Iowa’s “Care Gap” Meets the “Action Gap”

Care Gap: 

Prepare to Care

”Prepare to Care” is Iowa’s new direct care and support training curriculum. “Prepare to Care’s” flexible, consistent courses can prepare you for career options in community living, personal support, and health support. With “Prepare to Care”, you own your education, and you choose your career path! The training is becoming available statewide and is offered by trained instructors at community colleges or some employers. In addition, the introductory Core course is available online for free.

You can learn more on the “Prepare to Care” website at There you can find links to information on the career pathways and course descriptions as well as how to find and enroll in a course. There is also a link provided to the online Core. If you have questions, please email:

According to the State’s Direct Care Workforce Initiative, Iowa needs to fill 20,000 new direct care jobs by 2020 while retaining the 75,000 who currently work in direct care, the largest sector of Iowa’s workforce. That is no easy feat with an average annual turnover rate of over 60%. The high turnover comes at a high cost in real dollars, costing taxpayers and providers $193 million in 2013 and diminished quality when Iowans who need care are faced with a different caregiver every few months.

The age of the workforce is getting older which means many experienced direct care workers will retire over the next few years.  Others leave because being a certified nursing assistant, home care or hospice aide, or personal assistant is a stepping stone to another profession such as a licensed nurse or social worker.  The majority leave due to burn out, unrealistic expectations about the nature of the work, low wages, lack of  health care coverage and retirement benefits, and the lack of educational or advancement opportunities within the field of direct care.

The care needs of Iowans can’t be met if the needs of the workforce that provides most of the direct hands on care are not met. No magic wand will keep people in the field or produce 20,000 new, well-educated, skilled, compensated, and compassionate direct care workers. But Iowa must move forward in addressing this issue.

Download Care Gap Document


Action Gap:

More meetings that produce more reports that leave the problems identified but the solutions unaddressed is simply no longer acceptable. 

The Iowa CareGivers has documented no fewer than eighteen efforts to address direct care workforce and quality of care issues since 1998. In a never-ending quest for over-rated innovative solutions, millions of public and private dollars have been spent on task forces, surveys, committees, commissions, advisory councils, summits, and pilot projects that have yielded volumes of reports containing similar recommendations.

One of the key recommendations of the Governor appointed Direct Care Worker Task Force, and a common thread throughout many of the reports, is the need for more standardized education for those who work in direct care.   Standards would provide consistency in education and training across care settings, elevate the status of the workforce through state recognized credentials, prevent workers from having to complete similar training over and over if they change employers, provide continuing education standards, and much more. 

“Prepare to Care” is a new state-approved training curriculum that now needs a significant investment on the part of elected officials to promote statewide, and the infrastructure within the Iowa Department of Public Health to track and maintain the training and certifications of those who work in direct care.

Legislators have been willing to invest in all the task forces, committees, and reports to define the problem but have not been willing to make a significant investment in the solutions identified.  It’s time to say…Enough!  Bold action on the parts of elected officials, workers, health and long term care providers, advocates, and others is needed. 

If policy-makers fail to act or if they remain content with the status quo, and refuse to support the implementation of the recommendations outlined by the various task forces and committees they supported through legislation, we will all pay a bitter price.   We will pay the price of being unable to find anyone to help care for our parents, children, or spouses, and face the likelihood that the care received will be greatly diminished.

This is an election year. Vote for the candidates who understand that quality jobs and a quality workforce = access to quality care! 


Download Action Gap Document

Download Solutions Gap Document

Di Findley, Executive Director
Iowa CareGivers
515 249 0138