Universal Training and Credentialing: Building a Stronger Direct Care Workforce
The direct care workforce is the backbone of home- and community-based services (HCBS). With more than 5 million workers today and nearly 9 million projected job openings by 2032 (PHI, 2024), this workforce is essential to helping older adults and people with disabilities live independently and with dignity. Yet, as the 2025 ADvancing States HCBS Conference underscored, the system that supports this workforce remains fragmented, underfunded, and undervalued.
The Caregiving and Workforce Intensive placed a spotlight on one of the most promising strategies for turning the tide: universal training and credentialing systems. These models aim to establish core competencies, portable credentials, and career ladders that elevate job quality, strengthen recruitment and retention, and ensure high-quality care.
The Case for Universal Training and Credentialing
Current workforce challenges are well documented:
Low pay and limited benefits. Median hourly wage is $16.72, with nearly half of workers relying on public assistance.
Inadequate training and supervision. Requirements vary widely by state and occupation, leaving workers unprepared for complex care tasks.
Lack of recognition and advancement. Direct care jobs are often seen as “entry-level” with no clear career ladder.
High turnover and staffing shortages. Employers face constant churn, while care recipients experience disruptions in continuity and quality.
PHI and state leaders at the conference framed universal training and credentialing as both a workforce strategy and a quality-of-care strategy. By creating a common foundation of competencies and stackable credentials, states can:
Professionalize the workforce.
Rationalize training infrastructure.
Support mobility between care settings.
Reduce redundant retraining.
Elevate the public perception of direct care as a career.
Elements of a Universal Model
PHI presented a framework with five key elements:
Universal Core Competencies
Shared across direct care roles and settings.
Cover fundamentals like infection control, person-centered care, and communication.
Consistent Training Standards
Accessible, affordable, and competency-based.
Delivered through high-quality programs with evaluation mechanisms.
High-Quality Credentials
Portable and stackable across employers and states.
Recognized universally by payers, providers, and consumers.
Career Pathways and Wage Progression
Advanced roles and peer mentoring opportunities.
Clear ladders and lattices across care settings.
Policy and System Alignment
Interagency cooperation to ensure coordination across Medicaid, workforce, and education agencies.
Funding strategies to sustain infrastructure.
This is not about “training for training’s sake.” It is about building an infrastructure that elevates job quality and ensures consistent care across systems.
State Spotlights: Michigan and Wisconsin
Several states are leading the way with initiatives that could serve as models for others.
Michigan: Competencies, Advocacy, and Investment
Michigan’s Department of Health and Human Services, working with the IMPART Alliance and a statewide coalition, has adopted 15 competency, professional, and ethical guidelines for direct care work.
Key strategies include:
Establishing competency-based credentials aligned to career pathways.
Developing accessible training guidelines and pathways.
Advocacy and systems change to elevate the social and economic value of direct care work.
Employer-led collaboratives piloting curricula and recruitment strategies.
Michigan has already secured state general funds and a $25M grant to expand its initiatives, showing how aligning advocacy, policy, and investment can generate momentum.
Wisconsin: Certified Direct Care Professional (CDCP) Program
Wisconsin’s CDCP program offers a free, online, self-paced training (~30 hours) built on national standards. Graduates earn a three-year certification, placement in a state registry, and a virtual badge recognized by employers.
Key features:
14 competency areas, tested through a proctored exam.
Career pathways, including a CDCP-to-CNA bridge that reduces CNA training hours.
Upskilling through micro-credentials and continuing education.
Language access in English, Spanish, and Hmong, with Swahili coming soon.
Referral bonuses for teachers and peers to drive recruitment.
Wisconsin has leaned heavily on marketing campaigns and partnerships with educational institutions to build visibility. The program now connects directly to WisCaregiver Connections, linking certified workers with employers.
Challenges and Considerations
While the benefits are clear, panelists emphasized the practical challenges states face:
Funding sustainability. ARPA and HCBS capacity funds have fueled pilot programs, but states need durable financing models, ideally blending Medicaid FMAP, general funds, and grants.
Scope and definition. Who counts as a direct care worker? CNA, HHA, PCA, DSP? How states define the workforce determines eligibility, training content, and funding flows.
Accessibility. Training must be free or affordable, available in multiple languages, and designed for workers with limited digital literacy or irregular schedules.
Employer buy-in. Providers worry about poaching and costs. They must be engaged early to ensure the system supports—not threatens—their operations.
Evaluation. States need metrics to track ROI: are workers staying longer, earning more, and providing better care? Are consumers reporting better outcomes?
Without attention to these challenges, universal credentialing risks becoming another underutilized program.
Policy and System Levers
Several levers emerged as critical for scaling universal credentialing systems:
Interagency collaboration. Workforce, Medicaid, education, and aging/disability agencies must align around common goals.
Legislative mandates. Some states (e.g., Washington, Arizona) have created authority through statute; others rely on agency leadership and federal grants.
Partnerships with education institutions. Universities and community colleges can provide training infrastructure, credibility, and additional resources.
Transparency. Publicly available competencies and curricula allow for adaptation and expansion.
Regional coordination. Neighboring states sharing labor markets may benefit from aligning standards.
Why This Matters for the HCBS Landscape
Universal training and credentialing are not just workforce policies. They are HCBS access policies.
For states: a stronger workforce pipeline and better data to manage shortages.
For providers: reduced turnover, higher quality, and less duplication in training costs.
For workers: recognition, mobility, and career pathways.
For consumers: better matches and more consistent care.
As Mary Lazare of ACL reminded attendees, the care gap is now, not a decade away. With 53 million unpaid caregivers already strained and an aging population outpacing the supply of paid workers, the stakes could not be higher.
Reflections: Policy to Practice
From a strategic standpoint, universal training and credentialing offer a north star for workforce reform. But they will only succeed if states:
Define the workforce clearly and inclusively.
Fund infrastructure sustainably beyond short-term grants.
Prioritize accessibility and equity.
Engage employers and workers as co-designers, not afterthoughts.
Track outcomes rigorously to make the case for ongoing investment.
The fragmented training environment has long undermined recruitment, retention, and quality. This session made clear that the moment is ripe for bold, coordinated action.
Closing Thoughts
The Caregiving and Workforce Intensive made it clear: the direct care workforce crisis cannot be solved by wages alone. Training, credentialing, and career pathways are equally essential to professionalize the workforce and ensure quality care.
States like Michigan and Wisconsin are showing what’s possible. PHI’s framework provides a roadmap. The challenge now is to scale these models nationally, while honoring state flexibility and diversity.
Universal training and credentialing will not fix every challenge. But they are a powerful lever to strengthen care jobs, stabilize the workforce, and improve outcomes for millions of Americans.
