PHI

10/27/2026

As demand for long-term care grows, workforce shortages and limited resources are widening the gap between the care older adults and people with disabilities need and the care that is available.

A KFF Health News report (previously published in The New York Times) shows how this is playing out in nursing homes, where Medicaid reimbursement levels and staffing shortages are reportedly leading to reduced admissions and even closing nursing home doors altogether. Job quality concerns underlie those staffing shortages; the report cites PHI data showing that nursing assistants in nursing homes earned a median of $20.67 an hour last year, and about 40 percent rely on public assistance. https://kffhealthnews.org/aging/new-old-age-nursing-home-beds-scarce-capacity-baby-boomers-workforce/

This November’s elections will help decide whether the long-term care gap grows or shrinks. Sufficient funding through Medicaid, immigration policies that support immigrants in direct care rather than driving them out of the workforce, and restored labor protections are all essential to helping direct care workers stay in these jobs—in nursing homes and across long-term care settings—and provide the services that are needed.

PHI’s midterm policy brief series highlight the specific and urgent actions that policymakers must take on each of these fronts: https://www.phinational.org/restore-support-defend-phi-midterm-policy-brief-series-maps-whats-at-stake-for-the-direct-care-workforce/

As the oldest baby boomers turn 80, researchers worry there won’t be enough room in nursing facilities for a rapidly graying nation.

10/23/2026

This midterm, care is on the ballot.

Medicaid cuts, immigration enforcement, and the rollback of basic labor protections are converging on the 5.4 million direct care workers who support older adults and people with disabilities every day. The policy choices made by the next Congress and state leaders will determine whether this workforce gets the investment it needs to meet growing care needs, or faces even deeper instability.

PHI’s midterm policy brief series, Restore Medicaid, Support Immigrants, and Defend Labor Rights, maps what’s at stake and what policymakers can do.

Read the series: https://www.phinational.org/restore-support-defend-phi-midterm-policy-brief-series-maps-whats-at-stake-for-the-direct-care-workforce/

10/19/2026

This month marks 88 years since the Fair Labor Standards Act took effect, nearly a century of ensuring minimum wage and overtime protections for most workers. Yet home care workers were excluded from these protections until 2015. Today, a federal proposal to roll back those protections for more than 3.4 million home care workers threatens their financial security and the stability of the care they provide: https://www.phinational.org/home-care-workers-rights-new-rule/

As voters head to the polls this November, the future of these protections is at stake. It is vital that Congress and the states act to protect the workers who support older adults and people with disabilities every day. PHI’s Defend Labor Rights brief lays out how policymakers and the states can uphold these rights and strengthen direct care jobs: https://www.phinational.org/resource/phi-midterm-policy-brief-series-defend-labor-rights/

Direct care workers are losing the basic workplace protections that millions of other American workers take for granted. This brief, the third in PHI’s three-part midterm policy series, examines how federal actions—including a proposed rollback of minimum wage and overtime protections for home c...

10/16/2026

Five governors are warning that a rushed rollout of new Medicaid work requirements could cause eligible people to lose health coverage:https://www.washingtonpost.com/documents/9a4ecd9a-5741-4489-ba1b-6949d3c42f7e.pdf

For direct care workers who rely on Medicaid for their jobs or their health coverage, disruptions will undermine their financial stability and make it harder to remain in essential care jobs. Care is on the ballot this November, and the choices made now will shape who can count on it.

As the January 1 deadline approaches, state policymakers should follow the recommendations in our Restore Medicaid brief and prioritize clear outreach, streamlined verification, and enrollment assistance to help eligible people stay covered: https://www.phinational.org/resource/policy-brief-series-restore-medicaid/

10/14/2026

Nebraska’s early Medicaid work requirement data offers a warning: 92 percent of enrollees who lost coverage at renewal lost it because they couldn’t provide the requested information in time, not because they weren’t working or eligible for an exemption. Read the full coverage here: https://ccf.georgetown.edu/2026/09/30/nebraska-releases-first-data-on-medicaid-work-reporting-requirement-as-expected-coverage-losses-start-to-mount-due-to-red-tape/

With less than three months until all states must implement the federal Medicaid work requirements, states can and should take steps to prevent avoidable coverage losses like these. For direct care workers, 29 percent of whom rely on Medicaid, keeping coverage can mean keeping their job, protecting their health, and holding onto financial security.

