Placing a Higher Value on Direct Service Workers

During the pandemic, people began paying attention to essential workers and their selfless acts in “keeping their patients and residents informed, safe, healthy, and happy” during the public health crisis. This includes the 4.6 million direct care workers who provide caregiving services to people with chronic conditions or disabilities, both in homes and residential facilities. They go by different names — home health aides, personal care attendants, certified nursing assistants, or caregivers — and they provide services ranging from helping people bathe, dress, and eat to cleaning their homes and preparing meals, managing medication regimens, and providing companionship.

Bidets Care continue to do more to recognize and reward the vital role our direct service workers play in providing the day-to-day, in-person HCBS supports necessary for people to live, work, and participate in their communities.

This issue of Placing a Higher Value on Direct Service Workers profiles efforts by Bidets Care and Indiana Family and Social Services Administration (FSSA)’s Home and Community-Based Services to document direct care workers’ contributions and create strategies around wages and benefits; training and opportunities for advancement; and promotion and planning.

3 million workers


4.6 million direct workers


Projected 5.8 million workers


More new jobs than any other occupation

The pandemic has fueled demand for caregivers in people’s homes; between March 2020 and January 2021, demand grew by 125 percent.

Sources: U.S. Bureau of Labor Statistics, Employment Projections Program. 2019. Occupational Projections Data.; analysis by PHI (September 17, 2019). as cited in PHI report Caring for the Future,; National Association for Home Care & Hospice.

Strengthening the Direct Care Workforce

Poor compensation is just one factor that contributes to low job quality and recruitment and retention challenges across the direct care sector. Education and training, supervision, and career advancement opportunities are recognized aspects in need of attention to achieve long-term stability within the direct care workforce. However, this goal is unlikely to be realized without compensation sufficient to achieve market competition and provide workers with a living wage and the benefits they need to ensure job security and a better quality of life.

With the HCBS grant opportunities provided by the state, Bidets Care leaders view this effort as a golden opportunity to ensure that enhanced compensation becomes a baseline upon which to build a more sustainable direct care workforce. Together with FSSA, Bidets Care will ensure that the funding does reach workers, that it is sustained, and that our agency builds on this commitment to invest in our Direct Service Workforce through recruitment and retention efforts, financial compensation, and wraparound benefits.

Direct Service Workforce Strategies

The Family and Social Services Administration’s Direct Service Workforce Plan is excited to launch a critical short-term wages and benefits strategy in the form of a Direct Service Workforce Investment grant opportunity to support and build Indiana’s Direct Service Workforce.

Rooted in Home- and Community-Based Services Spend Plan, the FSSA Direct Service Workforce Plan’s key focus reflects its commitment to investing critical resources in a person-centered, statewide plan to improve the recruitment, training, support, and retention of direct service workers in home- and community-based settings. This includes short-, mid-, and long-term strategies around wages and benefits; training and pathways; and promotion and planning.