Aging in America News

Robert Espinoza on Training and Career Pathways for the Care Workforce

Building a Stronger Workforce, a new issue brief from the National Skills Coalition, explores the challenges facing child care and direct care workers. The solution lies in training and career pathways. The brief coincides with the launch of the cross-sector Care Workforce Advisory Council. CEO Robert Espinoza, who coauthored the brief with Amanda Bergson-Shilcock, says the multi-year initiative aims to change public policy around care workers. This conversation has been edited for length and clarity.

Care work has been described as the backbone of the economy, but supply and demand never seem to add up. What do you see as the main problem?

Care workers form the backbone of so many industries in our country, but they face incredible employment and education barriers. We often hear from businesses that employees don’t have enough access to either child care or long-term care. If we’re going to offer care as a supportive service, we need to think about improving the prospects for that workforce.

How is the National Skills Coalition expanding the range of stakeholders in the conversation?

Historically, when we’ve talked to folks in the workforce development sector, we would often hear that they were hesitant about getting involved in this work because the jobs don’t pay enough. They have a mandate to make sure that they’re putting workers into high-paying jobs. But that creates a conundrum: if you don’t invest in the training and advancement, you don’t improve the jobs, and then the jobs stay poor in quality. So we’re bringing experts together to imagine training and career pathways and policies that benefit both child care and direct care workers. 

Who’s doing these jobs? 

The direct care workforce tends to be made up of women. They’re disproportionately Black and Latino, people of color, and immigrants. They also tend to be 50 plus, and they tend to be low-wage workers or have a history of low-wage work. Oftentimes the people who take these jobs leave direct care for other low-wage jobs like fast food or retail that happen to pay a little bit more. The vast majority are in home care, which is where most people want to receive their care, but they find the jobs unsupportive and not respectful of the incredible value that they offer. And so they often leave within the first 90 days. And that creates, of course, job shortages for the sector. 

What are some additional factors making it hard for care workers to get and keep better jobs?

The direct care sector is incredibly fragmented. Training requirements vary by state, by occupation, and by setting. They vary by employer as well. For example, if you want to be a home care worker in both New Jersey and New York, you have to be trained in both states, and you have to pay for different trainings and earn different credentials. If you’re trained as a home care worker, you can’t necessarily work as a nursing assistant, even though they share a lot of the same characteristics. Nursing homes have very different requirements and standards and certifications than personal care at home, even though the skills are comparable. Training curricula are often outdated. They’re based on the number of hours that you go through, say, 120 hours for nursing assistants. It isn’t based on skills or competencies. And it doesn’t capitalize on the new forms of learning and technology that other sectors and industries have figured out. 

Training costs money. Who’s going to pay?

The American Rescue Plan Act gave states a lot of money to invest in direct care. Federal leaders and state leaders need to invest more in training. We need to put more money into the curricula, whether it’s the staffing, the development of modules, virtual in-person, hybrid, the whole infrastructure that often requires a certain amount of training.

What are the opportunities right now?

If we use an opportunity lens, I would hope that this is an opportunity for states to double down on what they should be doing to support direct care workers. Many states have led the way: California, Washington State, New York, New Jersey, Minnesota. Those states are already offering good wages, and they’re doing good stuff on training, on equity and all that stuff. They tend to be the states that invest a lot in Medicaid, but they also have strapped budgets, and they’re going to be more strapped in the months and years.

Discover PHI’s Direct Care Workforce State Index

What about Red States?

The challenge that we’re seeing in Red States is that they never really invested in Medicaid. And several of them have clauses in their Medicaid expansion—if the federal funding goes away, the state money stops, too. And care jobs are already pretty bad in those states. So I would be most worried about those states, because I wonder what their backup plan is. The people who will pay the cost will be older people, people with disabilities, and workers. 

How can technology help?

Technology can expand access to virtual training, especially in rural and underserved areas. A lot of people, especially adult learners, would benefit from flexible self-paced learning, and technology can do that. AI might be able to develop best practices quickly, in terms of training modules and exercises. One of their biggest challenges for employers is scheduling a large number of cases, and AI and technology can help.