The direct care workforce provides hands-on care and services to older adults and individuals with disabilities across the continuum of care. An escalating direct care workforce dilemma has direct care workers (DCWs) leaving jobs—creating a shortage—while it’s concurrently becoming more and more difficult to recruit new DCWs.1 In the face of this dilemma, a pressing question emerges: How do DCWs feel about compensation, benefits, career advancement, training, or employment satisfaction?

In 2022, Colorado’s Department of Health Care Policy and Financing (HCPF) partnered with Vital Research, LLC (Vital) to initiate a groundbreaking survey project to address the workforce shortage of DCWs in Colorado. The goal was to conduct a statewide assessment aimed at understanding DCWs’ satisfaction and engagement levels across various aspects of their employment. HCPF, in collaboration with Vital, has demonstrated that by leveraging data and actively engaging with DCWs directly, tangible solutions to better retain this workforce are within reach. HCPF now conducts an annual survey to continue understanding the challenges that DCWs face to better support this workforce.

Five Key Takeaways

The Colorado case study offers five valuable lessons for other states and organizations working with the direct care workforce:

  1. The work that DCWs perform is highly important, and a growing shortage of these workers may have devastating impacts for populations who rely on DCWs for care.
  2. Almost all surveyed DCWs think the work they do is highly important and fulfilling.
  3. Conducting a statewide survey for DCWs resulted in identifying factors that are important to them, such as medical benefits and retirement options.
  4. Offering additional compensation for travel time may help alleviate the burden of traveling to provide care for DCWs.
  5. Findings from the survey helped produce actionable insights that may improve the quality of work-life for DCWs across Colorado.

Amplifying DCW Voices Through Data

While Colorado routinely engages Home and Community Based Services (HCBS) providers using a National State of the Workforce survey, they recognized the need for a more direct approach to addressing the individual needs of DCWs. In collaboration with Vital, HCPF aimed to explore gaps not addressed in the State of the Workforce survey, particularly regarding individual worker satisfaction and experience. However, they faced a complex challenge: how to capture DCW voices in a meaningful way and effectively utilize data.

The Power of Collaboration & Expertise

Vital brought their survey development expertise to the table, conducting a thorough literature review and collaborating closely with HCPF to develop a survey item bank that covered the domains of job satisfaction, working conditions, autonomy, job fulfillment, and work environment. Once the survey was developed, Vital launched the survey online to DCWs across the state of Colorado to learn more about reasons they consider leaving the workforce and the reasons that keep them in their roles.

The process included:

  1. Piloting the survey to refine questions
  2. Collecting and analyzing initial data
  3. Further refining the survey in collaboration with HCPF to emphasize benefits and basic needs

This methodical approach ensured that the survey would capture relevant, actionable data that was valid and reliable. The data collected could then be used to inform key decisions related to recruitment strategies, enhance employee retention efforts, improve job satisfaction, and identify areas for organizational development.

Uncovering Critical Insights

The initial survey results were eye-opening. DCWs were least satisfied with medical benefits and retirement options. Nearly three-fourths (72%) of DCWs reported satisfaction with their wages, but 45% expressed dissatisfaction with available medical benefits and retirement options. This crucial insight highlighted a disparity between compensation and benefits, providing a clear direction for improvement. Additionally, DCWs reported high dissatisfaction (42%) with the compensation they received for their travel time. This finding emphasized that DCWs who travel longer distances to work may benefit from additional compensation. Yet, despite these areas of dissatisfaction, over 90% reported finding their job fulfilling or very fulfilling.

DCWs were very satisfied with several aspects of their job, including flexibility and the importance of their work. Most DCWs also reported feeling highly satisfied with their work environment, including collaboration with other DCWs (97%), receiving clear instructions and assignments (88%), and receiving proper training (86%). Only 20% of DCWs who responded to the survey indicated that they were somewhat or very likely to leave in the next year.

From Data to Action

HCPF presented these findings to Colorado’s Direct Care Workforce Collaborative stakeholder group, igniting important discussions to address the lack of benefits. This data-driven approach led to two concrete initiatives:

  1. Connecting DCWs and small employers with the health insurance marketplace
  2. Connecting DCWs and employers with the state-sponsored retirement program

The direct care workforce dilemma is complex, but with the right tools and approach, we can uncover the insights that lead to meaningful change. By leveraging data and actively engaging with DCW voices, we can build a stronger, more satisfied, engaged workforce capable of providing the high-quality care our communities deserve. Vital is proud to assist with HCPF’s research questions and remains committed to utilizing our expertise in future research areas.

Working in the area of direct care workers, health or human services and looking to get more out of your data? Contact Vital Research President, Harold Urman, PhD.

For more details on the specific work and partnership mentioned in this article, contact the Long-Term Direct Care Workforce Unit in Colorado’s Department of Health Care Policy and Financing (HCPF).