More than 110 direct care workers, employers, educators, policy officials, and other experts recently convened in person and virtually to take on the important and challenging task of better defining the direct care workforce. Their contributions will be used to develop a statewide framework for defining and ultimately measuring and supporting this important part of the healthcare workforce, which provides essential care to the aging population, individuals with intellectual and developmental disabilities, and other vulnerable populations.

This workshop, hosted by the NC Center on the Workforce for Health in collaboration with NC DHHS, NC Institute of Medicine, NC Coalition on Aging, NC AHEC, and Piedmont AHEC, marked the first in a four-part series aimed at advancing recommendations outlined in the 2024 Caregiving Workforce Strategic Leadership Council Report. Each workshop is developed around one of the four Direct Care Worker recommendations, with the first recommendation of the report emphasizing the need to establish a comprehensive definition of the Direct Care Workforce.

The Challenge of Defining the Direct Care Workforce
Creating a framework for the Direct Care Workforce is no small feat. Variations in job titles and responsibilities across settings, coupled with limited data infrastructure, make it difficult to track and categorize this workforce. In North Carolina, more than five registries exist for different types of DCWs. This fragmented system highlights the urgent need for a unified definition to guide policy, allocate resources, and ensure accurate workforce data collection.

What services do Direct Care Workers provide?
Direct Care Workers (DCWs) assist older adults and individuals with disabilities in daily activities such as dressing, bathing, eating, meal preparation, housekeeping, and errands. Personal care aides often support clients with social engagement and transportation, while home health aides, under supervision, perform clinical tasks such as wound care, blood pressure monitoring, and range-of-motion exercises.

Workshop Highlights
The workshop featured a panel discussion titled Strengthening the Direct Care Workforce: Insights from the Caregiving Workforce Strategic moderated by Hugh Tilson, Executive Director of NC AHEC. The panel included representatives from NC DPI, NC Commerce, NC AHEC and NC Council on Disabilities.

They addressed topics including:
• The growing need for DCWs in North Carolina as the state’s population ages
• The role DCWs play enabling disabled people and the elderly to remain in their homes and live full lives
• Attracting more people to the field
• Establishing educational pathways starting in middle and high school
• Establishing career pathways for DCWs to advance professionally if they choose
• Establishing living wages to keep people in the profession
• Addressing employer, worker and population needs

Attendees also heard a recorded address from Jake McDonald, Senior State Policy Advocacy Specialist at PHI, who provided a national perspective on defining the Direct Care Workforce. The final speaker of the day was Trish Farnham from the NC Coalition on Aging.

Breakout Sessions: Tackling Complex Questions
In breakout sessions, participants delved into challenges associated with defining the DCW. Topics included:
• Inventorying the roles, skills, and responsibilities that comprise direct care work
• Identifying needs and challenges across DCW-related settings
• Developing shared language around current and potential job titles, entry points into the direct care workforce, and pathways for direct care workers.

These discussions underscored the complexities of crafting a definition that accounts for the diversity of roles, responsibilities, settings and career trajectories within the Direct Care Workforce.

Next Steps
Following the workshop, experts at NCIOM will synthesize the feedback to begin formulating a comprehensive definition of the Direct Care Workforce. This definition will serve as a cornerstone for addressing workforce challenges, improving job quality, and ensuring the delivery of high-quality care across the state.

Upcoming workshops focus on the final three recommendations in the Council Report.

Advancing the DCW Data Landscape, Feb. 19
Key Discussion Areas:
• Identify existing data availability
• Mechanisms for identifying employers of DCWs
• Categorizing DCW data
Expanding DCW Apprenticeships, March 5
Key Discussion Areas:
• Building apprenticeship-focused relationships among key state and local stakeholders
• Highlighting successful apprenticeship programs
• Identifying financial incentives and models to sustain apprenticeships

Expanding DCW Apprenticeships, March 5
Key Discussion Areas:
• Building apprenticeship-focused relationships among key state and local stakeholders
• Highlighting successful apprenticeship programs
• Identifying financial incentives and models to sustain apprenticeships

Expanding and Stabilizing the DCW, April 4, 2025
Key Discussion Areas:
• State of Medicaid rates for DCW roles
• Review of other states’ actions on DCW compensation
• Align training, credentialing, and career pathways
• Drivers of retention

For more information or to register for upcoming sessions, please visit the Direct Care Workforce Event Series page.