The North Carolina Center on the Workforce for Health, in collaboration with the NC Department of Health and Human Services (DHHS), NC Institute of Medicine, NC Coalition on Aging, NC AHEC, and Piedmont AHEC, recently completed a workshop series aimed at strengthening the state’s direct care workforce. The purpose was to advance the recommendations of the 2024 Caregiving Workforce Strategic Leadership Council Report, which offers urgent and actionable steps to train, recruit and retain direct care workers, referred to as direct support professionals in some settings.

As North Carolina’s population ages, the demand for these essential workers—who assist older adults and individuals with disabilities with fundamentally important tasks such as bathing, dressing, cooking, and even basic clinical care—is outpacing workforce growth. North Carolina’s direct care workforce is projected to have more than  207,000 openings in the 10-year period between 2022 and 2032, according to PHI, an organization working to transform elder care and disability care.

The workshop series tackled this challenge through four focus areas:

• Defining the direct care workforce
• Expanding apprenticeships
• Advancing the data landscape
• Expanding and stabilizing the direct care workforce

Defining the Direct Care Workforce

In January, over 110 participants—including direct care workers, employers, educators, and policymakers—gathered virtually and in person to begin crafting a shared framework for defining North Carolina’s direct care workforce. Variability in job titles and responsibilities across settings has made workforce tracking and support difficult.

Panelists from NC Department of Public Instruction, NC Commerce, NC AHEC, and the NC Council on Disabilities explored how a clear definition of a shared framework can inform policy, training standards, and resource allocation. Participants in breakout sessions discussed ways to determine consistent job titles, clarify entry points into the profession, and identify core responsibilities across care settings.

Advancing the Direct Care Workforce  Data Landscape

To effectively address the challenges affecting the direct care workforce , the state needs better and more complete information on employment trends, demographics and compensation. Two data-focused sessions—held virtually in February and in-person in March—brought together workforce analysts, employers, and agency officials to identify gaps and prioritize data needs.

Participants discussed strategies for measuring and evaluating direct care workers and direct care support professionals:

• Job satisfaction
• Credentialing and training processes
• Career trajectories after leaving the field
• Projected future demand

The group emphasized the importance of building a comprehensive, employer-informed data model that extends beyond traditional licensure systems and reflects the realities of the caregiving field. Specific data categories—such as turnover, job satisfaction, pay, and career changes—will be prioritized using methods tailored to the unique data collection challenges presented by this workforce. Once data are gathered and analyzed, the Caregiving Council, including direct care and direct support representatives, will convene to review findings and collaboratively address workforce challenges.

Expanding Direct Care Worker apprenticeships

In March, a workshop explored how to grow and strengthen apprenticeship programs. Apprenticeships are seen as a valuable tool to prepare a more skilled, stable workforce and create viable career pathways.

Discussion and presentation topics included:

• Direct Care workforce  apprenticeships programs and models in NC
• Creating sustainable partnerships between employers and educational institutions to support apprenticeship programs

• Engaging middle and high school students
• Funding models and financial incentives to support apprenticeships
• Standardizing on-the-job training across settings

Successful apprenticeship models from inside and outside the state were showcased and participants addressed key barriers—including inconsistent compensation and limited training capacity.

Expanding and Stabilizing the Direct Care Workforce

The final workshop, held in April, focused on the issue of job quality. Many direct care workers and direct support professionals  do not earn a living wage or receive access to employer-based benefits and support, contributing to high turnover and recruitment challenges

The session opened with a look at PHI’s five pillars of job quality :

• Fair Compensation
• Quality Training
• Respect and Recognition
• Quality Supervision and Support
• Career Advancement Opportunities

Participants discussed strategies such as wage scales tied to credentials, guaranteed full-time hours and benefits like paid leave, retirement plans, mental health counseling, and childcare. The “benefits cliff”—where small wage increases disqualify workers from essential public assistance—emerged as a key challenge.

A panel discussion explored how community colleges and employers can better align training, credentials, and compensation structures to professionalize the field and reduce attrition.

Looking Ahead

Now that the direct care workforce  workshop series is complete, the NC Center on the Workforce for Health—along with its partners—will prepare a comprehensive report for NC DHHS. This report will:

• Summarize key themes and recommendations from each session
• Provide actionable strategies for defining, expanding, and stabilizing the direct care workforce
• Offer feedback on the language and proposals in the Caregiving Workforce Council report
• Include an appendix on immigration policy and federal actions affecting the workforce

To support broader understanding, a concise two-page summary will also be released to distill the findings for policymakers, employers, and the public. These workshops mark an important step toward building a more stable, respected, and professional direct care workforce for the future.