Research and Resources

Iowa CareGivers Releases Direct Care Workforce Recommendations

A Comprehensive System to Build a Strong Direct Care Workforce

Scaling Up Iowa CareGivers Programs

Direct Care Worker (DCW) Registry and Education Survey Reveals Information Gaps

Education of DCWs About the Purpose of the DCW Registry and Steps to Remain Active on the DCW Registry is Needed                          

It is important to note that Certified Nurse Aides (CNAs) who work in nursing homes do not have a state-approved continuing education standard that is linked to their maintaining their eligibility to work by being on the active DCW Registry. Nursing home providers are required to provide 12 hours of in-service for staff, but those hours are not considered continuing education and therefore, do NOT keep CNAs active on the DCW Registry.  CNAs must work 8 hours in a 24-month period in state approved settings to retain their active status.  The settings that qualify were expanded to certified hospitals, ambulatory surgery centers, home health agencies, and hospices in 2017. Employers in these additional settings can submit employment verification to Department of Inspections and Appeals to keep DCWs active on the Registry. However, many employers do not report employment which can be problematic for DCWs who may be transitioning to a different job or move to a different location in the state.

Click here to view Combined Data from Active and No Employment Registry

Click here to view Only DCWs from Active Registry

Click here to view Only DCWs from the No Employment Registry

It is Time to Solve Iowa’s Direct Service Workforce Crisis

The Case for Strengthening and Stabilizing This Essential Workforce, prepared by The Lewin Group and PHI National 2021.

Click here to read the brief.

Environmental Scan of Direct Care Worker Curriculums and Career Pathway Programs Offered by Iowa’s Community Colleges

Click here to view the report
(Prepared for Iowa Department of Public Health by Iowa CareGivers July 2021)

Iowa Department of Public Health Releases Iowa Rural Healthcare Workforce Strategic Action Plan

A Multi-Stakeholder Strategy to Improve Healthcare Workforce

Click here to view the report.

2019 Direct Care Worker Wage and Benefit Survey & Executive Summary

Iowa CareGivers Releases 2019 Direct Care Worker Wage and Benefit Survey & Executive Summary With Key Findings and Recommendations.

Click here to view Survey.
Click here to view Executive Summary, Key Findings and Recommendations of the Direct Care Workers of Iowa 2019 Wage and Benefit Survey (electronic version).
Click here to view Executive Summary (printable version).


Building a Strong Direct Care Workforce Direct Care Worker Wages Was One of the Topics

70 thought-leaders from around the state convened to focus on solutions to: Building a Strong Direct Care Workforce Direct Care Worker Wages Was One of the Topics.

Click here to learn more.


United Way Alice Report for Iowa. Do you know Alice?

ALICE, Asset-Limited, Income-Constrained, Employed, places a spotlight on a large population of hardworking residents who work at low-paying jobs, have little or no savings, and are one emergency away from falling into poverty.

Click here to learn more.


Iowa Nursing Facility Staff Turnover Summary Report 2012 – 2015

Turnover of Certified Nursing Assistant (CNA) and other nursing home staff has been the subject of many studies over the years, and has been a concern expressed by those working in the field, those residing in nursing homes and their families, employers, and others.  Iowa’s nursing homes have been required, for a number of years, to report their staff turnover by worker classification (Certified Nursing Assistant (CNA), Director of Nursing (DON), Administrator, Dietary, etc.) on their cost reports submitted to the Department of Human Services (DHS).  The Department is then required to submit an analysis report to the Iowa Legislature annually.  Unfortunately, the report to the legislature contains nothing more than a list of nursing homes and their turnover rates for each of the designated worker classifications.  There is no in-depth analysis on the data being conducted nor was there ever any criteria established by the legislature on what the analysis might include.  We have prepared a 4-year summary of the turnover data with recommendations on how to better utilize the data.  We hope that this report will become a catalyst for further exploration into determining how analysis of the existing data can lead to enhanced quality of care for nursing home residents, and the quality of jobs of those who work in the field.  Please contact Di Findley with questions  

Iowa Nursing Facility Staff Turnover Summary Report

A "Point in Time" survey conducted by Iowa Workforce Development for Iowa CareGivers revealed

  • 287 of 319 Health and Long-Term Care/Service Employers reported a total of  1,826 vacancies for direct care positions.
  • 539 expected direct care position retirements in the next year.
  • There are over 40,000 working in the occupational titles: certified nursing assistant, personal care aide, and home health aide.

