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Improving Care for Older Adults & People with Disabilities

The person is at the heart of quality care, and direct care workers are key to their daily living and well-being.


Older adults and people with disabilities across the country are increasingly relying on long-term care to live healthy and fulfilling lives. While more people are opting to receive care at home and in their communities, nursing homes and other residential facilities are still a viable alternative for many people who need around-the-clock care. The rapid growth in the older adult population—coupled with longer life expectancy and a rise in severe, chronic illnesses—has intensified the demand for long-term care. Unfortunately, PHI’s work with providers of all types too often shows that quality person-centered care in this sector remains more an aspiration than a lived reality for today’s consumers.

In addition, long-term care, as well as a vision for person-centered care, is hampered by a lack of investment from government and industry leaders. Medicaid, which serves as the primary payer for long-term care, remains stretched thin at the federal and state level, limiting funding for strengthening the direct care workforce and improving the state of home-based and residential care. For too long, direct care work has been undervalued by the same public and private leaders equipped to allocate workforce development and training dollars for this underfunded occupation. Our mission and core message—that quality care depends on the quality of jobs for the people who deliver that care—remain as critical as ever.


The increased recognition of the importance of improving person-centered care is perhaps most evident in PHI’s work with providers and policymakers. This approach to long-term care is embedded in PHI’s services with providers, notably our coaching, training, and career advancement models. We believe that the client (or the resident) should be at the heart of a provider’s organizational chart, and that those services and supports should be offered in culturally and linguistically appropriate ways in order to serve a diverse population. Additionally, PHI has consistently offered technical assistance to improve care for older adults and people with disabilities—a growing interest in government circles. In 2015, PHI provided more than 30 recommendations to the Centers for Medicare and Medicaid Services (CMS) on how to modernize its regulations that govern Medicaid managed care and provided nearly 80 recommendations on how to improve nursing home regulations.

Key Takeaways

Quality long-term care depends on the quality of jobs for the people who deliver that care.
Government and industry leaders should invest in approaches rooted in person-centered care.
The client or resident should be at the heart of a long-term care provider's organizational chart.

By the Numbers: Person-Centered Care

88 million

Projected number of people aged 65+ in 2050. Between 2015 and 2050, this population will nearly double from 47.8 million to 88 million. Source: U.S. Census Bureau, 2014

1.3 million

Number of residents in certified nursing facilities in 2015. Source: University of California, San Francisco and Kaiser Family Foundation

3.2 million

Number of people accessing Medicaid-funded home- and community-based services in 2012. Source: Kaiser Family Foundation

Caring for the Future

Our new policy report takes an extensive look at today's direct care workforce—in five installments.

Workforce Data Center

From wages to employment statistics, find the latest data on the direct care workforce.