Why This Matters

An estimated 115,000 - 120,000 direct care workers in North Carolina provide essential care to older adults, people with disabilities, and those with chronic or acute health conditions at home, in residential settings, nursing facilities, and hospitals. As North Carolina’s population ages and the demand for long-term care grows, supporting the direct care workforce becomes an economic and public health necessity. Yet this workforce faces systemic challenges: low wages, lack of recognition, inconsistent training, and high turnover.

As North Carolina works to meet the increasing need for this essential workforce, the insights reflected in “Building North Carolina’s Direct Care Workforce: Report on 2025 Workshop Series,” can inform its direction [1].

Key Takeaways from Our Workshops

Earlier this year, the North Carolina Center on the Workforce for Health convened four workshops dedicated to the recommendations of the NC Caregiving Workforce Strategic Leadership Council outlined in a 2024 report [2]. This report is organized around each of those workshops:

1. Defining the Direct Care Workforce
   There is no single, standardized definition of a direct care worker in North Carolina. This leads to confusion in policy, training, compensation levels and data collection. The North Carolina Caregiving Workforce Strategic Leadership Council called for an umbrella definition that broadly reflects the direct care workforce. Based on workshop dialogue, an umbrella definition should acknowledge that direct care workers:
   • Assist older adults and people with disabilities, chronic health conditions, and/or acute illnesses in various settings, including private homes, residential care facilities, nursing homes, and hospitals.
   • Assist with activities of daily living, personal care and/or provide social and community support.
   • May have the ability to assist with or complete more complex care tasks or support needs with additional training.
   • Maintain relationships with the client, the client’s family, community, and the client’s care team members for the benefit of the client.
   • May consider their direct care job as a temporary role, career ladder role, or terminal profession.
2. Advancing the Direct Care Workforce Data Landscape
   Developing a comprehensive picture of the direct care workforce will require data from existing sources, as well as gathering new data from the field. Statewide data on direct care workers is fragmented across agencies and data sources. The workshop identified existing data sources, including the Centers for Medicare and Medicaid Services, PHI, state registries, Medicaid claims, National Core Indicators (NCI) surveys and the North Carolina Health Talent Alliance. The workshop also identified core data elements to be tracked.

3. Expanding and Stabilizing the Direct Care Workforce
   Low pay and poor benefits remain among the biggest barriers to recruitment and retention. Recognizing that worker wages are being examined under different initiatives, the workshop focused on approaches to improve recruitment and retention, beyond increasing wages. The report highlights strategies like recruitment and retention bonuses, increasing unpaid leave and paid time off, childcare subsidies, mileage reimbursements, flexible scheduling, and safety improvements. Consortium approaches may help small employers provide better benefits to direct care workers. Government partners and employers should consider how increased wages may cause direct care workers to experience benefits cliffs and consider this impact when setting wages.
4. Expanding Direct Care Worker Apprenticeships
   The registered apprenticeship model may be difficult to apply to direct care professions, especially those that are uncredentialed. Nevertheless, “learn and earn” models have significant potential for certified nursing assistants (CNAs) and direct support professionals (DSPs) working towards subsequent credentials.

A Collaborative Effort

The workshops and resulting report were the products of a collaboration among the North Carolina Department of Health and Human Services, North Carolina Center on the Workforce for Health, the North Carolina Institute of Medicine, the North Carolina Area Health Education Centers (AHEC), the North Carolina Coalition on Aging, and the Piedmont Area AHEC. A planning committee comprised of individuals from these organizations was responsible for guiding this workshop series.

Join Us

Strengthening North Carolina’s direct care workforce will require sustained effort and investment.

We invite you to read the full report, share it with your networks, and join the conversation about how we can better support our direct care workforce.

Download the full report here 

Learn more about the NC Center on the Workforce for Health

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Written by

Patrick Y. Tang, MPH

Project Director, NCIOM

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References

1. NC Center on the Workforce for Health. Building North Carolina’s Direct Care Workforce: Report on 2025 Workshop Series. Raleigh, NC: NC Center on the Workforce for Health; 2025. https://workforceforhealth.org/wp-content/uploads/2025/09/Building-NC-Direct-Care-Workforce-Council-Workshop-Report-2025-FINAL.pdf.
2. North Carolina Department of Health and Human Services. Investing in North Carolina’s Caregiving Workforce: Recommendations to Strengthen North Carolina’s Nursing, Direct Care, and Behavioral Health Workforce. Raleigh, NC: NCDHHS; January 22, 2024. https://www.ncdhhs.gov/investing-north-carolinas-caregiving-workforce-recommendations-strengthen-north-carolinas-nursing/download?attachment.
3. NC Center on the Workforce for Health. Workforce for Health. https://workforceforhealth.org/.