(A Direct Care Workforce Initiative committee  of Iowa Departments of Workforce Development, Inspections and Appeals, Human Services, Public Health, Education, and Aging, and Iowa CareGivers, and others  estimated another 20,000-25,000 working under other titles or titles not yet recognized by Department of Labor such as consumer directed attendant care workers, private duty, psychiatric aides, and others serving individuals with disabilities)

Average Wages for Entry Level to Experienced Direct Care Positions:

  • Certified Nursing Assistants:     $10.00-$13.22/HR
  • Home Health Aides                   $9.23-$11.74/HR
  • Personal Care Aides                 $9.01-11.63/HR

Click here to read a brief summary.
Click here for the full report.
Click here for news release.


Direct Care Worker Wages Down When Factoring Cost of Living!

Click here for the full report.


Summit Hosted by Iowa Department of Public Health on Direct Care Workforce Sheds Light on Challenges and Solutions

About 30 stakeholders participated in a discussion led by Director Gerd Claybaugh, on key challenges related to the recruitment and retention of the direct care workforce.  Panelists included Fran Mancl, Certified Nursing Assistant who said, “I had to work a second job to supplement my income so I could afford to work in the direct care job that I love.”; Michael Wolnerman, Pharmacist and family caregiver, who stated, “Our family had 50 different home care aides and nurses in one year’s time assigned to help my mother before she passed”; read more here and Michele Meadors Omaha, who, following a car accident was left quadriplegic said, “I thought my worst nightmare, upon moving to Des Moines, would be transportation and housing, and they were.  But my biggest nightmare was finding people to come into my home to assist me.”   Other panelists included: Gene Leutzinger, Hawkeye Community College; Dr. Brad Richardson, University of Iowa, NRCFCP; Courtney Greene, Iowa Workforce Development, who commented on a recent report indicating a high number of direct care job vacancies that health and long term care providers are having difficulty filling; and Joyce McDanel, Unity Point in Des Moines; who further commented on the difficulty in finding and keeping both direct care workers and licensed nurses, and Di Findley, Iowa CareGivers, who stressed the need for policies and infrastructure to maintain the training credentials and supply and demand of the direct care workforce and to identify and implement strategies to enhance compensation.

Panel presentations were followed by a discussions involving all participants, some of the leading recommended priorities that surfaced included, wages and compensation and to build upon the work that the Department is already doing.

Click here to view the Direct Care Workforce Initiative Summit Report.


ISSUE: Direct Care/Service Workforce Central Data Base System

Currently, there does not exist, a state-based central data base system that maintains records of the training and/or credentials of all who work in direct care.  The Department of Inspections and Appeals (DIA) is required by the federal government to manage the Iowa Nurse Aide/Direct Care Worker Registry.  The Registry maintains a list of Certified Nursing Assistants who work in nursing homes only.  Those working in other settings like assisted living, home care, and even hospitals do not have the option of being included on the Registry and record keeping is sketchy and fragmented.  This lack of consistency creates challenges for those working in the field as well as their employers.   

An issue paper on this topic has been prepared to shed light on the need for such a system.  Those who work in the field deserve to have a system in place that will provide them with assurances that their training is valued enough to be part of a permanent record that can follow them from one place or person served to the next.  Contact Di Findley with questions

Direct Care Workforce Central Data Base System Issue Paper

Other Reports

Certified Nursing Assistant (CNA) Needs Assessment
Better Jobs Better Care
DCW Wages and Benefits
DCW Education
Healthcare for DCWs
2015 White House Conference on Aging 

The work of the Iowa CareGivers is based upon a number of surveys and reports that were conducted to gauge the climate of direct care in Iowa.  These reports are all Iowa-specific and relate to the key component of our mission…

“Enhancing the quality of care by providing education, recognition, advocacy, and research in support of direct care workers.”