As voters weigh what matters in this election, care for older adults and people with disabilities deserves a place on the ballot, and so do the workers who make it possible. Our Restore Medicaid brief outlines how policymakers can protect coverage and strengthen care: https://www.phinational.org/resource/policy-brief-series-restore-medicaid/

At a recent Medicaid Advisory Committee meeting, the state of Nebraska, the first in the nation to implement what will soon be a mandatory Medicaid work reporting requirement (WRR), shared the first data on what has happened so far in the first few months of implementation. Nebraska began implementi...

10/14/2026

Raising wages is essential to stabilizing the direct care workforce. But without changes to public benefits rules, a raise can leave workers and their families with less.

Last week, PHI Research & Evaluation Associate Sarah Angell presented at the Reimagining Quality conference in Baltimore, sharing our benefits cliff research to leaders in the intellectual and developmental disabilities field. The solutions are within states’ reach: raise eligibility limits in public benefits programs to keep pace with wage gains, and fund benefits-cliff coaching so workers can plan for transitions. Sarah also outlined how upcoming cuts to Medicaid, SNAP, and other programs will further erode the financial support many direct care workers rely on.

Sarah was joined on a panel examining statewide policy and DSP workforce outcomes by Diogo Fortes (PhD, Johns Hopkins University), Julie Bershadsky (Institute on Community Integration, University of Minnesota), and Adrienne Mazeau (New York State Office for People With Developmental Disabilities).

Read more on our research on benefits cliffs in Virginia, funded by LeadingAge Virginia: https://www.phinational.org/resource/tipping-point-exploring-the-risk-of-benefits-cliffs-among-direct-care-workers-in-virginia/

10/13/2026

Last chance to register! Federal policy changes, including cuts to Medicaid, threaten the progress direct care workers have made in wages and job quality over the past several years. What can policymakers and advocates do to protect it?

Join PHI experts this Thursday for a free webinar on Direct Care Workers in the United States: Key Facts 2026. We’ll walk through the latest data and the policy steps needed to sustain and strengthen this workforce.

Thursday, October 15 | 2:00 PM ET

Register: https://phinational-org.zoom.us/webinar/register/WN_7-ISuLUjQXSJ8XIHyO4R5w #/registration

10/07/2026

A proposed rule from the District of Columbia Department of Health (DC Health) would merge CNA and HHA training into one shared credential covering both home care and nursing homes. That means more opportunities for job seekers and a more versatile direct care workforce, without unnecessary barriers to entry into either role.

The rule also recognizes CNAs from Maryland and Virginia and offers temporary certification while full certification is processed, a meaningful step for interstate portability.

Consistent with PHI's Universal Direct Care Workforce Model™, the change makes it easier for workers to carry their skills from one care setting to another. To realize the full benefit, training must stay accessible, with real opportunities for advancement and wage growth.

Read more from Jake McDonald, PHI's Senior Policy Advocacy Specialist: https://www.phinational.org/d-c-moves-toward-a-single-credential-for-nurse-aides-and-home-health-aides/

10/05/2026

Upcoming Webinar: Direct care is projected to add more than 886,000 jobs from 2025 to 2035, more than any other U.S. occupation. Pandemic-era investment helped raise wages and improve job quality, but looming federal policy changes put those hard-won gains at risk.

Join PHI experts on October 15 for a free, data-driven look at Direct Care Workers in the United States: Key Facts 2026. We'll cover emerging trends in wages, employment, and job quality, what the new data mean for workers, employers, and the people who rely on care, and how policymakers and advocates can protect and strengthen this workforce.

Thursday, October 15 | 2:00 PM ET

Register here: https://phinational-org.zoom.us/webinar/register/WN_7-ISuLUjQXSJ8XIHyO4R5w #/registration

10/02/2026

Direct care workers make it possible for older adults and people with disabilities to live independently in their own homes and communities. As the need for direct care surges, too many direct care workers are still underpaid and lack the training and career opportunities they deserve.

This week, House Education and Workforce Committee Ranking Member Bobby Scott (VA-03) and Reps. Adelita Grijalva (AZ-07) and Susie Lee (NV-03) re-introduced the Direct CARE Opportunity Act of 2026, a step toward building quality jobs in direct care. The bill invests in recruitment, retention, training, registered apprenticeships, and career pathways.

PHI is proud to endorse this legislation, and to see our research inform it. As Medicaid cuts and state HCBS reductions threaten job stability and access to care, investing in direct care workers means better jobs for the workforce and better care for older adults and people with disabilities.

Thank you to the bill's sponsors for their leadership.

Read more here:

Education & Workforce Committee Democrats