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Direct care workers (DCWs) provide long-term care services to vulnerable populations—largely older adults and people with disabilities—and often help keep people in their homes. Medicaid is the largest payer for long-term care services, many of which are provided by DCWs.

According to the 2024 Michigan Healthcare Workforce Index, Michigan’s home health aides, personal care aides and nursing assistants have some of the highest shortage levels and turnover rates of all healthcare workers in the state.

As in the rest of the nation, DCWs in Michigan face many challenges that contribute to the overall undersupply: a) low compensation, b) lack of training and career advancement, c) burn-out.

Across the nation, states are working in varied ways to support DCWs. Michigan employers and policymakers may find that other states can offer useful examples of additional or complementary approaches to further build support for this crucial sector of the healthcare workforce. This brief shares the most common strategies states are using to support their direct care workforce.