Please note: The contact information for the Iowa CareGivers in many of the following reports may have changed.  Please use our updated information for any questions or contact:

Iowa CareGivers
1231 8th Street #236
West Des Moines, IA  50265
Phone:  515-223-2805
Fax:  515-226-3214


Certified Nursing Assistant (CNA) Needs Assessment and Pilot Interventions
Iowa CareGivers conducted the first statewide CNA needs assessment survey in 1998 which revealed the top reasons CNA's leave the field to be: short staffing, low wages and poor benefits; inadequate education; and lack of respect. The Iowa CareGivers vision, mission, programs, and the practices and policies are deeply rooted in these survey findings. We are actively responding to the needs expressed by you, as direct care workers.


Better Jobs Better Care
The Better Jobs Better Care (BJBC) Program was a national research and demonstration program funded by The Robert Wood Johnson Foundation and The Atlantic Philanthropies. The goal was to see improvements in the long term care system that increased recruitment and retention of direct care workers and provided a more qualified and stable workforce. Iowa was one of five states to receive this 3 ½ year, $1.3 million demonstration grant. Iowa CareGivers served as lead agency in Iowa. As a part of the BJBC program (2003-2007)several original research studies were conducted that have led or are leading to changes in caregiving work itself or changes in public policy that will enable DCWs to improve their work performance. The findings from the studies serve as a catalyst to many of the ongoing and long term practice and policy initiatives of the Iowa CareGivers/ROC. To learn more, please review the following reports.


Direct Care Worker Wages and Benefits

Direct Care Worker Education and Certification
We’ve learned that many of you leave the field of direct care because you don’t receive enough education and training to do what is expected of you; some of you may lack opportunities for advancement within the fields of direct care; and the state and federal standards related to your education, training, or certification is not very clear or consistent. Some of you have said that you have lost your certification when you left one care setting to work in another.

Work is being done to help make the system better for you, those you serve, and your employers. 

Direct Care Workers Should Not Lose Certification...

... If They Don't Work For A Couple Of Years!!

Federal Law Must Be Changed!!
If you have a story to share about losing your certification let us know.

Click here to view the brief on Improving Continuing Education Opportunities for Iowa's Direct Care Workforce.


Direct Care Workforce Initiative
The following reports review the recommendations by a Governor-appointed Direct Care Worker Task Force that met from 2005-2008. The work of the Task Force was then continued by the Direct Care Worker Advisory Council (2008 – current).

Stay Informed about a state effort to improve direct care worker education in Iowa. At long last you may one day receive the professional status you deserve! The Iowa Direct Care Worker Advisory Council would like to build a network of individuals and organizations to keep informed about the Initiative. Click here to join our mailing list. Click here to learn more!


Direct Care Worker Registry
Survey of Nurse Aide Registries in the United States

Certified Nursing Assistant (CNA) Expired Certification Study


Health Care for Direct Care Workers
Health care coverage is not an academic issue or an abstract public policy debate. It’s a subject that deeply affects real people in Iowa; your friends, employers, co-workers, neighbors, and relatives. 

Approximately 275,000 Iowans have no health insurance coverage. Thousands more have inadequate coverage—coverage that they pay too much for or get too little from.

Read about the Real Stories of Health Care Coverage of 5 direct care workers.


2015 Iowa White House Conference on Aging Event Sheds Light On Importance of Direct Care Workforce and Family Caregivers
Click here to read the report.


From time to time, it becomes apparent that a discussion is needed to gather input on current topics revolving around the direct care workforce. Iowa CareGivers has played an important role in bringing various stakeholders together to get their views on the issues, as well as their values in seeking solutions. Please review the reports below for more information.