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Minimal Data on the Workforce & the Quality of Care

Tracking and reporting regular data on the workforce will help spot workforce needs where they’re most needed.


The increased attention on the capacity of the direct care workforce has highlighted the need for updated, reliable information about these workers. Neither state nor federal long-term care systems gather and report the data necessary to inform public policy and workforce initiatives, set priorities for reforming the long-term care system, or compare states’ progress nationwide.[1] Additionally, the home- and community-based services field lacks an agreed-upon definition of “quality,” as well as the measures needed to improve it.[2] Though recent federally funded work by the National Quality Forum has begun filling that gap, policymakers across the board are hampered by a general lack of data.

In a growing number of states, the shift to Medicaid managed long-term care has placed more responsibility on managed care plans to monitor the quality of those services. Unfortunately, without an agreed-upon framework, plans and states cannot measure quality accurately. Moreover, two areas where better funding and evaluation would improve quality and save dollars—chronic care delivery models and telehealth interventions—remain severely understudied, underfunded, and underutilized.


PHI has identified three essential areas for data collection on the direct care workforce. “Workforce volume,” which includes the number of full-time and part-time workers, would measure the distribution of workers across settings and programs and determine where resources should be allocated. “Workforce stability,” which includes turnover rates and vacancy rates, would assess whether investments in the workforce reduce turnover and improve retention. “Worker compensation,” which includes average hourly wages, full- and part-time hours, annual income, and benefits such as health insurance and paid time-off, would illustrate whether direct care jobs are competitively attractive with other occupations. These indicators provide a strong start for improving data and reporting on this workforce.


  1. National Direct Service Workforce Resource Center, Centers for Medicare & Medicaid Services. 2009. The Need for Monitoring the Long-Term Care Direct Service Workforce and Recommendations for Data Collection. Baltimore, MD: CMS.
  2. National Quality Forum. 2016. Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement. Washington, DC: NQF.

Key Takeaways

States should collect better data on the direct care workforce to identify gaps in services.
The home care field hasn’t adequately implemented a strong and clear definition of quality.
Workforce data should systematically capture workforce volume, stability, and compensation.

By the Numbers: Data Collection & Quality


States that track nursing assistant turnover rates in nursing homes. Source: Iowa Department of Health Services, 2016.


States with matching service registries that connect direct care workers with consumers. Source: PHI, 2017.


Number of Medicaid Managed Care Organizations across the United States. Source: Kaiser Family Foundation, 2017

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