The demand for caregivers continues to grow significantly. But unless job quality improves, filling these roles will be an uphill battle.

That’s according to PHI, a New York-based advocacy organization for direct care workers. On Tuesday, the organization released a new report detailing recommendations to improve job quality for caregivers.

Overall, the direct care workforce includes 4.6 million workers. About 2.4 million of these caregivers are home care workers.

Between 2018 and 2028, there will be an estimated 8.2 million job openings in direct care. This includes 1.3 million new jobs to meet the growing demand for care and 6.9 million openings caused by workers leaving this line of work.

Currently, there are a number of factors that impact job quality for caregivers, including low compensation, inadequate training, limited career advancement opportunities, and gender and racial inequalities. Those challenges, in turn, make it more difficult for home-based care providers to recruit and retain workers on a long-term basis.

“For too long, direct care jobs have remained poor quality, impacting workers, employers, and consumers and their families,” Robert Espinoza, vice president of policy at PHI, said in a press release statement. “A positive transformation of this job sector will make life easier for all of these groups.”

On top of existing challenges, the COVID-19 emergency has further compounded working conditions for caregivers.

“The impact of COVID-19 and an under-resourced system continues today as providers struggle to not only provide quality care but to adequately protect and support their workforce,” the PHI report stated.

In order to address workforce challenges, PHI made eight recommendations.

For starters, PHI is calling for reforms to long-term care financing. This includes increasing Medicaid reimbursement rates and strengthening public financing for long-term care.

PHI also is suggesting an increase in wages for caregivers. This includes paying workers a living wage, improving access to full-time schedules and enhancing workplace benefits.

Additionally, PHI recommends improving training standards, funding direct care workforce interventions, creating robust workforce data collection systems, and integrating caregivers into important advisory roles and leadership positions. It also says providers need to address systemic racial and gender barriers.

“This country is at a critical and promising moment in history when we can finally move forward a range of strong policy measures that improve direct care jobs and enhance care for older adults and people with disabilities — we need to act now,” Kezia Scales, director of policy research at PHI, said in a statement.

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