| Allison Cook

| Inside New Jersey’s blueprint for direct care reform — and what it can teach other states

9.6 million. That’s the number of square kilometers in China — or roughly the population of Hungary. It’s also the number of direct care jobs — home care workers, certified nursing assistants, direct support professionals — that the U.S. will need to fill over the next decade, according to PHI’s latest report. The number is so large it can feel abstract, until you’re the older adult on a waitlist, or the family caregiver who can’t find help. 

Undaunted by the size of the problem, one coalition came together in New Jersey to figure out solutions that will work for their state. Funded by The Henry and Marilyn Taub Foundation, the Essential Jobs, Essential Care NJ (EJEC NJ) coalition comprises local organizations with on-the-ground expertise and a national expert (PHI). The mission of the coalition is to focus on increasing investments in, and supports for, the direct care workforce. They aim to “think holistically about solutions across sectors,” said Jake McDonald, senior policy advocacy specialist at PHI. “We want to enlarge the pie instead of fighting over scraps.”  

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And they’ve had success over their first four years: a new statewide strategic plan, a career pipeline for home health aides, and a first-of-its-kind advisory council of direct care workers themselves.

The Direct Care Workforce Strategic Plan lays out over 40 strategies to invest in and support the workforce. The Certified Home Health Aide Career Program, a pilot addressing barriers like compensation, transportation, and childcare for trainees, has resulted in over 280 new certifications. And the Direct Care Professional Advisory Council — modeled on an approach from Maine — brings actual direct care professionals into the room to advise the state. Members are compensated for their time.

Through these wins, EJEC NJ has created momentum for improving direct care jobs and supports across the state, and they hope it is just the beginning. The CHHA Career Program’s supports (compensation, childcare, and transportation) appear to be working: the number of home care workers in the state has increased by 35% over the past few years, a meaningful step forward in addressing the shortage.

They also hope to be a model for other states. “The need for recruiting, retaining, and training these workers and making sure they’re supported properly isn’t unique to New Jersey,” said Tyla Minnear, chief operating officer at the NJ Health Care Quality Institute. Their experience offers lessons for anyone working to strengthen this workforce, depending on where you sit:

• For legislators and policymakers: A Direct Care Workforce Strategic Plan (possibly developed in coordination with a Multisector Plan on Aging) can chart a clear, coordinated path forward rather than leaving reform to piecemeal efforts.
• For advocates and providers: Building a coalition with a clear, dedicated focus on this workforce can create the kind of sustained pressure that produces real change. And marrying local expertise with national breadth can help the coalition identify and act on proven strategies. 
• For funders: It doesn’t take a large coalition of funders to start. Even one dedicated foundation can help set change in motion (and, ideally, bring others into the fold).

The scale of the direct care workforce shortage can feel overwhelming. New Jersey’s experience suggests it doesn’t have to be solved all at once — just one strategic plan, one advisory council, and one coalition at a time.

Allison Cook is founder of Better Aging and Policy Consulting.