Building Better Matches: Lessons from Registries and Job Platforms in Direct Care
Family caregivers are only one part of the caregiving equation. The other is the paid direct care workforce, where turnover remains high and access is uneven. At the 2025 ADvancing States HCBS Conference, the Caregiving and Workforce Intensive brought together researchers, state leaders, and innovators to examine a pressing question: how can we strengthen job matching, training, and credentialing to stabilize the direct care workforce?
The conversation spotlighted lessons from states, nonprofits, and platforms experimenting with registries and online job matching systems. The message was clear: technology alone won’t solve workforce shortages, but it can make the system more transparent, more efficient, and more supportive—if designed and funded wisely.
Why Registries and Platforms Matter
Most people outside the system don’t realize that direct care workers are not universally tracked, credentialed, or connected.
CNA registries are federally required, but only for nursing assistants.
Personal Care Aides (PCAs) and Home Health Aides (HHAs) fall into a patchwork of state rules.
Consumers in self-directed programs often have no efficient way to find or vet workers.
Providers scramble to fill shifts with limited data about availability or training.
The result? Fragmentation, inefficiency, and frustration—for workers, families, and state systems.
Job platforms and registries attempt to bridge this gap by providing:
Verified worker registries with credentials and training history.
Job matching algorithms to connect workers with consumers or agencies.
Resource hubs for training, continuing education, and career development.
Data insights for states to forecast workforce needs.
But not all registries are created equal. The conference highlighted both successes and cautionary lessons.
PHI’s Scan: A Fragmented Landscape
Kezia Scales of PHI provided a national scan:
14 states have some form of centralized PCA registry.
Platforms like Carina (WA, OR), QuickMatch (CA, VA), Rewarding Work (CT, KS, MA), and Direct Care Careers (CO, ND, TX) each reflect different models.
Specialized respite registries exist in states like IL, MT, and NY.
Despite variation, the underlying goals are consistent: increase transparency, support self-direction, and professionalize direct care.
PHI’s forthcoming report will catalogue these systems in greater detail, but the key takeaway is already visible: the U.S. lacks a common taxonomy and framework for registries. Each state is experimenting in isolation, even while workforce shortages are national in scale.
Carina: Building a Community
Carina, operating in Washington and Oregon, has become a standout example of what a registry can achieve.
15 million hours of care facilitated.
$270 million in wages flowing to caregivers.
25% of matches lasting two years or more.
What sets Carina apart?
Balanced recruitment. The platform intentionally recruits both workers and consumers, often through unions, case managers, and training classes.
Accessibility. Mobile-friendly design and external tools like texting ensure workers without the latest tech can still participate.
Human realities. The platform acknowledges that this is human work—systems must be designed to manage trolls, incomplete data, and the unpredictability of human behavior.
Healthcare coverage connections. About one in four caregivers seek out Carina specifically for its link to benefits, a rare value-add in this workforce.
The lesson: a platform succeeds not just by matching jobs, but by building a community and delivering tangible value to both sides of the match.
Direct Care Careers:
Shared Cost, Shared Benefits
ADvancing States’ Direct Care Careers (DCC) platform—used in Colorado, North Dakota, and Texas—offers another model. Built in partnership with Altarum, it combines:
Worker registry with credentialing.
LMS with portable certifications and badges.
Communication tools for workers, providers, and consumers.
Data dashboards for state-level workforce analysis.
Early data shows promise:
Over 2,000 direct care workers enrolled.
1,000+ agencies and providers participating.
600 resources added by states for workforce development.
60 training courses available through the platform.
By pooling resources across states and exploring federal matching funds, DCC is designed to be affordable, customizable, and sustainable.
The shared cost model is key: no single state has to carry the burden of development and maintenance.
Wisconsin’s WisCaregiver Model
Wisconsin took a slightly different approach, leveraging Handshake, a pre-existing platform widely used in higher education. Their Certified Direct Care Professional (CDCP) program builds career ladders and lattices:
Free, self-paced, 30-hour training based on 14 national competencies.
Proctored exam leading to a 3-year certification and placement on a state registry.
Virtual badges that workers can share on résumés or social media.
Career pathways, including a CDCP-to-CNA bridge program.
The model shows that states don’t always have to build from scratch—they can adapt existing infrastructure if it meets workforce and consumer needs.
Key Design Considerations
Across all platforms, speakers emphasized several design lessons:
Clarity of purpose. What problem are you solving—worker shortages, consumer access, training gaps, or all of the above?
Accessibility. Mobile-friendly, language-accessible, and easy to use for low-digital-literacy populations.
Safety. Systems must balance transparency with privacy (e.g., showing location without revealing addresses).
Marketing. Platforms only succeed if workers and consumers actually use them; outreach beyond traditional state channels is essential.
Evaluation. Metrics must track not just usage, but outcomes: retention, job satisfaction, care quality.
Without attention to these details, registries risk becoming underused databases rather than living systems.
The Funding Puzzle
Every speaker circled back to the same question: who pays, and how?
Options include:
Federal matching funds (e.g., FMAP enhancements for HCBS technology solutions).
State general funds or reallocated ARPA dollars.
User fees (though risky in a low-wage sector).
Partnerships with health plans seeking workforce stability.
The sustainability of these platforms depends on blending funding streams and demonstrating ROI.
Aspirational vs. Realistic Futures
Panelists ended with a “crystal ball” exercise: what’s next for registries and job platforms?
Aspirational vision:
A national model where PCAs are recognized like CNAs, with standardized training and portable credentials.
Any consumer can easily find and vet qualified caregivers.
Workers are recognized as professionals, with high-quality jobs, benefits, and career ladders.
Realistic near-term vision:
Continued experimentation with state-level platforms.
More data to inform recruitment, retention, and funding strategies.
Incremental improvements in accessibility, training, and trust.
Ongoing tension between technology’s promise and the financial and human realities of the sector.
Reflections: Policy to Practice
This session highlighted the promise and limits of registries. They can:
Increase choice and control for consumers.
Professionalize the workforce through training and credentials.
Provide data for policymakers to forecast and plan.
But they cannot replace the underlying need for better pay, recognition, and support for caregivers.
For policymakers, the lesson is clear: investing in registries without investing in workforce quality risks building systems that look good on paper but fail in practice.
Closing Thoughts
The 2025 Caregiving and Workforce Intensive made it clear that registries and job platforms are not silver bullets—but they are critical infrastructure.
Just as highways connect people to jobs and markets, registries connect caregivers to consumers, training, and careers. Without them, the system remains fragmented. With them, we can begin to build transparency, mobility, and professionalism.
The path forward requires both innovation and humility: states must share lessons, align definitions, and invest in workforce quality as much as in technology.
