past 15 years, Gloria has enjoyed the loyal companionship of her cat, Joey, whom she has raised since he was a kitten. “Joey’s been with me a long time, and he trusts me now,” says Gloria. “He trusts anyone who walks through that door.”